Legislative Program Review and Investigations Committee
Scope of Study
Investigation of Department of Mental Retardation Practices to Ensure Client Safety in Community Living Arrangements
Background
The Department of Mental Retardation (DMR) operates itself or funds private contractors to operate 768 group homes, also known as community living arrangements (CLAs), throughout Connecticut. About 3,450 DMR clients live in these group homes at a cost to the department of about $280 million a year.
In December 2001, the media published a series of stories reporting deaths in group homes operated for persons under the care of DMR or its contractors. The newspaper articles indicated that over a 10-year period 364 people died in group homes. In 36 cases, the articles linked neglect, staff error, or "other questionable circumstances" in the homes to the clients' deaths. The newspaper stories also charged the department had not made information related to deaths and related investigations available to client families and/or their legal representatives in a timely and cooperative way.
In the wake of the articles in the press, both the executive and legislative branches responded. In early February of this year, the governor issued an executive order directing significant and immediate changes in the way DMR client deaths are reported and investigated. Legislatively, a joint public hearing of the public health and program review committees was held on December 17, 2001, with invited speakers including the Commissioner of the Department of Mental Retardation, the Chief Medical Examiner, and the Executive Director of the Office of Protection and Advocacy. In late January 2002, the Joint Committee on Legislative Management voted to request the Legislative Program Review and Investigations Committee to conduct an investigation of the Department of Mental Retardation focused on client safety (motion attached ). Subsequently, the program review committee voted on February 5 to draft a scope for the investigation.
Area of Focus
The study will investigate the policies and practices of DMR and its contractors to ensure the safety and physical well-being of DMR clients in community living arrangements. The study will determine whether those policies and practices are followed, including those related to communication and reporting, and/or whether there are systemic weaknesses requiring remedy.
Areas of Analysis
I. Prior to Placement
· Evaluate safety risk assessment efforts made to ensure clients are placed in the most appropriate residential settings
· Determine whether client safety needs are adequately addressed, and how the resulting measures are communicated among DMR, client families, legal representatives, medical caregivers, residential providers, and staff
· Evaluate how clients' health and safety needs are addressed in provider contracts with DMR
II. During Residential Placement
· Examine DMR and contractor policies and practices for staff screening, hiring, training, and supervision
· Examine policies and practices for contract management and oversight, facility licensing and inspection, and quality assurance, including overall plans of service review
· Examine how resource allocations are determined to meet residential needs, and how audited
· Examine communication among various parties about a client's residential program and how it meets the client's safety and well-being needs
III. Occurrences of Incidents and Deaths
· Examine how "reportable incidents", abuse and neglect cases, and deaths are handled for DMR-operated and DMR-regulated homes
· Determine the responsibilities of various agencies involved (e.g., Office of Protection and Advocacy, Office of Chief Medical Examiner, local or state police) in reporting and investigating incidents and deaths and evaluate their roles
· Examine statutory and regulatory provisions related to DMR client confidentiality and evaluate the balance between individual privacy and agency accountability
· Analyze Connecticut's DMR resident population, incident, and mortality rate data, and compare with similar populations
· Review DMR's ongoing assessment of its client population, client death and incident statistics, and what measures it has adopted during the last decade to address areas of concern
· Conduct case reviews of incidents and deaths including cases identified in newspaper articles
Not Included in the Scope
This study is focused on residential health and safety issues for group home clients; it will not examine other elements such as vocational and educational programs for these clients.
ATTACHMENT
Joint Committee on Legislative Management
Motion to Request an Investigation of the Department of Mental Retardation
To request the Legislative Program Review and Investigations Committee, pursuant to C.G.S. Sec. 2-53g(a)(5)(B), to conduct an investigation into how the Department of Mental Retardation ensures the safety of its clients in DMR run or regulated community living arrangements. In conducting the investigation, the Committee shall examine the role of the agency's policies, procedures, practices, staffing and training as they pertain to the safety of DMR clients, examine the agency's interaction with clients' families, including their legal representatives, concerning access to information on incidents endangering the safety of clients, and examine selected cases of untimely deaths to determine whether there are systemic weaknesses amenable to legislative remedy.
Approved 1/30/02 by Joint Committee on Legislative Management