By Daniel LeDuc
Washington Post Staff Writer
Sunday, June 29, 2008

Dozens of developmentally disabled persons in the District's care are being moved to new homes after three major care providers decided to stop residential services in the city because they said they were not being paid enough.

Almost 5 percent of the adults in the city's care -- 61 of 1,207 people -- have been moved or will be moved by mid-July.

The relocations have been disruptive for some of the residents, many of whom have behavioral issues and lack family members to watch out for them. Advocates say it has been extremely stressful for residents to have to suddenly adjust to new living environments, get new caregivers, change doctors and be sent to new treatment and social programs.

The moves began in January, when Philadelphia-based Resources for Human Development left. Chicago-based Human Resources Development Institute will leave the District on Monday. And PSI Family Services will dramatically cut back residential care by July 15, stopping residential care to all but a handful of clients.

It is the largest housing transfer of the developmentally disabled in the District in recent memory and comes as the city faces federal court hearings this year to determine how to improve its services.

"This is the first time we've had this many providers leave at once," said Sandy Bernstein, legal director of University Legal Services, which represents many developmentally disabled people in a long-running lawsuit against the District. "When you move people, they have to get new doctors and have new staff working with them. It can be very traumatic."

Laura Nuss, the city's new head of services for the developmentally disabled, has been praised by care providers for her diligence in her new role. But she acknowledged that the moves had been a strain on many of the residents and her staff.

"You'd never choose this to happen, but the department has risen to the challenge," she said. "It has been a tremendous amount of change for our individuals and for us."

Nuss said that after the changes, more of the residents will be allowed to select programs and doctors, leading to improved care in the long run.

Tammy Barlow, a spokeswoman for Resources for Human Development, said its departure was prompted by low fees.

"The funds we received aren't adequate to run the programs needed in the D.C. area," Barlow said. "This is an issue that the District has to work out."

Representatives of the other departing companies did not return messages seeking comment.

The city kept rates the same for more than five years but last year provided a one-time jump of 19.2 percent. Nuss said future cost-of-living adjustments are accounted for in the rates.

The rates are set by the city's Medical Assistance Administration, which will soon be renamed the Department of Healthcare Finances. Under Mayor Adrian M. Fenty (D), Nuss, who runs the Developmental Disabilities Administration, has more say in setting future rates.

"We're not stopping at 19 percent," Nuss said. "We're actively going forward."

Care providers and advocates for the developmentally disabled say improved rates are essential to improving care because more money allows hiring of better staff and better training. Numerous providers contract with the city for residential services as well as medical and other types of care.

"The rates are simply too low," said Marsha Thompson, who formerly headed D.C.'s agency overseeing the developmentally disabled and now works for Careco, a healthcare provider. "You're not going to get the quality you need. If [a provider] can't make the dollars back that you invest, you can't stay in business."

The two providers leaving the District had been here two years, replacing another agency that had been criticized for poor care. Some providers say there could be more turnover unless rates increase.

Care of the developmentally disabled has been a long-running problem for the District, which was sued 30 years ago by advocates for residents in group homes. In March 2007, U.S. District Judge Ellen S. Huvelle ruled that the city had failed those residents and called their care "inadequate."

In May, a federal court monitor reported that "serious deficits" remained in care for the developmentally disabled. Huvelle has ordered hearings in December to determine what must be done to improve care, possibly including a court takeover.