Nonprofits Struggle in a Current of Greed
By Katherine Boo
The world of the District's mentally retarded has its warm and light-filled corners, and the source of that light, more often than not, is a small nonprofit organization.
Thanks to a United Cerebral Palsy day program, some of the system's sickest retarded people get affection in a Northeast Washington warehouse made beautiful with paint and care. Some of the angriest in the system get the calm staff of St. John's Community Services, which started taking refugees from Forest Haven more than 30 years before the asylum was shut down. Some of the higher-functioning get help finding free-market jobs at the Life Skills Center in Mount Pleasant. But lately, Life Skills counselors have had to worry about their own jobs, too. The nonprofit recently missed its payroll for the first time in a quarter- century because the city government was $50,000 behind in its payments.
In a system marked by private-sector greed and listless government oversight, good nonprofit programs have been, in the '90s, collateral casualties. "It's scary," says Shirley Wade, executive director of the District of Columbia Arc, a nonprofit group that runs programs for the retarded. "The people not in this to make money are being gobbled up."
St. John's Community Services, a nonprofit affiliated with the historic Episcopal church across Lafayette Square from the White House, is credited in city records with respectful, stimulating care. Its residents volunteer at nursing homes, participate in Best Buddies programs and know their neighbors. But St. John's is struggling after a year of decreased Medicaid reimbursements and a lost contract.
"We can't balance our budget," says President Thomas Wilds, who notes that the District's mass of regulations may not have prevented abuse by those intent on profiteering, but they have created a financial burden on small nonprofits that take those regulations seriously. One stipulation alone -- that only a licensed practical nurse can hand out medication to residents -- has cost him tens of thousands of dollars a year.
At the Community of the Ark, whose two group homes are characterized by the Department of Human Services as among the city's best, residents get one-on-one attention from live-in staff and volunteers. The homes' inspection troubles are along the lines of letting the house cat walk across the kitchen floor. But the group's attempts to serve more than its eight current residents have been rejected by the Department of Human Services even as for-profits that charge the city higher rates have expanded their group home networks.
In fact, the Community of the Ark has had to struggle to hold onto the two houses it has.
One year, after the Community of the Ark had received no payments for seven months, its executive director, John Cook, asked the city for a contract increase. "We were weeks away from having no food," he recalls. He says Human Services officials told him that if he persisted with his request, they would immediately remove the retarded from the homes -- homes some of them had lived in for a decade.
"If it was a government I trusted to follow rules, I would have tried to force them to treat our clients fairly," Cook says. "But knowing the District's history, I didn't trust that they wouldn't show up with a van on Monday and put everybody out. We didn't want our people to go through that." The group backed down.
Frances Bowie, head of the Mental Retardation and Developmental Disabilities Administration, disputes the specifics of Cook's account and says her agency has accommodated the homes' needs as much as its budget has allowed. But she says her agency will work harder in the future to support the group home system's remaining altruists.
States across the country are decreasing reliance on the group home system altogether by taking advantage of a federal Medicaid reform that allows them to use federal funds to care for the retarded in their own family homes, foster care homes or other small settings.
State governments tend to like the home care option, at least in part because it costs them less money than funding residential facilities. Advocates for the retarded like the option for another reason: It's a means of encouraging a more natural and nurturing environment for the mentally disabled. But in 1996, the District earned the distinction of being the last jurisdiction in the nation to secure the waiver required to take advantage of this federal reform. And in the years since, only seven of the District's retarded dependents have been given the funding that allows them to forsake group homes for more normal ones.
A normal home is what one elderly District woman has been searching for all winter, trying before she dies to find a caring place for the retarded middle-age son she has looked after since his birth. "Little jails," she calls the group homes she's seen this month -- albeit jails tidied up for her inspection. A smiling counselor-salesman at every door. A carefully placed bunny on every bed.
"When they're kids, they're cute and they pluck the heartstrings," she frets. "But when they get big and ugly, no one wants them."
Even as she panics, the elderly woman is convinced. There are still good group homes in the District, despite the fact that the city sometimes punishes their sponsors instead of supporting them. A special place run by sensitive people: Someday soon she will find it. And it will somehow make room for her boy.
© Copyright 1999 The Washington Post Company