by Conor Friedersdorf

A reader writes:

I support developmentally disabled adults for a living, so I can put your post in more context (I live in Wisconsin). One of my guys has behavior that makes Pryor's guy sound like a saint.  He attacks us without warning.  He is well over 6 feet tall, and 250 pounds.  He is very scary.  Like Pryor's guy, this guy legally must be supervised 24/7.  Because of his size and aggression, it is unsafe for one person alone to care for him.  So, during hours when he is normally awake (8:30am to 10pm), there are two people with him, and when he is normally asleep (10pm to 8:30am) there is only one person supervising him.  But this person keeps him or herself in a locked room.  Nevertheless, there have been (very scary) times when our guy attacked someone in the middle of the night, without help, who happened to leave the safe room to use the restroom at the wrong time.

So, if you add this up, for every 24-hour day, there are 37.5 man hours of labor to support this one person.  And each person gets $11-$12 per hour--or about $20,000 per year if you work 40 hours/week.  So just for direct support staff's hourly wages, this costs $150,000 per year. 

When you factor in health insurance for the people who work there, rent for the guy's apartment, groceries, doctors appointments, prescription drugs, and salaries of our incredibly overworked supervisors who take care of the needs of everyone supported by the agency (like social security benefits, hiring [unsurprisingly, turnover is very rapid], mountains of paperwork, etc), $250,000 per year is about what it takes.  I was shocked when I first heard that as well, but it is very expensive to support someone like this.  Surprisingly, an institution (which would be less humane) is much, much more expensive than supporting a developmentally disabled adult in a home setting.  For a time, the gentleman I described was in an institution, but instead of 2 people with him at all times, it was five.  My guess is that he is happy living in his apartment and working at a job (yes, he has a job), and therefore less likely to attack.  But it's pretty tough to be happy at an institution, so he attacks more and more violently.  So the $250,000 for residential support is actually cost cutting compared to the only other alternative, an institution, which would probably be twice as expensive.  The only other cost-cutting would be a straight jacket or euthanasia.

Others who require 24/7 supervision can be supported for far less if they are not aggressive--they can have room mates so instead of paying for 2 staff for a single client it's 2-4 clients per one staff.  That's a huge cost saving.  But you can see that measuring cost per client is not a good assessment of effectiveness since cost varies so much based on the nature of a developmentally disabled adult's condition.

Our agency also has adults with less severe disabilities.  Typically, they get 2 hours of support per day; one is spent by the staff person helping with chores and cooking meals, and for the other, the staff person takes them out to the library or sandwich shop or something.  When politicians try to cut budgets for the developmentally disabled, they think that everyone will have to cut back a little bit.  In reality, it's closer to squeezing blood from a stone, since some people legally must be supervised 24/7 and there is no way to cut back on these individuals.  The only possible cutback is with the people without this legal requirement; in practice, this means that instead of 1 hour of support helping with chores and 1 hour of support out in the community, higher-functioning clients get just one hour of support helping with chores.  This means that these people do not get to leave their apartment, and that is pretty unfair--either that or our agency decides they cannot support people with 24/7 needs and they get thrown into an institution which is inhumane and far, far more expensive (and thus "cutting wasteful spending" actually backfires).

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