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A Reflection on Group Homes and Supported Living

by David Wetherow

Linda is being pushed to place Darlene in a group home, by an expert and a system that doesn't understand supported living.  Here's the picture, as I see it...

In a shift-staffed group home, to cover one staff position twenty-four hours a day, it takes 5.3 'staff-man-years'.  You're covering 3 shifts (that's 3 'staff-man-years'), plus weekends, statutory holidays, sick leave backup, and professional development days.

This means that in a 5-bed group home with a 1:1 staff/client ratio, there is only one staff person available to the five people on any given shift. Remember it takes 5.3 people to cover one position 24 hours a day.  So the real ratio that people actually experience is 1:5.  In an eight-hour shift, the most personal time each person could get is 1/5th of the divided attention of the staff person - about 1.6 hours per eight hour shift.

If the staff person spends half their time filling out forms, cooking, cleaning, talking on the telephone, receiving supervision, etc., this leaves 48 minutes per shift for personal attention / engagement with each person 'served'.

48 minutes of engagement out of an eight hour shift is not a high level of support.

It feels intense to the person who's on shift, because s/he never gets a chance to draw a deep breath.

It looks intensive to the outsider who believes that what's being delivered is 1:1 'expert' attention.

But what does it mean for the people?

Well, the staff person doesn't actually spend 48 minutes with John and then 48 minutes with Jane.  S/he 'floats' her attention from one person to another.  John needs help getting his shirt on.  Then Jane wants to call her mom.  Then it's time to make breakfast.  Whoops!  Sally came downstairs with her hair in tangles.  Meanwhile, Jack, who doesn't talk, starts moaning and rocking -- what's going on, Jack?  Sally, I'll be right with you!  Jack?

In the long run, the way you learn to get attention is to have a problem. Slide out of your wheelchair.  Have a fight with your housemate about hairbrushes.  Poke yourself in the eye.  Poke your neighbour in the eye. Jack gave up years ago, and just rocks.  It's a good thing this place is hiring people who are experts about behaviour.

The 'mission statement' of the group home is to provide a safe environment, loving encouragement for the people, work on skill development and communication, and to lead people into connection with the larger community -- supporting relationships, finding places where people can make contributions, sustaining connections with family and friends.  But how do you do this when you're supporting five people?  When the only way to leave the house is to do it in a 'group'?  How do you ever get beyond 'van therapy'?

If you double the staffing component on the evening and weekend day shifts, it gets a little better, but it doesn't get a whole lot better. Sally has some more personal 'outings'.  Jack has three hours a week of communication training -- but people keep losing track of exactly how to do it.  Now the home employs somewhere between 7.3 and 9.3 staff.  Costs are going up, complexity is going through the roof, but the basic pattern hasn't changed.  By the way, I'm not interested in arguing the 'math'.  I'm looking at the dynamics, as they are lived.

Visitors to the house meet everyone at once, and don't make many return visits.  "Well, I actually came to visit John, but it's not John's house, it's the program's house".

Each of the people who are supported now has to handle daily relationships with four other people who have challenging needs, plus 8-9 staff.

Tuesday morning.  Sally's falling out of her chair.  Jack's got a cold.  The state monitoring team is coming next week!  Shoot!  We've got to get everybody's documentation up to date!  Mary's cash account is short ten dollars, and we're going to get gigged by the public trustee.  Who didn't turn in their receipts?  What?  One of the staff is borrowing money from the clients?

Two staff members have been gossiping about each other's performance and each is taking supervisors aside and complaining about the other.  Charles is a new 'casual' worker, and is the only one on shift on Sunday morning.  He's had two 'orientation' shifts, and is trying figure out what each person needs by reading the charts.  Meds, dishes, darn! The dryer's not working and the supervisor has her pager turned off -- now who do I call?

Next week, the union is certifying the work-force, and the executive director will spend the next six months totally consumed in labour negotiations and meeting with lawyers, trying to work out a first contract. Her expertise and passion -- the reason she got into the field in the first place -- is out of the picture for the better part of a year.

If you don't think this is real, just spend a week there.

Remind me again, who is it that needs this? Specifically, how does it help Darlene? And how does this translate to a 'high level of support'?

Let's look at the 'economics'.  In order to buy this service, each person in the group home needs to be drawing enough resources to create a good life (salary, benefits, etc.) for 1-2 other people (remember, there are 5.3 to 9.3 people working here), plus one-fifth of overall administration, supervision, training, management, and one-fifth of the cost of housing, maintenance, utilities, repairs, etc.  It looks like we're saving money on housing, but the cost of staffing and administration is going through the roof.

Ahhh! John's cold is getting worse.  Nobody called the dryer repair place, because everybody figures that it was somebody else's job.  It's in the Communication Book.  Maybe we need to have longer staff meetings.  Oh! We were talking about economics...

Living with her mom, Darlene is getting more support, direction, instruction, consistency, connection, and strategic attention than she could possibly get in a group home -- SIMPLY BECAUSE OF THE ARITHMETIC!   We're not saying that 'group home providers' are bad people.   It's just that the arithmetic doesn't work, and can't be made to work.

The 'experts' are telling Linda that Darlene 'needs' the high level of support that only a group home can provide.  They're doing more than telling her that.  They're rolling their eyes, bullying, badgering, intimidating, making her feel small and guilty and wrong.  Linda's 'expert' needs to spend a week living in one of the facilities he's promoting.  Not talking.  Not consulting.  Just living there.  Paying attention.

The picture that the 'expert' has in his head about group homes and 'levels of support' isn't real.  It's constructed of words that have gotten unattached from their real meanings.

Linda knows that there is another way.  In fact, there are many other ways:

Tomorrow, bring in somebody to help Linda (let her do the hiring).

Next month, add someone to be a 'bridge builder' for Darlene -- someone who can accompany her into connection with places in the community where her gift can be given (remember our earlier discussion about moving from activities to connection?

In the spring, create a studio apartment attached to mom's house (or a house for Darlene with a studio apartment for mom), and set Darlene up with a non-handicapped roommate... or even two.  Pay the roommates a monthly stipend, plus a break on rent.  The bridge builder stays around.  The helper stays connected so the roommates have balance in their lives.   Mom stays connected.

Actually, Linda is more than connected.  She's watching like a hawk. She's providing thoughtful, knowledgeable, strategic direction to the helpers.  She's developing a circle of support around Darlene (think about how this is different than recruiting 'volunteers for the group home').  And the circle is beginning to develop confidence and competence, beginning to take on some of the 'mom' roles.  Together, they're providing management, direction, and accountability.  Darlene is part of every gathering.  She and one of her roommates are out tonight, cooking enchiladas with a neighbourhood gourmet group.  Did you know she likes to cook?

2003 David and Faye Wetherow ! CommunityWorks

 
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