Premium ContentMouse over Home then click on Premium Content for information.LINCOLN — There's room for two more people in the ranch-style house with the neatly landscaped yard overlooking Mayberry and Manson Streets.
Only four residents have settled into the west Omaha home since it opened to care for people with developmental disabilities and complex medical needs.
But, for more than 18 months, a contract has required the state to pay as if the home were full. That's $2,296 per day, or $1.3 million since the first person moved in on April 7, 2010.
Under the same contract, the state is required to pay for empty spots in 10 other homes created for people leaving the troubled Beatrice State Developmental Center. The Mayberry home was the first of the 11 to open.
Total payments have run into the millions of dollars.
The homes, operated by Mosaic, an Omaha-based private nonprofit, have more empty beds than full ones. The 11 homes are in Omaha, Papillion, Norfolk, Grand Island and York.
As of last week, 31 of 66 spots are filled. Some homes have only one resident. One home has none. Only one home is full.
Payments for the empty home will start as soon as one resident moves in.
The situation astounded state lawmakers when they learned of it at a recent hearing.
State Sen. Steve Lathrop of Omaha, chairman of the Legislature's special committee on developmental disabilities, faulted state officials for not getting the beds filled.
"When the state is using resources on beds that are empty, that's money that could be used to provide services for people," he said.
Sen. Bob Krist of Omaha was also critical.
"That contract puts the state in a position where we are actually paying for services we have not received," he said. "I don't think that's what we should be doing."
He and other senators questioned how the state got itself into such a position.
The March 2009 contract was inked before Jodi Fenner became state developmental disability services director.
But she said Nebraska Department of Health and Human Services officials based the contract on the best information available at the time.
"If they had the foresight and information we have today, they probably would have made different decisions," she said.
What officials did not predict was how difficult it would prove to fill the homes.
They didn't anticipate that many families would decide against moving their loved ones into the new homes or that other community-based providers would step up to care for former Beatrice center residents with complex needs.
Still, Fenner said, the Mosaic homes meet a need by providing a new type of service for the state. She expressed absolute confidence they will get filled.
"The reality is, there is a long-term need for these kind of services," she said.
State officials signed the contract in the midst of turmoil surrounding the Beatrice center.
Less than two months earlier, state health officials had ordered the emergency removal of 47 center residents deemed medically fragile.
Meanwhile, the institution had lost its federal Medicaid certification and was headed toward losing its Medicaid funding. A U.S. Department of Justice investigation had concluded that the center violated residents' civil rights, including their right to be free from abuse and neglect.
The announcement of a partnership between HHS and a well-established local provider to create homes for people with complex medical needs appeared to offer a ray of hope.
Officials expected the homes could entice families to move loved ones out of the Beatrice center or out of the nursing homes where about 50 center residents had been moved.
The homes also were touted as places that could meet the special needs of the 47 medically fragile Beatrice residents.
Under the contract, Beatrice center residents and former residents were to have priority for placement.
"We always anticipated full occupancy would be achieved in a timely manner," said Linda Timmons, Mosaic president and CEO.
By the time the homes opened, though, most of the medically fragile had moved to other community placements or back to the Beatrice center. Some had died, as had more than half the people who moved to nursing homes.
Many families of people referred to the Mosaic homes refused to move their loved ones from the Beatrice center or from nursing homes.
In addition, Mosaic turned down some referrals because of behavior problems. And some people chose other providers.
Of 83 referrals made since October 2009, only 33 people ended up moving into the new homes. Two have since died. Ten people are preparing to move within the next few weeks.
The result is that the state is paying for unused spots. Under the contract, the state agreed to pay rates that would cover the costs of special staffing — costs that exist whether the homes have one resident or six.
Meanwhile, Mosaic is approaching a Dec. 31 deadline to fill four homes financed with low-income housing dollars or face financial penalties.
HHS and Mosaic are pointing fingers at each other over the situation.
Fenner said Mosaic could reach out to families on its own to find interested clients.
Timmons said Mosaic is concerned that the state would pay lower rates for people who don't come through the state referral system. Traditional rates would not cover the cost of the specialized care, she said.
Fenner blamed the nonprofit for refusing some referrals and for quality of care problems that led to two Omaha homes being denied Medicaid certification after an initial inspection, including one whose state license was placed on probation. No residents can be moved to a home while it is on probation.
Timmons acknowledged that Mosaic has had "stress and strain" in opening several homes at once.
She said the certification and licensure problems involved getting appropriate health care professionals, problems that Mosaic has been working to address.
Fenner said the tax credit issue is one for Mosaic to deal with. She said the state was not involved in the organization's financing decisions. Timmons said she is hopeful about filling those homes by the deadline.
Lathrop put the responsibility for filling the homes squarely on HHS, the agency that controls funding for developmental disability services and works with people looking for services.
"The failure isn't with increasing the capacity, and it isn't with the contract," he said. "It's with not getting people to Mosaic that they can put in the beds."
Fenner said the contract gives state officials "every incentive" to fill the homes. She said HHS is taking several steps to find people who could benefit from the new homes, including beyond Beatrice center residents.
Among the steps, the state is looking through injury reports for people in other community-based services to see who might need more medical care. The state also has talked with local service coordinators and paid for the development of informational CDs about the Mosaic homes.
She predicted that the homes will fill eventually and that the state will be back to looking for new services for people with developmentally disabled people.
Timmons also expects the homes will reach capacity. She said Mosaic is looking at possibly serving people who have more complex behavioral needs, which could expand the pool of people who could move into the homes.
"This is a long-term commitment Mosaic made," she said. "There are people out there we will be serving."
Contact the writer:
402-473-9583, martha.stoddard@owh.com
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