The West Virginia Capitol Building. Photo by WV Legislative Photography.

West Virginia’s deputy secretary of Health and Human Resources stood before state lawmakers earlier this week and described the latest death at one of the state’s group homes for intellectually and developmentally disabled people.

“It was a situation where, basically, the individual [was] emaciated, and was not properly cared for, and died as a result of that lack of care,” Jeremiah Samples said. 

He didn’t give any additional details about the person, or the health care provider responsible for their death at Tuesday night’s meeting of the Legislative Oversight Commission on Health and Human Resources Accountability. But the tragedy was not an anomaly.

“We’ve had some heinous deaths, and I don’t use those words lightly,” Samples said.

It’s been four months after an initial report on abuse and neglect at group homes was delivered to the same group of lawmakers. That report outlined grave conditions: a teenager who died in a car wreck after getting the keys to a facility vehicle, residents who weren’t provided with hundreds of necessary doses of medication, excessive uses of restraint, a resident who drank antifreeze but wasn’t taken to a hospital for hours even after complaining. There have also been reports of sexual and physical abuse in group homes.

But the dire conditions have continued, and the state continues to do business with behavioral health centers that have had severe violations. Now, another person has died. While state officials have instituted small changes to address the problem — the  Office of Health Facility Licensure and Certification is in the process of closing or transferring management of 10 problematic facilities and is working on new training materials with the Department of Health and Human Resources — the behavioral health facilities’ issues are numerous, and will require more drastic action to correct.

“Regulators have reported some improvements, but they continue to report situations with deplorable living conditions, even after all of the attention, which is very concerning,” Samples said. There are nearly 2,000 people living in these group homes around West Virginia.

But despite the urgency of the situation, legislators aren’t likely to act soon. Tuesday’s meeting focused on recommendations from stakeholders, who include care providers and disability advocates, arrived at in meetings with DHHR and OHFLAC. They’re suggesting lawmakers take steps to increase staffing at behavioral health facilities, create new training programs, increase funding, and increase direct oversight by OHFLAC and the ability of the state to penalize bad actors.

While DHHR and OHFLAC have identified the problem providers, they say they’re limited in the steps they can take: Shutting down the homes they run would mean permanently eliminating the beds, which could mean that residents have nowhere else to go.

Samples said his primary concern was staffing issues. With non-competitive pay and few training requirements in some cases, maintaining qualified employees has been a challenge for group homes of all types. According to DHHR, in 2020, West Virginia was able to employ only an estimated 17% of the necessary mental health care professionals to take care of people in need in the state. The national average is 27%, and West Virginia ranks 48th among the states.

To fix this issue and attract more qualified workers for these group homes, DHHR wants  lawmakers to use American Rescue Plan funds, some of which are already earmarked by Medicaid to hire and keep staff. But more money from the state’s coffers will likely be necessary. DHHR would also like group homes to introduce a tiered pay model, which would allow for upward mobility for staffers.

As it stands, low pay is endemic in the industry, which makes finding and retaining qualified caretakers difficult. Without a large budget increase, even beyond the American Rescue Plan funds, there is little hope of fixing the staffing issues.

According to committee member Delegate Mike Pushkin, D-Kanawha, it will ultimately require the Legislature to put up the necessary money, at cost to the state. 

“The government has to step in when there are things that just aren’t profitable for the private sector to do,” Pushkin said in an interview. “Especially when you’re talking about taking care of a vulnerable population that can’t take care of itself. This is one of the most important roles of government.”

During the meeting, Delegate Amy Summers, R-Taylor, a registered nurse, pointed out that recruiting qualified staff members is one of the most important steps towards improving care for residents — but that it may take more to solve the crisis.

“If you make two more dollars an hour, you’re not gonna not starve people,” she said. “These are bad people, no matter what we pay them.”

The stakeholders say another major way to improve the care facilities provide to the developmentally disabled is to move people  from Intermediate Care Facilities, which typically house up to eight residents, to Intensive Support Settings. The latter tend to have fewer residents, and are often leased by residents, providing them with renters’ rights. These types of homes have recently seen an increase in federal funding, and advocates say they often provide preferential treatment, in spite of the fact they receive less OHFLAC oversight in West Virginia — with the agency only surveying the sites when a complaint is filed

But, as was made clear in the last committee meeting on the subject in May, while Intermediate Care Facilities may see more abuse, Intensive Support Settings are not immune. 

Other recommendations included increased training, enhancing the role of a Mental Health Ombudsman Office to promote safety in behavioral health facilities, developing an abuse and neglect registry, and increasing prosecutions of abuse and neglect.

“We don’t know if any of this is going to work,” Samples said. “We hope it does, but we have to maintain vigilance.”

Ian Karbal is a Report for America corps member, and the state government watchdog reporter for Mountain State Spotlight.