YELLOW SHEET Office of the State Auditor of Missouri Claire McCaskill

An estimated 27,500 Missourians with developmental disabilities receive services from the Division of Mental Retardation and Developmental Disabilities of the Department of Mental Health each year.� The division is� responsible for supervising residential facilities, day programs, and specialized services.� In addition the division provides oversight of contractor-operated facilities, programs, and other funded or licensed services.� Its goals are to improve the lives of persons with developmental disabilities through programs and services to enable those persons to live independently and productively.� 

In 1988, the division began participation in the Medicaid home and community-based waiver program, designed to help expand needed services throughout the state.� About 5,000 Medicaid waiver clients live in contractor-operated residential facilities.� Meanwhile, the division itself operates 17 facilities that provide or purchase specialized services. 

No registered nurse on staff at many facilities 

As part of our audit we obtained and reviewed over 3,800 client health risk assessment reports prepared by the division�s 11 regional centers in late 2000.� We analyzed these reports to identify the number of clients who were at risk of developing serious medical complications and find out which providers did not have a registered nurse on staff. 

About 1,400 of the division�s clients living in contractor-operated facilities have health conditions that the division has categorized as a high level of health risk.� The division, however, has not assured that these clients and all other clients have professional nursing care, which is required by law.� Without professional nursing supervision, the division has little assurance that contractor unlicensed health care personnel are performing at an adequate level while completing nursing care tasks for their clients. 

Among our recommendations we suggest the division revise contracts with providers who operate group homes and individualized supported living facilities to require the providers to employ a professional registered nurse as needed.� We also recommend periodic reviews to ensure contractors are employing registered nurses and that proper certified medication aides administer medicine to clients.

Disparity in operational costs exist between group homes and supported living facilities 

Our report also notes the cost of caring for clients in individualized supported living facilities are rising faster than group home costs.� In response to this finding the division claims most group home rates were established years ago and attempts to receive cost of living adjustments have gone unheeded by Missouri�s General Assembly.� Subsequently, independent supported living facilities created in recent years are operating on budgets which more accurately reflect today�s costs.� Although group home rates have not kept pace, the division assures correct funding levels will be established as new group homes are developed and opened.

Complete Audit Report