Testimony of Human Services Commissioner Sarah Adelman

Senate Health, Human Services and Senior Citizens Committee

December 19, 2024

Good morning/afternoon Chairman Vitale and members of the committee.

I am Human Services Commissioner Sarah Adelman, and I thank you for the opportunity to testify today on this important matter.

I’d like to thank Chairman Vitale, Vice Chair Burgess, and Senator McKnight for sponsoring the bills in this package, and for your partnership and support in the Department’s goals.

New Jersey Human Services is deeply committed to enhancing the lives of individuals with intellectual and/or developmental disabilities.

The Department understands the unique challenges individuals with IDD face, and is dedicated to improving services and creating a robust and trusted system that provides the necessary and reliable supports to allow individuals to thrive and participate in communities across our state.

Our core mission is ensuring that every individual receives the respect, resources, and opportunities they deserve.

As part of this fundamental purpose, we are dedicated to ensuring the highest quality of care and demanding the best from providers by setting rigorous standards and expectations prioritizing the health, safety and support of adults with IDD.

I believe and it’s our Department’s experience, that most provider agencies and DSPs are caring professionals that want to serve people the in the best way possible.

However, when serving vulnerable individuals, incidents can and do occur, and sometimes as a result of abuse or neglect. All allegations of abuse and neglect are taken seriously, and - as we have shown - the Department does not hesitate to take aggressive steps ranging from halting admissions and issuing probationary licenses to revocation of licenses and closures of residences.

For instance, during the first months of the Murphy Administration we had to take the extreme and difficult action to close the state’s largest group home provider, Bellwether, and transition support of its 460 residents to nine other providers because of repeated and egregious violations of state standards that threatened the health and safety of residents. New Jersey Human Services was committed to and accomplished a safe and smooth transition of Bellwether’s programs beneficial to the individuals we serve and their families.

We also stood up the Stephen Komninos’ Law effective May 1, 2018, providing some of the most vigorous monitoring activities in the nation.

We prioritized the implementation of this law and significantly expanded capacity and staffing to take on new functions.

Since the law’s implementation, our actions have resulted in placing 283 individuals to the Central Registry of Offenders Against Individuals with Developmental Disabilities, representing 56 percent of all the offenders on it since the registry was initiated in May 2011.

And the Department’s Field Safety and Service Unit has made over 22,000 unannounced site visits across 2,200 adult residential settings to assess whether individuals are at risk of or being subjected to abuse, neglect, or exploitation.

This includes having visited every individual living in a group home multiple times, for a total of over 80,000 face-to-face visits.

As a result of these visits, 1,375 incident reports covering a broad range of issues were identified and routed to the appropriate entity for follow-up and/or investigation.

But there are more enforcement tools our department needs and we must continuously modernize our system.

That’s why my team and I have been working with Chairman Vitale on the transformative legislative package you are considering today.

This bill package is not just about strengthening the State’s oversight.

It is about further ensuring that individuals with IDD receive the dignity, care, and respect that they deserve.

It is a step toward making our system of care even safer, more transparent, and more responsive to the needs of individuals and their families.

At the heart of these initiatives is a commitment to stronger enforcement and oversight.

Significantly, one proposal would empower the Department to impose financial penalties on providers that fail to meet basic safety and quality standards.

For example, service providers that neglect to conduct background checks on employees or fail to investigate incidents of abuse or neglect would be held accountable through fines and penalties.

Today, current law imposes financial penalties on staff who fail to comply with certain laws and this package would expand penalties to treat these settings similarly to other licensed settings in the state, such as nursing homes and other health care facilities.

Currently, the Department has the ability to hold a direct support professional accountable when we can establish a burden of proof that they committed an act of abuse, neglect or exploitation. However, there are times when a single individual may not be at fault or a burden of proof cannot be established, but it is clear a series of systemic failures led to a bad outcome. This bill package will empower us to hold providers accountable for those systemic failures, which is authority we lack today. 

Under these proposals, providers that do not meet the rigorous standards set by the Division of Developmental Disabilities may even face termination of payment authorization, ensuring that only responsible providers are reimbursed by the state.

But accountability is not just about penalties.

It is also about ensuring that providers act transparently and ethically.

The package establishes new standards for providers that ensure good governance, including notifying clients and families of significant operational events; adopting policies to prevent nepotism, conflicts of interest, discrimination, and retaliation; and ensuring transparency of board activities.

These policies would enhance financial transparency of service providers by requiring the public posting of audited financial statements, capping executive compensation and ensuring that the majority of state funds are used to improve direct care, not bolster profit.

Some in the industry have asserted these bills as an overreach, but to be clear, the legislature imposed even more rigorous standards on New Jersey’s nursing facilities just a few years ago.

For context, New Jersey spends 2.2 billion dollars on nursing homes annually to serve about 25,000 people; and we spend 3.4 billion dollars on community IDD services for nearly 28,000 adults.   It is reasonable to expect we hold similar providers to similar standards.

DDD providers are funded almost entirely by Medicaid and it is our responsibility to ensure fiscal stewardship of limited Medicaid funds and protect against fraud, waste, and abuse.

In just the last few years we have seen extensive growth in our provider network, leading us to re-evaluate the tools we have to monitor for quality and hold an expanding industry to the highest standards. In January 2018, DDD contracted with only 171 providers – 32 for-profits and 139 were not-for-profit.  Now there are over 1,000 agencies approved by DDD and Medicaid to provide these services; 863 are for profit and 220 are not-for-profit.

Additionally, the creation of a new Director of Medical Services would strengthen our ability to provide medical oversight and improve the investigation of abuse and neglect cases, particularly for individuals with complex medical needs.

Our state’s ability to swiftly and effectively respond to allegations of abuse or neglect is critical to the safety and well-being of those we serve.

The proposed Disability Mortality and Abuse Prevention Advisory Committee would build on the Department’s efforts to continuously evaluate and strengthen our system of care for adults with IDD.

This body would confidentially review cases of abuse, neglect, and death among adults with IDD and make recommendations to improve policies, systems, and responses.

One of the most significant components of the legislation is the proposed establishment of a clear legal framework for the appointment of a receiver to take over a provider agency that consistently fails to meet health and safety standards.

This provision would give Human Services more authority to intervene through the courts to step in and take control of situations where the health and safety of individuals are at risk.

It’s an important tool to ensure that no provider operates with impunity when their actions repeatedly endanger the lives of vulnerable individuals. This is not theoretical- this is a need we know we have, following the Department’s closure of Bellwether referenced earlier in my testimony.

In addition to the emphasis on safety and accountability, this package places a strong focus on empowering the direct care workforce.

By requiring service providers to complete an annual workforce survey, we can better understand the challenges faced by these essential workers and develop policies to support them.

Direct support professionals are the backbone of our system.

They provide the daily care that individuals with IDD need to live fulfilling lives.

We must ensure that these workers are supported, valued, and given the tools and resources that they need to succeed in their vital roles.

This package reflects the work we’ve been doing at the Department for years to modernize our approach to care for individuals with IDD.

Thanks to Governor Murphy and the Legislature’s commitment and investments over recent years, DDD’s budget has grown by over $1.8 billion since FY2018. This funding reflects our commitment to growing services and serving more individuals.

From expanding DSP training requirements and increasing wages, enhancing emergency crisis prevention and intervention services to developing community-based housing for individuals transitioning out of institutions to expanding employment training programs and improving health care options, we’ve been working to create a system that is more responsive, more inclusive, and more empowering.

We launched a new Disability Information Hub with our other state partners as a one-stop online resource to connect New Jerseyans with disabilities, their families, caregivers and advocates with state services and resources.

We initiated the Jobs That Care NJ web site to highlight direct care job opportunities, and partnered with other state agencies on a student loan redemption program to benefit direct care professionals serving, among others, individuals with IDD in the community.

The reforms you’re considering today would build on this progress by ensuring that stricter accountability and oversight are part of the fabric of our system.

These bills double-down on our promise to every family in New Jersey that we are committed to building a system of care that works for them.

A system where every individual with IDD is treated with the dignity and respect they deserve.

Where providers are held accountable.

And where families can trust that the State has their back.

With the continued collaboration of all stakeholders, including the voices of those with disabilities and their families, we can ensure that these advances have a lasting, positive impact on the lives of New Jersey’s most vulnerable residents.

The Department will never waver in its commitment to preserving dignity and safety for people with disabilities, and will continue to invest in innovative approaches to strengthen and prioritize supports for individuals with IDD.

Thank you for your support of this bill package.

New Jersey Incident Reporting and Investigatory Process Factsheet