An important issue to consider when examining maternity group home programs is the typical cost of serving young mothers in this setting. To fully explore this issue, it is necessary to have information both on the cost of operating the programs and on the typical amount of time residents stay in these homes. For this reason, we asked staff members to provide information on the cost of operating their programs, as well as the amount of time their residents typically remain in the homes.
Getting complete and precise information on program costs proved difficult in some instances. Program staff were sometimes reluctant to share information on costs. In addition, some of the staff we spoke with were not knowledgeable about budget issues or did not have this information readily available. In other cases, it was difficult to separate the cost of the maternity group home program from the cost of other programs the parent organization operated. In spite of these challenges, we were able to collect fairly complete information on per-resident costs from most programs. However, given the difficulties encountered, the costs reported here should be considered only as estimates of the actual per-resident costs.
Getting detailed information on residents’ typical length of stay proved to be even more challenging. Homes often did not keep detailed records on length of stay or did not have this information in a form that could be readily compiled and tabulated. In addition, when information on average length of stay was available from programs, it was not always clear how the information had been calculated and how, for example, the ongoing stays of current residents were factored in to any averages reported. Finally, it appeared that when staff members did not have specific information on this topic and instead gave their general sense of the typical length of stay, they tended to overestimate how long residents remained in the homes. They generally reported much longer stays than were indicated from reports based on specific data on all program participants.3
To address the limitations of the cost information, we report figures in terms of average monthly costs per resident family, rather than average total costs per resident family served (which would require precise information on average length of stay).4 We then describe the available information on typical length of stay and discuss what this suggests about the typical total cost for serving young mothers and their children in this setting. However, since the length of stay information is less complete, we do not calculate specific total cost estimates per resident family served for each of the study programs.
Typical Monthly Costs. Operating a maternity group home can be expensive. Many programs reported average costs per resident family of more than $4,000 a month (Table IV.2). By far the largest expense in operating these programs is staffing cost. Salaries and benefits can make up 70 percent or more of their overall operating expenses. As discussed in Chapter III, maternity group home programs typically offer 24-hour supervision, as well as intensive support to residents. This high level of supervision and support requires a large number of staff members per resident family. These high per-resident staffing levels lead to high per-resident costs.
The cost of providing housing is another important component of program costs. Program staff indicated that housing costs represented anywhere from 10 to 30 percent of their operating expenses. There are several reasons why the proportion of program costs devoted to housing may vary. In many cases, the parent organizations that operate maternity group home programs own the buildings where the homes are located, which help keep their ongoing housing costs down. Other programs rent space for their maternity group homes. In these cases, housing costs typically are higher and represent a larger fraction of overall operating expenses. In addition, costs vary substantially by location. In general, homes located in urban areas face much higher housing costs than those in small-town or rural settings.5
Funding levels per resident vary greatly across maternity group homes. Several homes reported average costs per resident family of less than $1,500 per month, while others reported average monthly costs of more than $8,000 per family (Table IV.2). Not surprisingly, costs are closely tied to the number of staff members the home employs. Programs with average or above average costs tend to have the highest number of staff per resident (Table IV.2). For example, the Maine program had the highest costs per resident family of the programs we visited, as well as the highest staff-to-resident ratio, with 1.6 full-time equivalent staff members per resident family. Conversely, the programs with the lowest per-resident family costs (those in Michigan, New Mexico, and Washington) had the lowest number of staff per resident. These programs all averaged fewer than one staff member per resident family.6
In addition, programs that operate smaller homes tend to have higher per-resident costs.7 The Maine and Georgia programs, which have above-average costs, operate homes that average fewer than six resident families per home (Table IV.2). In contrast, the average size of homes in the Michigan and Washington programs, which have relatively low costs per resident, is 10 or more. This connection between home size and per-resident costs may be tied to staffing levels. For example, it generally takes more staff per resident to offer 24-hour supervision in a home with 5 resident families than it does in a home with 10 resident families. In addition, there may be other ways in which larger homes enjoy “economies of scale” and are able to offer the same level of service with fewer staff members.
THE RELATIONSHIP BETWEEN STAFFING LEVELS AND COSTS
Two examples illustrate the considerable variation in staffing levels at different maternity group homes, as well as how these staffing levels affect both program services and program costs. One of the highest staff-to-resident ratios we observed was in the St. Andre program in Maine, which operates four small congregate-model homes. These homes typically have one part-time and six full-time staff members to serve four resident families — about 1.6 FTE staff members per family. This high staffing level allows the home to provide a high level of service for its residents, including 24-hour supervision, parenting and life-skills classes three or four times a week, and intensive mental health treatment. It also leads to fairly high costs, about $8,600 per month per resident family served.
In contrast, one large apartment-model home operated by Friends of Youth in Washington had one of the lowest staff-to-resident ratios we observed. This facility has one full-time and seven part-time staff members to serve 14 resident families — about 0.3 FTE staff members per family. Because of the lower staffing levels, the home offers a less intensive set of services to its residents. For example, unlike the Maine home, the Washington home does not offer intensive mental health services and conducts parenting and life skills classes only about twice a month. The lower staffing level at this home keeps their costs relative low, only about $1,300 per month per resident family served.
Finally, programs with higher per-resident costs generally provide a more intensive set of services. The Maine and Georgia programs, for example, place strong emphasis on mental health treatment. In both programs, residents see a trained therapist weekly. These sessions are usually conducted by a specially trained, licensed social worker who is a member of the group home staff. In addition, many residents in the Maine and Georgia programs see a psychiatrist regularly. For both these programs, the cost of this intensive mental health treatment is included in their overall program budgets. Other programs place substantially less emphasis on mental health treatment, and most residents in these other programs do not receive regular mental health therapy. In addition, the mental health treatment that is provided for residents in these other programs usually is provided by other organizations and is not part of the budget of the homes. Similarly, the New York program, which has above average costs, also offers a particularly intensive set of services. Residents in the New York program are required to participate in six weekly one-hour classes on independent living skills, childbirth, infant care, health, substance abuse prevention, and other special topics. No other program we observed included as many hours of formal instruction.
Typical Length of Stay. Residents of maternity group homesare generally free to remain in these programs a relatively long time. Several programs have official limits on stays of 18 to 24 months. In other programs, residents may remain in the home as long as they are below the program’s age limit (often 21). Home staff often reported that they were flexible about these limits and, in some cases, allowed residents to stay beyond them if it appeared that the family would benefit from remaining in the program.
In spite of the potential for fairly long stays in these homes, it appears that the typical stay is relatively short. As mentioned, the data available on length of stay are limited and incomplete. However, in programs and homes for which this information is available, the average length of stay is about four to six months. For example, staff in the Georgia program reported that the average stay for its residents was just over four months, while staff from the Massachusetts program reported an average of about six months. Similarly, in the one Michigan home that was able to provide this information, the average length of stay was just over six months. Staff at the New York program indicated that the average stay for its residents was about five months.8
In some cases, residents remain in the program only a short time. In programs that had this information available, anywhere from 10 to 25 percent of residents remained in the program for a month or less. In other programs, staff reported anecdotally that residents sometimes left the program after only a few days, once it became clear to them what life in the home would be like. In other cases, residents remained in the program for a year or more. Programs that had this information indicated that 10 to 15 percent of residents remained in the program for at least a year. Staff at many homes mentioned several of their recent residents who had remained in the home for more than a year.
Typical Total Costs. We end this chapter by considering the typical total cost of serving a family in a maternity group home. To estimate this figure, we must combine information on the typical length of stay with information on typical monthly costs. Based on the information gathered in this study, it appears that a stay of five to six months is fairly typical for a family residing in one of these homes. In addition, although costs vary substantially across homes, several programs had homes with monthly costs in the $4,000 to $5,000 per-family range, which falls in the middle of the full range of costs we observed. Combining these figures suggests that a reasonable estimate of the typical cost of serving a family in a maternity group home is $20,000 to $30,000 for a five- or six-month stay. Of course, families often remain in these homes for more or less time than that. Therefore, the actual cost of serving a family in one of these homes would often be higher or lower than this range.