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Institutions To Close Under Deal With Feds

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In what Justice Department officials are hailing as their third landmark agreement in as many years resolving Americans with Disabilities Act violations, one state will shutter most of its institutions and make strides toward enhancing community living opportunities for people with developmental disabilities.

Under the settlement announced Thursday, Virginia will make fundamental changes to its developmental disabilities system to greatly expand community living options for those currently living in state facilities and individuals at risk for institutionalization.

The plan calls for four of the state’s five institutions for people with developmental disabilities to close and, over the next 10 years, the state has committed to providing nearly 4,200 Medicaid home and community-based waivers.

What’s more, the settlement requires Virginia to enhance its crisis services and provide family supports for 1,000 individuals currently residing in the community. Housing and employment assistance will also be expanded under the agreement.

Officials said the settlement, which came as the result of an extensive Justice Department investigation, is expected to impact over 5,000 Virginia residents with disabilities. Implementation of the deal will be overseen by an independent monitor.

“This is a landmark agreement, a blueprint for sustainable reform, and a model for ADA Olmstead enforcement going forward,” said Thomas E. Perez, assistant attorney general.

The efforts in Virginia are part of a federal initiative that began in 2009 to aggressively enforce the Supreme Court’s decision in Olmstead v. L.C. The 1999 case found that people with disabilities should have the option to live in the community whenever possible.

“In virtually every corner of the country, we’re hearing similar stories, parents who quit their jobs to care for their child,” Perez said. “It doesn’t take a math whiz to know that you can serve more people and you can do it better (in the community).”

In Virginia, for example, it’s estimated to cost $216,000 annually to care for a person with a disability in an institution versus an average of $75,000 in the community.

Since 2009, the Justice Department has taken action on 35 matters in 20 states to address violations of the Olmstead decision. Comprehensive agreements, like the one with Virginia, have already been reached with Georgia and Delaware, Perez said.

Further enforcement activities are currently underway in Mississippi, Oregon, North Carolina and New Hampshire, among other states.

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Comments (16 Responses)

  1. Adam K says:

    You may be able to do it cheaper in the community, as jails and morgues do not cost as much. But doing it “veter?” Please show the data that suggests that for individuals with severe intellectual disabilities, a move out of training centers has provided a better quality of life. Because what I see, anecdotally, is the exact opposite; these individuals end up with more medications, hospitalizations, and incarcerations. Virginia will be complicit in the very probable morbidity and mortality of these individuals. Please request the DOJ and the state to study the quality of life parameters, and construct appropriate plans for those with the most sever of disabilities, before pushing any more residents out into the community.

  2. Bill Smithson says:

    I’m sure you meant “better.” :-). Excellent points, though. Many of our less fortunate should have the option to live in the community, but should not be forced into what could easily be a worse situation.

  3. Anne says:

    I don’t know if you have a child with a disability or have ever been in an institution but I can tell you that as the parent of a severely disabled adult child that I would much prefer to have them live in the community than in an institution. Most institutions simply warehouse people. My child deserves better AND if it can be done at a lower cost so much the better.

  4. Kim G says:

    As the mother of a child who is severely intellectually disabled, having him placed in an institution was never an option. I don’t believe this DOJ decision has anything to do with “cheaper” in the community. It has to do with the civil rights of individuals with ID/DD and their families. People with ID/DD deserve the same rights, protections, and choices as everyone else. They have a right to their community and we all have a responsiblity to protect them and those rights, the same way we do for all our citizens.

  5. Charles says:

    Are you referring to “intellectually disabled”, or “mentally ill”? The two are vastly different. True, some with severe will need care either in an institutional setting or an Intermediate Care Facility. Not all ID persons qualify as “severe”. Many can and do function very well living in their communities somewhat independently with various levels of supervised care. Many hold part-time jobs while living in the community. ID waivers (you are waiving your “right” to institutionalization) provide support services to the individual and family caregivers including employment support and respite care. Institutions should be a last resort.

  6. Debbie says:

    Do the math – how well could you live on even $150,000 a year? – still way cheaper than the institutions. Quality of life includes not only health, safety, welfare but CHOICE. Choice of actvities, choice of food, choice of where you live and choice about who you ask to support you. It’s about time Virginia is made to step up and do the right thing for people with disabilities.

  7. Cheryl says:

    1. Choice – that’s what it’s all about and that is what the Olmstead Decision says – why are the choices of those who choose to live in the institution having their choice taken away?
    2. One may think that in the “community” one has choices but it’s not the case, You live where there is a room – you don’t get to choose your housemates or your caregivers – you have to take what’s there (or not there)
    3. It is a false assumption that the institution is more restrictive – for many it is less restrictive.
    4. It is a false assumption that those in an instition have no choice. Maybe in the “olden” days but times have changed and it’s time that people realized this.
    5. No one is forced to live in the institution – who is behind the lawsuits to close them? It’s basically The Arc which tends to benefit from closing the institutions. They have no clue about how to care for those with the most severe, complex and high support needs.
    6. As an aside, the Arc is against any congregate care – why? Why are they the ones who decide that those with ID cannot live in a congregate care setting when all others in our society hav that choice. By these lawsuits people are actually taking away choice -
    7. As another aside, the recent news of the little boy in the Target ads – it’s ironic that this boy attends a “center-based” school run by The Arc of Essex County. How can the Arc be against congregate care but support a center-based school? This school draws kids from over 20 Townships in New Jersey – I don’t have an issues with this but to me it seems hypocritical on the part of The Arc.

    Much more this lawsuit is not progress – it’s quite the opposite. As one perons writes, yes the morgue does not cost as much.

  8. Martin Lampner says:

    If you look closely at the actual settlement, one quickly notices that this will not be a rapid process. While I have no doubt the community is better for people with I/DD this settlement will do little in the near term to insure easy access to those services.

  9. Sarah says:

    I worked for 25+ years in one of The Virginia “Training Centers” (Institutions) and now care for 2 severely Intellectually disabled people in my home. Just for myself, I believe it is time for this change. I worked very hard at the Center and came to care very much for the folks I worked with. Their needs were generally very extensive, and the medical and behavioral support we provided was really top notch. I’m very proud of the work I did, was blessed to work with many, though certainly not all, other staff that felt the same way I did.

    As a Residential Sponsor in Virginia, my Individuals have lives that are completely in line with their preferences, desires and needs. It’s the best life I could imagine for them. They are members of our family now, and we love them as family. One of them had extremely challenging behavioral issues, and when he left the Training Center people told me “He’ll be back in a week”. Well, years later he’s doing just great. People are amazed. Yes, Virginia, this can be done better and cheaper. I’m doing it.

    Yes, there are less than ideal group homes, and families need to stay informed to be sure that the level of care remains high, or have your loved one moved to a better place. In my opinion, Sponsored Placement is the best solution. But let’s face it, no system will be perfect. The Centers certainly were not, I assure you.

    The old model did what it needed to do, and now times have changed. It’s time for a new model, and here it is.

  10. brie says:

    closing these places would put lots of people out of a place to stay not everyone has family , and what happens when that family or parents die , i would like to see more family / small house out there , to think of my son going to a hospital type place makes me sad , i think you should make it easier for families to keep the adults home by making the hallways wider for the wheel chairs and have a nurse come in to help with the bathing and lefting and respite care and maybe a way that a parent could get payed to take care of a loved one , so that they could , i know its so hard for me to find a job around the hours im not taking care of my son , its hard to work all nite and take care of someone during the day and lets face it im gonna die someday , then what happens !!!!

  11. Renee says:

    Sarah, can you e-mail me about sponsored placement? I’m considering it for my son and don’t often get to speak to anyone who is doing it. I want to pick you brain. rcjacobs at cox dot net. thank.

  12. Renee says:

    sorry it’s rcjacobs4 at cox dot net

  13. Disability Rights Advocate says:

    @ Kim and Debbie…I cannot agree more! The Olmstead decision impacted the disability rights movement in a way that mandates that individuals with disabilities are able to live as independently as they see fit and otherwise be integrated in the community. Community living is readily achievable by way of bringing the supports (medical, case management, social services and other supports) to the individuals in the community, rather than housing the individual in any sort of institution such as nursing home, group home or other residential facility. Institutional bias is what keeps these places in business and generating unneeded expenses charged to the state by way of taxpayers. It is high time we eliminate the medical and institutional model of care and allow individuals with disabilities to excercise their right to be independent, self-directing and make their own choices.

  14. Cheryl J says:

    We’ve done it in Maryland and it has been quite successful. I’ve been involved in efforts to close institutions since 1985. To address the whole issue would be impossible. Sure there are some issues, but not as many as compared to the care received by many in institutions. By providing individualized care based on needs and preferences, differences are made in so many people’s lives.

  15. Bonnie says:

    Group homes might be the answer for some, But for others we prefer a residential setting, where more PROFESSIONAL eyes are on our children. If you place your child in a group home with three bad apple caregivers, who is going to know how the severely disabled is being treated?? NOT all severely disabled have communication skills. Another thing, the residential homes have a large community of caregivers, doctors, RN’s, LPN’s, psychology…. the kids go on field trips, they go home for visits, their families take them out shopping… they ARE still part of the community! I would be terrified having my child in a group home, not knowing if my child is locked in a closet for days, food being kept from my child, dirty diapers… That would NEVER happen in a residential center, with dozens of PROFESSIONAL eyes watching your child everyday!!! SMALL (150 clients, or less)resdential homes, are the ONLY answer for some. Group homes are good for those that can get around and speak up for themselves.

  16. Jeannie Luna says:

    This is difficult me as I straddle both sides of this debate. I also live in Calif therefore we have have services like Regional Centers that other States do not yet our system of care/services is extremely broken & taxed beyond it’s limits.
    My husband & I started doing High Risk Teen Foster-Care over 30 years ago. 23 years ago we were asked to take a 3 month old. He is a survivor of ‘Shaken Infant Syndrome’ Needless to say there were many issues with health, seizures, behaviors & down the road ID. After years of attempting family reunification (yes with the abusive parents) we were asked if we would be willing to ‘keep’ him in perm/care. We were not allowed to adopt as he was deemed UN-adoptable by our DSS. Things DO change as 14 years ago we did adopt yet another that was given to us. thank god.
    They are my son’s & we have a daughter also. They are our children as much as the 3 I gave birth too. We are truly blessed to have 7 children 4 of which have special needs. But they are also my JOB. We have had many children come though our doors as we have always remained an active & open Special Needs Home. We have 4 at home, 23, 22, 21 & 16.
    Do you see my straddle? As a parent I chose to ‘age out’ to become an Adult Res/Facility in order NOT to have my young adult kids placed in another Group Home. Why? The very same fear expressed by all; abuse & neglect & poorly run. We know better than most the types of horrors that are out there. BUT …
    Then … there ARE Homes like mine; well ok … mine is the best, lol.
    The problem is there are not enough of us. Yet there could/should be. It CAN be done, we do it everyday, 24/7. Do we have staff? yes. I have 4. How old are they? close to my kids ages, as a matter of fact 2 even went to school with mine. Why? Because they are hip slick & cool & we’re not, lol. They listen to the same music, they know the dances, they know all the Tenco gadgets, they date, they have friends & my guys are involved in all of it …. Do you see where I’m going? We are the poster family/home/facility for ‘integration’ & how it works. We work an active Indep. Living Skills program as I have two who will be capable in time to move out. Our next venture is to do a Day Program. Why? because we have one who will fail if put in our local Programs & he will wined up in a State Institution. We fought our Regional Center in court for two years & won his entitlement to live in the ‘Least Restrictive’ You can Protect and Advocate at the same time. You can have an ARF & still be a family home. They can have their owns rooms & deco however they want. They do choose what, when & how. They do not have to do ‘Group’ outings if they’d rather not, you can have enough staff to make this choice viable. They can have pets. You DO NOT need to look like a Facility in order to meet all Licensing/W&I codes. You do not have to have continual Client/Staff turn over. In the last 4 years I let go one staff due to unsuitability & we have a waiting list.
    Am I inexpensive … No, but I’m cheaper than an Institution. Is my funding enough? No. Are my staff paid enough? No. Do my guys receive all services they are entitled too? No. Yet we all live well are happy & healthy.
    Here is where the Fed’s, individual States need to put their monies. To develop Program Designs & Homes like mine. Better laws & reg’s to weed out those who do it for the money & provide minimal care.
    In closing please just remember when we are all complaining about how broken the system is/will be … offer the idea/solution of homes like mine. You who are parents, think about opening your door. Is it easy? No. Is it worth it? Yes.

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