Monday, January 24, 2011

Virginia governor makes a "down payment" on moving people with disabilities to a community-based system

From The Virginian-Pilot:

Gov. Bob McDonnell's proposal to add $30 million to this year's state budget to help people with disabilities poses a quandary for advocates:

How to say thank you while immediately pointing out that it's not enough.

Even the governor has acknowledged the realities.

He described the money as a "down payment" to moving Virginia's disabled to a more community-based system.

It comes at a particularly vulnerable time for a system long overdue for change.

The U.S. Department of Justice is wrapping up an investigation into civil rights violations of residents at Central Virginia Training Center in Lynchburg. Started in 2008, the inquiry expanded into a systemwide examination of the state's mental health facilities.

And in November, the state inspector general issued a stinging report pointing out a slew of problems: Decertification of a geriatric center at Eastern State Hospital because of safety violations. Overtime issues at a training center that hurt staff morale and put patients at risk. Delays in transitioning people in institutions to less restrictive settings because of a lack of services in communities.

The challenge, according to state Secretary of Health and Human Services Bill Hazel, is to keep residents safe in state facilities while at the same time moving more of the disabled into community-based settings.

"We want to get it right, and we want there to be balance," Hazel said last week.

But it's tough to satisfy everyone and to find the money to make it all happen. One group of advocates is lobbying for more community-based care and closure of state facilities. Jamie Liban, executive director of The ARC of Virginia, said the agency for the disabled is pleased at the $9.8 million allocated for Medicaid waivers to serve 275 people in the community.

The waivers allow Medicaid dollars that normally would go toward institutional care to be used in a home setting.

Currently, though, more than 6,000 people are waiting for waivers. The agency is asking the state to provide more than 1,000 waivers above what the governor proposed this year. That's the number needed to meet a state goal of eliminating waiting lists by 2020.

McDonnell's proposal addresses people with intellectual disabilities - more than 5,000 are on that waiting list - but leaves out those with developmental disabilities such as autism and cerebral palsy. More than 1,000 people are on that list. There have been no new waivers for them since 2007.

Fifteen-year-old John Regan Carvil of Virginia Beach (pictured) has been on that list for four years. His mother, Sue Carvil, said John was born with defects that have caused speech, physical and mental delays. He's had numerous back surgeries since he was 6.

Carvil's husband died of cancer last year, leaving her to care for John and his 6-year-old brother, Joseph, on her own. A waiver could help her adapt her home to make it easier to care for him.

"I know everyone has needs," Carvil said. "But he's No. 400 and something on the list, so 400 kids are coming before him."

On the other side of the equation are people who still live in the state's training centers. Advocacy groups and families of those populations want to ensure that the centers get enough money to maintain their quality of care.

The governor's budget includes $7.1 million to address staffing ratios and improve safety for the 1,113 people who live at the state's five training centers, one of which - the Southeastern Virginia Training Center - is in Chesapeake.

His proposal also provides money for staff training and to help residents make the transition to community settings.

While some disability groups advocate closing all institutions, Jane Anthony, whose son lives at the Northern Virginia Training Center in Fairfax, said she opposes that idea.

"It's time for disability groups to come together and support the full continuum of care," said Anthony, who's a member of several organizations of training center supporters. "We don't have the luxury in this economy to be going at each other."

Hazel said he expects the Department of Justice to issue results of its investigation early this year. In Georgia, a similar Justice Department investigation ended in an agreement to stop new admissions of people with developmental disabilities to the state facilities by July, and to move people out of institutions by July 2015.

The Justice Department is responsible for enforcing the landmark 1999 Olmstead decision by the Supreme Court. That ruling found that unnecessary institutionalization of people with disabilities is a form of discrimination.

Hazel said Virginia has received positive feedback from the Department of Justice about the governor's funding proposal.

The population of the training centers in the state has steadily declined over the years. In 1996, for instance, it was 2,132, twice the current number. Still, Virginia's institutionalized population is the 10th largest in the nation, according to the State of the States in Developmental Disability 2010 report.

Hazel said it's been a challenge to satisfy the competing desires of those who support community services and those who want to preserve training center options. He said the administration supports the move toward community-based settings but wants to be sure services are in place to support them.

"It's difficult because you can't do either/or, you have to do both. But we are indicating a clear direction."