Thursday, March 3, 2011

Future of disability training centers in Virginia uncertain

From The Virginian-Pilot:

CHESAPEAKE, Va. -- At a time when the future of Virginia's training centers for the disabled hangs in the balance, there's a flurry of activity at the one tucked behind a busy industrial corridor in Greenbrier.

New roads are being laid at the Southeastern Virginia Training Center, and concrete poured for the foundations of 15 new cottages.

At the same time, state officials, to avoid a federal lawsuit, are vowing to make a dramatic shift in moving disabled people from institutions like Southeastern to community-based programs.

The question still to be answered is this:

Could the downsizing of the state's training centers lead to closing them altogether?

The answer might not come for months or years, and Virginia is not alone in making the journey.

Georgia, one of the most recent states to go through a Department of Justice investigation, came to a settlement in October to stop new admissions of people with developmental disabilities to the state facilities by July, and to move all people out of institutions by July 2015.

The Justice Department also filed briefs last year in Florida, Illinois and New Jersey, calling for more community-based services in those states for people with disabilities.

In Virginia, there are 1,100 residents with intellectual disabilities at five regional training centers; there are 125 at the Chesapeake facility.

A Department of Justice letter in February said that the state has violated the civil rights of training center residents by keeping them in settings that are too restrictive and segregated. Also, some 6,400 disabled Virginians are left on waiting lists in the community with no services at all.

The Justice Department is responsible for enforcing the landmark 1999 Olmstead decision by the Supreme Court, which found that unnecessary institutionalization of people with disabilities is a form of discrimination. To avoid a lawsuit, the state must move more people from training centers into the community and reduce its waiting lists for what's called "Medicaid waiver" services in smaller, community settings.

The question is, how many and how quickly? Virginia officials were required to submit a plan of action within 49 days of the time they received the findings, which was Feb. 10.

A budget adopted by legislators on Sunday included $30 million to set up a trust fund to help move people out of training centers and to address other deficiencies in the system. In addition, $47 million was included for 425 waiver slots, respite care hours and other community-based services for the disabled.

Chesapeake's center is the smallest of the state's five regional training centers. In December 2008, then-Gov. Timothy M. Kaine had proposed shutting it down to offset a budget shortfall. He said it also would align with the state's objective of moving the disabled into more community-based settings.

Parents and family members of residents objected, and prevailed. The General Assembly instead allocated $23 million in 2009 to rebuild the facility, with fewer beds, and at the same time allocated $8.4 million for group homes and intermediate-care facilities that would be built throughout the Hampton Roads community.

The 15 new cottages at the 100-acre Southeastern site on Steppingstone Square will house five residents each and are expected to be finished later this year.

Robert Shrewsberry, director of SEVTC, said they continue to work on discharging residents to less restrictive settings. The population has dropped from its licensed bed capacity of 200 to 140 last June to the current 125, and will need to drop to 75 when the new cottages are finished.

Many families of training center residents want them to stay there, although Shrewsberry said that could change once new community-based facilities are built.

Some advocates for the disabled say the new SEVTC buildings will not pass muster for what the Department of Justice considers a "least restrictive" setting.

Jamie Liban, executive director of the disabled advocacy group The Arc of Virginia, said that organization would like to see all of the state training centers close in favor of smaller, community-based services.

She said that 12 states and the District of Columbia have closed all their state institutions for the disabled, and that Virginia is one of only 10 states that hasn't closed any of its state-run facilities. Virginia has the 10th-largest institutionalized population, according to the State of States in Developmental Disability 2010 report.

Maureen Hollowell, director of advocacy and services at the Endependence Center in Norfolk, which helps the disabled live independently, also takes issue with moving people to other intermediate-care facilities rather than homes and apartments with supportive services.

There are 35 intermediate-care facilities licensed in the state, run by both public and private groups. Some have as few as four residents, but most are larger. St. Mary's Home for Disabled Children in Norfolk is licensed for 88 and will increase to 100 after a recently announced expansion is finished in 2012.

Hollowell said that type of setting is still segregated, institutional living, and her concern is that state legislators and officials will do what's politically expedient by moving people to what amounts to smaller institutions in the community.

That would mean Virginia would continue to lag behind the rest of the country in deinstitutionalizing its disabled population.

"Once we invest $30 million in the bricks and mortar of intermediate-care facilities, we will have them for 20 more years," Hollowell said.

Holding a contrasting opinion are parents and other family members who want their disabled relatives to stay at the training centers, or somewhere with the same state oversight and intensive care.

Jane Anthony's 35-year-old disabled son lives at the Northern Virginia Training Center in Fairfax. Anthony is a co-coordinator of a parents' group there. She said downsizing training centers over the past few decades has left a population of people with severe disabilities who are medically fragile or who have behavioral issues that pose a danger to themselves and others.

She said the more intensive care setting is appropriate for them: "The Department of Justice report doesn't say anything about closing training centers; it talks about downsizing and fixing."

She said states that close facilities before there is an adequate system of community care have had reports of former institution residents being abused in the smaller settings. She also believes the oversight is better at training centers, and that the smaller the setting, the less oversight there is to protect the most vulnerable of the disabled.

"This has been home for my son for many, many years," she said about Northern Virginia Training Center. "Moving him would be very disruptive."