Thursday, December 30, 2010

Maryland center for people with intellectual disabilities sees drop in clients over the years

From The Cumberland Times-News in Md.:

CUMBERLAND, Md. -— The Joseph D. Brandenburg Center isn’t closing, but the number of people who live there and use the services offered at the center has declined rapidly over the past dozen years.

The numbers seem startling — 15 years ago, the Brandenburg Center helped 57 intellectually disabled residents at the center; today that number is down to eight. The decline has nothing to do with the quality of care, transfers to another facility or changes in the number of intellectually disabled people in the population, said Cathy Marshall, the CEO of the Brandenburg Center and the Potomac Center in Hagerstown. Instead, the declining numbers reflect changes in law, public policy and attitudes toward the disabled, she said.

“Admissions are very few and far between,” Marshall said. “Nothing is a cookie-cutter anymore. It’s person-centered planning.” Karen Black, the director of public relations for the Maryland Department of Health and Mental Hygiene, which runs the Brandenburg Center, confirmed that there are no plans to close the center in response to an inquiry by the Times-News.

Both state-owned centers serve the intellectually disabled, who in the past might have been classified as mentally retarded. The centers represent an older notion of caring for the intellectually disabled, which is institutionalization in a 24/7 living facility, Marshall said. Nationwide, the number of government-run care facilities for the intellectually disabled is in free-fall, Marshall said, because institutionalization is being abandoned as a long-term solution for the disabled. Instead, individuals stay with their families, in an assisted-living facility or live on their own.

Most of the people who live at Brandenburg and Potomac are people with both intellectual limitations and mental illness and are placed in a facility by a court order, she said. “It’s not a lifelong thing anymore,” she said.

“Any time you are living with family, with support, there is much more freedom,” she said. “The focus is quality of life and a more fulfilling life.”

Eight states and the District of Columbia no longer operate institutions for the intellectually disabled and the average daily population at such facilities across the country has dropped from 131,345 in 1980 to 33,682 in 2009. That’s a 74 percent drop, according to a study by the College of Education and Human Development at the University of Minnesota, Marshall said.

In 1960, there were 354 large state institutions; by 2008, the number was down to 162, she said, citing the same study. Brandenburg has followed the national trend. In 1995, there were 57 residents; by the turn of the century the number was 43; and that number was halved to 20 by 2006, said Marshall.

The changes were driven by two factors, said Marshall. In 1978, federal law was changed to guarantee every child, regardless of disability, a public school education. A second change was a movement that also began in the 1970s, spearheaded both by families who wanted to keep their disabled children at home, and changes in thinking about the best way to help the intellectually disabled lead full lives.

This meant it made more sense for intellectually disabled children to stay at home and attend local schools and that adults with mental disabilities should be allowed to make choices about their own lives when possible, Marshall said. Funding moved away from institutions to families of children with disabilities and to the disabled themselves once they reach adulthood.

Oversight exists to protect people who live outside state institutions, Marshall said. The state Office of Healthcare Quality makes regular site visits to the places where intellectually disabled individuals live either with families, on their own or in alternative living arrangements. The alternative living arrangements often involve several individuals in the same home or apartment building.

Since Brandenburg needs fewer employees than previously, some positions were eliminated over the past few years by attrition. Layoffs also occurred about a year and a half ago, said Marshall. Brandenburg now has 18 staff members and about a dozen contract workers. The Potomac Center has 130 full-time staff and 54 residents. There is no plan to move the residents at Brandenburg to Potomac, she said.

Brandenburg’s staff is excellent and their reviews by the Office of Healthcare Quality have been deficiency-free, she said, which means the center is 100 percent in compliance with state and federal standards.

That’s no surprise to Delegate Kevin Kelly, who said that when he once toured Brandenburg with then-Gov. William Donald Schaefer, that Schaefer had “tears running down his cheeks” as he observed the love and compassion with which staff treated the individuals they served. “The level and quality of care was unsurpassed,” said Kelly.

Empty space at the center is being used for a school for autistic children operated by the Sheppard Pratt Health System, which is not run by the state, Marshall said.