DOJ: Virgina violated the rights of disabled residents of training centers by keeping them in institutions, instead of moving them into community

From The Virginian-Pilot:

A Department of Justice investigation has found that Virginia violated the civil rights of training center residents by keeping them in institutions rather than moving them to community settings.

The investigation was started in 2008 to see if the state was in violation of the Americans with Disabilities Act regarding mentally disabled residents at Central Virginia Training Center in Lynchburg. The investigation expanded in 2010 to include all the training centers, one of which is Southeastern Virginia Training Center in Chesapeake.

Secretary of Health and Human Services Bill Hazel said there were no surprises in the findings, but said state officials would need to not only increase the amount of community-based services for people with disabilities, but also make improvements to the state training centers.

The investigation's suggested remedies would require much more state funding, some of which may need to be addressed during the current General Assembly session.

"The issue is, even if we look at this particular patient population around the training center," Hazel said, "not only do we have to find the funding to do the things in the community settings, the more integrated settings, but we still also have to ensure that the folks who are in facilities are well taken care of. There is no either/or, it's just 'all of the above.' "

The findings noted that Virginia needs far more Medicaid "waivers" - funding to help people live at home or in other community settings instead of in institutions. The state also needs to accelerate the rate at which it moves people out of training centers, which the Department of Justice called "unacceptably slow."

The report also said the state needs to have more crisis-stabilization services, and to create new types of waivers for unserved populations.

Gov. Bob McDonnell has already proposed $30 million in funding in this year's budget, as a "down payment" for improvements to the system that would increase crisis-stabilization services and fund 275 additional Medicaid waiver slots.

However, the Justice Department report calls for more: "The current proposal of 275 waiver slots, while commendable, is far from adequate."

There are more than 6,000 people with mental and developmental disabilities who are on the waiting list for Medicaid waivers.

News of the Justice Department findings elicited swift reaction Friday.

"Virginia's antiquated system that segregates hundreds of people with intellectual disabilities is a violation of their civil rights," said Del. Patrick Hope, D-Arlington, who called the report "deeply troubling."

Hope called on the legislature and governor to "permanently address" the Intellectual Disability and Developmentally Disabled waiver waiting list and provide adequate resources for community-based services.

"I recognize this will require a significant investment of resources, but we have been under funding these services for decades, and it is high time we met our obligation to our most vulnerable citizens," he said.

The General Assembly also has been wrestling with cuts set to go in place this year to services that disabled people use to stay out of institutions, such as respite care and technology help. The Department of Justice findings could raise issues about those cuts.

The Senate budget would restore some of those cuts and retain the number of waivers the governor proposed. The House budget bill includes 275 waivers for people with mental disabilities, 100 for people transitioning out of training centers and 270 for those with developmental disabilities such as autism.

Other problems cited by the Department of Justice include:

- Flawed discharge and transition planning at training centers.

- Staff at training centers who don't have enough knowledge about community services and do not coordinate with providers.

- People with disabilities living in the community who are at risk of being forced into institutions because of the lack of community services.

- Residents at Central Virginia Training Center who are exposed to unsafe conditions, such as repeated accidents and injuries; and also to restraints that may have been involuntary.

The state has 49 days to respond to the Department of Justice with a plan of action. If a resolution is not reached, a federal lawsuit could be filed against the state.

Virginia's institutionalized population is the 10th-largest in the nation, according to the State of the States in Developmental Disability 2010 report.

Currently there are 1,100 residents in the state's training centers.

Jamie Liban of the Arc of Virginia, an organization that advocates for people with intellectual and developmental disabilities, said the Justice Department report "represents a major milestone in the efforts to move Virginia towards a community-based system."

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.

Justice investigations in other states have, in some cases, led to closing down institutions.

The Virginia findings released this week note that the state is spending a disproportionate amount in institutional settings, which "incurs unnecessary expense." The letter said Virginia could serve three people in the community for each person in a training center.

Colleen Miller, executive director of the Virginia Office for Protection and Advocacy, said the state has been promising for decades to create a more community-based system for people with disabilities, but has failed to follow up with action:

"I think this letter will make it clear that the time is now to live up to its commitment."