04 September 2011
Shameful
09/09/11 18:17 Filed in: Politics
Balancing the Budget on the Backs of the Disabled
Shortly after noon on Thursday, September 8th, 2011 Governor Pat Quinn of Illinois announced the closing of multiple facilities, including two developmental disabilities treatment centers in Illinois as part of an effort to reign in the state's budgetary crisis.
The state of Illinois is in dire financial straits. It has been for several years. Unfortunately it appears that the administration has decided to balance the budget on the backs of its most helpless citizens.
Between them Jack Mabley Developmental Center in Dixon and Jacksonville Developmental Center in Jacksonville serve nearly 300 people with severe developmental disabilities. In Illinois the State Operated Developmental Centers (SODC's) serve as a safety net for providing services to people with behavioral, medical, and personal care needs that cannot currently be met by community providers.
In short, the SODC's serve those people with the greatest level of need.
Closure Does Not Equal Community Placement
In his speech on Tuesday Governor Quinn suggested an upside to the closures of Mabley and Jacksonville - it would result in the deinstitutionalization of the people living there. This concept refers to the movement of people from large congregate living arrangements to smaller, more homelike settings. In general deinstitutionalization is a laudable goal, and one supported by a wide variety of people, organizations and agencies, myself included. Over the past twenty years I have had the good fortune to participate in teams on both the community and state institution side assisting people in transitioning out of institutions.
That said, it is a fallacy at best to believe that the closure of a state facility in Illinois represents an opportunity for community placement for any but a small percentage of the people living in the closing facility.
In the past 10 years Illinois has closed three SODC's: Singer Developmental Center in Rockford and Lincoln Developmental Center in Lincoln in 2002, and Howe Developmental Center in Tinley Park in 2010.
Lincoln and Howe were both relatively large facilities, serving 380 and 247 people respectively, who had to find alternative placement to effect closure. Then, as now, both of these closures were heralded as an opportunity for deinstitutionalization.
But this was only true for a select few. In both cases only about a quarter of the people living at those SODC's - 23% from Lincoln, 27% from Howe - moved to community placement. And where did they go, if not to smaller, more homelike settings?
They moved to another SODC.
In fact, many of the people who moved from Lincoln in 2001 and 2002 moved to Howe Developmental Center, only to be moved again to another SODC when that facility closed last year.
Singer Developmental Center was an edge case. That facility was part of a combined mental health and developmental disabilities program and served only 44 people at the time of it's closure. Further, of those 44 about half were people with significant physical disabilities - a population that providers in the have expertise in serving. This allowed for a larger percentage of people to move into the community from that program - about 34%. But, of course, the remaining people moved to other SODC's - many of them to Mabley.
To place this in perspective with respect to the deinstitutionalization goals it's important to have some context on these facilities and the direction of placement. Singer served 44 people in it's developmental program. It was the smallest developmental center in the state at the time. All of the people who moved from there to other SODC's moved into facilities more than twice the size.
Mabley in Dixon is now the smallest SODC, serving about 90 people. Of those 90 people, history tells us that the overwhelming majority will move to another SODC if the facility is closed in the fashion the governor proposes. For each and every one of those people they will be moving to a larger institution.
Clearly for all but a small minority of people facility closure does not equal deinstitutionalization. For most, it means relocation of institutionalization. In Illinois, closure means consolidation.
Community Readiness
Among people in the developmental disabilities treatment community there is a philosophy: Every person can be served in the community given appropriate resources.
This statement is almost certainly true and yet we see distressingly low rates of community placement coming out of these closures. Key to understanding why is within the last three words of that saying: "given appropriate resources".
SODC's in Illinois serve people with needs that cannot be currently be met by community providers. Most often those needs are behavioral in nature - people who hurt themselves and others at a level of frequency or severity that cannot be safely managed in a community home. The SODC's serve the role of safety net for those people, ensuring they have a place to go when no one else can help.
That safety net remains in place because the state has failed to build a system of community services to take it's place. Community providers are poorly reimbursed, and must navigate an extremely complicated bureaucratic system in order to gain the additional funding needed to serve people with intensive behavioral needs. As often as not, special deals have to be negotiated between the Department of Human Services and the community providers in order to facilitate movement of challenging people out of an SODC and into a community setting. These deals often take a considerable period of time to navigate.
The 25%-ish placement rates achieved by Lincoln and Howe were reached through a relatively long-term plan to close those facilities. Lincoln had 10 months in which to place people. Howe had nearly two years. The governor's plan is to close Jacksonville and Mabley by the end of February 2012, leaving only 5 1/2 months to find new community homes for nearly 300 people. It seems likely that very few of those people will find their way to community homes - fewer even compared to the placement results from Lincoln and Howe.
Community placement is certainly possible, even for people with intensive behavioral needs. It is being done in other states - Wisconsin, for example, has only three SODC's. What it also has, however, is a robust system of community providers resourced at a level that allows them to meet those needs.
The Illinois system is not robust.
This is a well understood fact. Several years ago Illinois established its Blueprint for System Redesign outlining changes needed to facilitate the move from institutional to community services. That plan explicitly indicates the need for increased capacity to manage challenging behaviors in the community as a key component of facilitating placement. Much of what was outlined in the blueprint has yet to be accomplished and those services that have begun - the Service Support Teams, for example - have only recently been started and are still building capacity and experience. Further, while community providers are private agencies, most of the people they serve pay for those services with state funding. The state of Illinois is periodically several months behind on its payment schedule. As a result, many agencies are financially strapped simply serving the people already in placement.
The community is not receiving the support needed to serve the people at Mabley and Jacksonville. Little to no time has been allowed to work through the special deals that sometimes compensate for that lack of support. A number of organizations that are typically in support of facility closure have also expressed concern about the governor's plan for these reasons. That concern is warranted - successful placement must be done with careful planning and appropriate resources rather than with the budget driven haste of the current decisions. The current course of action will ensure that, for most of the people at these centers, facility closure will mean only relocation of institutionalization rather than deinstitutionalization.
Shortly after noon on Thursday, September 8th, 2011 Governor Pat Quinn of Illinois announced the closing of multiple facilities, including two developmental disabilities treatment centers in Illinois as part of an effort to reign in the state's budgetary crisis.
The state of Illinois is in dire financial straits. It has been for several years. Unfortunately it appears that the administration has decided to balance the budget on the backs of its most helpless citizens.
Between them Jack Mabley Developmental Center in Dixon and Jacksonville Developmental Center in Jacksonville serve nearly 300 people with severe developmental disabilities. In Illinois the State Operated Developmental Centers (SODC's) serve as a safety net for providing services to people with behavioral, medical, and personal care needs that cannot currently be met by community providers.
In short, the SODC's serve those people with the greatest level of need.
Closure Does Not Equal Community Placement
In his speech on Tuesday Governor Quinn suggested an upside to the closures of Mabley and Jacksonville - it would result in the deinstitutionalization of the people living there. This concept refers to the movement of people from large congregate living arrangements to smaller, more homelike settings. In general deinstitutionalization is a laudable goal, and one supported by a wide variety of people, organizations and agencies, myself included. Over the past twenty years I have had the good fortune to participate in teams on both the community and state institution side assisting people in transitioning out of institutions.
That said, it is a fallacy at best to believe that the closure of a state facility in Illinois represents an opportunity for community placement for any but a small percentage of the people living in the closing facility.
In the past 10 years Illinois has closed three SODC's: Singer Developmental Center in Rockford and Lincoln Developmental Center in Lincoln in 2002, and Howe Developmental Center in Tinley Park in 2010.
Lincoln and Howe were both relatively large facilities, serving 380 and 247 people respectively, who had to find alternative placement to effect closure. Then, as now, both of these closures were heralded as an opportunity for deinstitutionalization.
But this was only true for a select few. In both cases only about a quarter of the people living at those SODC's - 23% from Lincoln, 27% from Howe - moved to community placement. And where did they go, if not to smaller, more homelike settings?
They moved to another SODC.
In fact, many of the people who moved from Lincoln in 2001 and 2002 moved to Howe Developmental Center, only to be moved again to another SODC when that facility closed last year.
Singer Developmental Center was an edge case. That facility was part of a combined mental health and developmental disabilities program and served only 44 people at the time of it's closure. Further, of those 44 about half were people with significant physical disabilities - a population that providers in the have expertise in serving. This allowed for a larger percentage of people to move into the community from that program - about 34%. But, of course, the remaining people moved to other SODC's - many of them to Mabley.
To place this in perspective with respect to the deinstitutionalization goals it's important to have some context on these facilities and the direction of placement. Singer served 44 people in it's developmental program. It was the smallest developmental center in the state at the time. All of the people who moved from there to other SODC's moved into facilities more than twice the size.
Mabley in Dixon is now the smallest SODC, serving about 90 people. Of those 90 people, history tells us that the overwhelming majority will move to another SODC if the facility is closed in the fashion the governor proposes. For each and every one of those people they will be moving to a larger institution.
Clearly for all but a small minority of people facility closure does not equal deinstitutionalization. For most, it means relocation of institutionalization. In Illinois, closure means consolidation.
Community Readiness
Among people in the developmental disabilities treatment community there is a philosophy: Every person can be served in the community given appropriate resources.
This statement is almost certainly true and yet we see distressingly low rates of community placement coming out of these closures. Key to understanding why is within the last three words of that saying: "given appropriate resources".
SODC's in Illinois serve people with needs that cannot be currently be met by community providers. Most often those needs are behavioral in nature - people who hurt themselves and others at a level of frequency or severity that cannot be safely managed in a community home. The SODC's serve the role of safety net for those people, ensuring they have a place to go when no one else can help.
That safety net remains in place because the state has failed to build a system of community services to take it's place. Community providers are poorly reimbursed, and must navigate an extremely complicated bureaucratic system in order to gain the additional funding needed to serve people with intensive behavioral needs. As often as not, special deals have to be negotiated between the Department of Human Services and the community providers in order to facilitate movement of challenging people out of an SODC and into a community setting. These deals often take a considerable period of time to navigate.
The 25%-ish placement rates achieved by Lincoln and Howe were reached through a relatively long-term plan to close those facilities. Lincoln had 10 months in which to place people. Howe had nearly two years. The governor's plan is to close Jacksonville and Mabley by the end of February 2012, leaving only 5 1/2 months to find new community homes for nearly 300 people. It seems likely that very few of those people will find their way to community homes - fewer even compared to the placement results from Lincoln and Howe.
Community placement is certainly possible, even for people with intensive behavioral needs. It is being done in other states - Wisconsin, for example, has only three SODC's. What it also has, however, is a robust system of community providers resourced at a level that allows them to meet those needs.
The Illinois system is not robust.
This is a well understood fact. Several years ago Illinois established its Blueprint for System Redesign outlining changes needed to facilitate the move from institutional to community services. That plan explicitly indicates the need for increased capacity to manage challenging behaviors in the community as a key component of facilitating placement. Much of what was outlined in the blueprint has yet to be accomplished and those services that have begun - the Service Support Teams, for example - have only recently been started and are still building capacity and experience. Further, while community providers are private agencies, most of the people they serve pay for those services with state funding. The state of Illinois is periodically several months behind on its payment schedule. As a result, many agencies are financially strapped simply serving the people already in placement.
The community is not receiving the support needed to serve the people at Mabley and Jacksonville. Little to no time has been allowed to work through the special deals that sometimes compensate for that lack of support. A number of organizations that are typically in support of facility closure have also expressed concern about the governor's plan for these reasons. That concern is warranted - successful placement must be done with careful planning and appropriate resources rather than with the budget driven haste of the current decisions. The current course of action will ensure that, for most of the people at these centers, facility closure will mean only relocation of institutionalization rather than deinstitutionalization.
