Shortsighted
When Governor Quinn announced that he was going to close seven different facilities across the state, including two developmental centers serving people with developmental disabilities, because of budget shortfalls he released a fact sheet outlining the amount of savings to be realized from the closings. However, it's hard to understand how the Governor arrived at his numbers.
The Governor states closing Jack Mabley and Jacksonville Developmental Centers by the end of February 2012 will save $14.6 million in fiscal year 2012. This is based upon reported annual operating budgets of $10.7 and $27.9 million for Mabley and Jacksonville respectively. These numbers are different than those listed in the FY2012 budget, but we'll use them as they are the numbers reported by the Governor.
The state's fiscal year runs from July 1 through June 30 each year. If both facilities close by February 29, 2012, they will be removed from the budget for the last four months of the fiscal year. This suggests that understanding the savings to be gained is a simple matter of dividing the annual operating budgets by 12 to determine the monthly cost for each center, then multiplying that number by four to find out what the state will save between March and June. I've done that below:
Confusingly enough, using the numbers the Governor provides, the actual savings come out to be about two million dollars less than the Governor projects. This would seem to bring into question whether the math for the rest of the Governor's plan adds up.
Even if we assume the Governor's numbers are correct, there is another significant detail that appears unaccounted for.
Where Did All the People Go?
The Governor's projected savings from the closing of Mabley and Jacksonville are listed as if all of the costs related to operating these programs will disappear the day the doors of the facility's have closed. But the Governor appears to have forgotten one important detail:
The nearly 290 people who live at Mabley and Jacksonville
Whether or not Mabley and Jacksonville are closed, the people living there will continue to need somewhere to live and will continue to require intensive care and supervision. As we've already discussed, the shamefully short timeframe that has been outlined virtually guarantees the majority will move to other State Operated Developmental Centers.
This will mean the populations of the remaining developmental centers in Illinois will grow. Along with that growth of population the cost of operating the other developmental centers will also grow. When Howe closed the costs of of caring for the people who lived there did not simply disappear. Rather, when it shut it's doors at the end of 2010 seven of the eight remaining state operated developmental centers - Shapiro, Ludeman, Kiley, Murray, Fox, and Jacksonville and Mabley - required budget adjustments - increases in the millions of dollars - in the 2011 operating budgets to provide care for the people moving out of Howe.
It Takes People to Care for People
Those increases in operating costs at the remaining facilities were primarily due to the increased personnel each center required. Ensuring the safety and care of people with developmental disabilities is a labor intensive activity.
Skilled labor, to be precise. When Howe was closed it is certainly the case that the state saved costs in terms of the maintenance and care of the facility and its grounds. But of the staff working at Howe, the overwhelming majority moved to similar positions at other developmental centers.
Given that the overwhelming majority - about 73% - of the people who lived at Howe also moved to other state centers, this makes sense. While Howe no longer existed, the people who lived there still did, and still continued to require skilled care. If they close these facilities, most of the operating cost, like the people living in them, can be expected to simply move to other state operated centers. Even if they were to move to community settings, they would still be cared for through state funding. The Governor’s plan doesn’t cut those costs - it simply relocates them.
What's Left to Save?
In fact, skilled care personnel is the major factor for every state operated developmental center. At Mabley the personnel budget for 2012 represents 84% of the cost of operating the facility, and it represents 87% of the operational cost for Jacksonville. When the people at those centers move those costs will not be saved - they will be transferred.
The only costs the Governor can reliably expect to save are those not related to personnel.
If we run the Governor's numbers again with this in mind, this is what we find:
If we take the Governor's numbers as he presents them, cutting the non-personnel related operational costs from Jacksonville and Mabley will save less than $1.8 million. Even if we accept that there will be some savings just by economy of scale it seems unlikely that the savings will amount to much more than $2 million. This is a far cry short of the $14.6 million that is suggested, and approaches amounts described by some as being equivalent to a budgetary rounding error.
It is, in fact, roughly equivalent to the error noted in the Governor's original calculations above.
The proposed closures of these facilities will uproot the lives of nearly 290 people with autism and other developmental disabilities - people who struggle significantly with inconsistency and change - only to move them to another state operated center all for a real-world savings that amounts to 0.004% of the state's $52.7 billion budget.
Shortsighted at best.
Shameful
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.
Jack London on Institutional Life
I've had the distinct honor in my career of working with a number of people who lived in Illinois' institutional system. As a result, I've heard a variety of stories about what this experience was like from their perspective. Those perspectives are many and varied, and always fascinating.
Forest City's own Dr. Kouris is a member of the American Academy of Developmental Medicine and Dentistry. The AADMD is an organization dedicated to to improving medical and dental care for people with developmental disabilities. In their most recent newsletter they provided a link to a 1914 essay by Jack London titled Told in the Drooling Ward. The essay is told from the first-person perspective of Tom, a person living in a large institution.
In the current political climate in Illinois an "institution" for people with a developmental disability is essentially any congregate living setting larger than 8 people. Originally, however, this word in the context of London's story referred to massive facilities built on the asylum model. These structures were typically built on the outskirts of small population centers, and were designed to be self-sufficient (thus maintaining separation). Many of the asylums were working subsistence farms, housed their own power plants, had textile operations for clothing the residents, and nurseries to care both for the infants admitted, and for those born there to the residents. It was typical for the staff working at the programs in the turn of the century to also live there. The Dixon State School was originally a train stop, with the rail grade that ran through the grounds now converted to a bike path.
In short, these were encapsulated worlds unto themselves, with much of the work of maintaining the colonies done by the people living there. London's story, contemporary to the era of these facilities heyday, is extremely consistent with the accounts I've received from the people with whom I've worked. For many of the people living in these settings - particularly those with more severe disabilities - they represented hellish conditions of barely sufficient custodial care. But for a select few - like Tom in the essay - life in the institution presented a setting in which, unlike the wider world outside of the facility, they had real and satisfying responsibilities. I have personally worked with a couple of different women who, for example, fondly recall being "working girls" - working in the nurseries and caring for babies.
Illinois began dismantling it's asylum system in the 1970's and, while it is still woefully behind the rest of the nation in funding smaller settings and closing the large facilities, it no longer operates on the separated colony model that once was in place. The people from whom I've had the privilege of hearing these stories are now in their 50's, 60's, and 70's. Like survivors of the Great Depression and World War II they represent a rapidly disappearing and unreplaceable resource.
The essay is an excellent, brief read, entirely available online at the site linked to above. I highly recommend it.
