Disability facilities getting a long look

Panel evaluating 5 centers in state

Almost three years after Arkansas fended off a pair of U.S. Department of Justice lawsuits over the care provided at the state’s five institutions for the developmentally disabled, a state advisory group is developing a long-range plan for the facilities, including whether any of them should eventually be closed.

Charlie Green, director of the Arkansas Department of Human Services’ Division of Developmental Disabilities Services, noted that the population of the state’s human-development centers has dropped from about 1,100 in 2003 to fewer than 950.

At the same time, the number of people with such disabilities receiving Medicaid-funded services while living in a community-based setting, such as a private home or a group home, has increased from 2,500 to 4,100.

Enhanced Medicaid funding, made available under the federal health-care overhaul law, is expected to increase the number of people receiving community-based services even more, allowing the state to serve 2,600 people who are now on a waiting list.

A task force, appointed in November, includes Human Services staff members, as well as the Disability Rights Center, representatives of groups that provide services to disabled people, and relatives of the disabled.

“They may come back and tell me that it’s better to have five centers and have them to provide more of a diverse environment for people who have unique needs, such as the behaviorally challenged folks, as opposed to the medically challenged folks,” Green said. “They may come back and tell me it would be better to have fewer centers.”

Darrell Pickney, president of the advocacy group Families and Friends of Care Facility Residents, which supports the centers, said he considers the task force “very suspect” because it includes the Disability Rights Center, which favors phasing out the centers, as well as community-based providers who would stand to gain business if the centers closed.

“It’s not in their best interest to be on a task force to say, how do we improve the human development centers?” Pickney said. “That’s their competition.”

At a meeting last week of Legislative Council’s Hospital and Medicaid Study Subcommittee, Pickney - whose 48-year-old daughter is a resident of the Jonesboro Human Development Center - and other relatives of development center residents contended that the centers provide the best care for certain people with disabilities.

They said they fear that the state’s focus on expanding community-based services will come at the expense of the centers.

Disability Rights Center Director Tom Masseau said that while the state needs facilities that provide short term “crisis” care, most or all the development centers residents could be better served in community settings “with appropriate supports.”

“We shouldn’t be spending good money continuing to rehabilitate these aging buildings when we can be providing services in the community,” Masseau said.

The centers - in Arkadelphia, Booneville, Conway, Jonesboro and Warren - provide residents with medical care, therapy and other services.

The state spends about $120 million a year on the centers’ operations, with about 70 percent of the funding coming from the federal government and the rest coming from state tax dollars.

The state Medicaid program spends an average of about $117,000 a year to care for a development-center resident, compared with about $59,000 for the average patient receiving services for a disability in a community setting, Green said.

Pickney said that comparison doesn’t account for the severity of most development center residents’ disabilities. Providing the level of care that the center residents need would cost just as much, or more, in a community setting as it would at a center, he said.

According to the Developmental Disabilities Services Division, almost three-fourths of the residents have mental health issues in addition to developmental disabilities.

In 2011, the state closed a center in Alexander after it was notified that the center would lose its Medicaid funding because the center’s staff members and the facility had continually failed to meet federal requirements for protecting residents.

The same year, U.S. District Judge Leon Holmes dismissed the two Justice Department lawsuits. One of them, filed in 2009, contended that the Conway center failed to provide adequate treatment and education for its residents and that the staff favored institutionalizing patients instead of treating them in a less-restrictive setting.

Holmes found that the Conway center had failed to provide an adequate education to its school-aged residents, but he noted that the center had filed a plan of correction with the state Education Department.

He ruled that the Justice Department had failed to prove its other claims.

The other suit, filed in 2010, claimed that all of the state’s centers violated the Americans with Disabilities Act. In that case, Holmes ruled that the Justice Department hadn’t taken the proper steps to allow the state to address the federal department’s findings before the department filed the suit.

Among the issues Green wants the task force to examine is how to carry out the state’s plan to phase out the long-term care of children at the Conway center, the only one that currently houses them.

The group will also explore how to provide the best space for the adult residents.

As more disabled people have opted for community-based services, those left in the centers tend to be older people with high medical needs and younger people with mental illnesses and behavior problems, Green said.

“Both of those populations need a lot of space and a lot of staff support,” Green said. “They need the physical plant to be customized to what their treatment needs to be.”

A plan developed in 2011 for the Booneville center, which was originally built in 1909 as a tuberculosis sanatorium, calls for renovating one building and demolishing 19 others and replacing them with new ones at a cost of almost $20 million.

In preparation for last year’s legislative session, Green requested money for a $6 million portion of the project, but that request ultimately wasn’t included in a list of capital improvement projects presented by the Department of Finance and Administration to Gov. Mike Beebe.

At last week’s legislative hearing, Sen. Jason Rapert, R-Bigelow and a chairman of the subcommittee, asked the Bureau of Legislative Research to work with the Human Services Department on a study of the centers’ needs to present to legislators.

“We’re going to make sure that funding is there for those facilities,” Rapert said.

He said he also plans to consult with the state’s congressional delegation to see if Arkansas could be reimbursed for more of what it spent on the Justice Department lawsuit against the Conway center.

The state spent about $4.3 million on the case. Holmes ruled that the state was not entitled to recover attorneys fees, but he did order the Justice Department to reimburse the state for $150,000 in fees for expert witnesses and other expenses.

Beebe will consider any recommendations by the task force for funding, spokesman Stacey Hall said in an email.

She said the governor “has always been a strong supporter of Human Development Centers and will continue to support them to the best of his ability.”

Front Section, Pages 1 on 01/12/2014

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