Amid Recommendations, an Uncertain Future at Institutions for Disabled

The debate over the future of Texas' institutions for the disabled is a perennial one; advocates for community living want them closed, while families of their residents fight to keep them open. 

But a groundbreaking recommendation from the state's Sunset Advisory Commission to shutter six of Texas' 13 state-supported living centers has reopened a giant divide in the disability community that had seemed to narrow in recent years. 

Ahead of the 2015 legislative session, staffers at the Sunset Commission, which is charged with highlighting inefficiencies at state agencies, have called for closing the Austin State-Supported Living Center and forming a panel to pinpoint five other centers statewide for closure. The facilities provide around-the-clock residential services for people with a wide range of physical and cognitive disabilities. 

Opponents of the state-supported living centers took the Sunset Commission recommendation as validation of what they've been saying for years: that conditions at the facilities are dangerous, and that more state dollars should be plunged into community-based services.

But supporters of the centers argue that community-based care does not work for everyone — especially people with profound medical and behavioral disabilities. They say closures would be hugely disruptive to the people living there, to their families and to the employees of the facilities, which are often located in remote communities. 

The state’s 13 state-supported living centers, formerly known as state schools, have been under scrutiny since 2009, when lawmakers agreed to a $112 million settlement with the U.S. Justice Department over extensive abuse and neglect at the taxpayer-funded facilities. For years, the state has attempted to prop up the centers and improve conditions by calling for increased per-patient funding and overhauling the oversight system for employees of the facilities.

While the calls for closure have largely gone unanswered, the Department of Aging and Disabilities Services (DADS), which oversees the facilities, is up for Sunset review this year. In a report released late last month, Sunset staffers indicated that the state “can no longer afford” the cost of supporting all 13 centers, which have seen their populations drop over the years.

In fiscal year 2013, operating the centers cost the state $661.9 million. As of September 2013, a total of 3,649 Texans with disabilities lived at centers statewide — down from about 5,000 in 2003. 

“Despite transitioning many residents into the community, Texas has not closed a facility since the 1990s,” the report notes. “With the costs to taxpayers growing unsustainably, the state must close some of the most problematic centers, while acknowledging the vulnerable nature of the residents and the emotions involved.”

Dennis Borel, executive director of the Coalition of Texans with Disabilities, said the Sunset staff “rightly hit on” the state’s need to “reduce and right-size the size of our institutional network.” Decreasing the number of centers in the state will save money that can be diverted to community-based services, he said, including individual homes and small group care.

In the report, Sunset staff estimated that the staggered closure of six of the centers would result in millions of dollars in annual savings for the state — about $7.3 million in fiscal year 2016, growing to $97.9 million by 2020. 

“When I saw [the recommendation], my initial thought was, ‘How nice it is to see an accurate assessment of the situation in a fundamentally sound recommendation,’” Borel said.

But Nancy Ward, with the Parent Association for the Retarded of Texas, said the recommendations are far from sound and that the criticism of the centers “isn’t coming from the parents” who will fight to keep them open.

“There are just some people that need the type of care that is offered at the state-supported living centers,” Ward said, adding that the reported problems at some of the centers don’t provide a comprehensive assessment of conditions at all of them. “I’ve seen more good things than bad things at the state schools.”

The debate over the closures could take center stage during the upcoming legislative session. Historically, that fight has pitted lawmakers with institutions in their districts against those who'd prefer to see them shuttered. The Sunset Commission will hold hearings to consider the recommendations later this month and will put forth a final decision in August.

State Sen. Jane Nelson, the Flower Mound Republican who chairs the commission, applauded the recommendations and said that the Sunset staff’s “ideas for policy changes have merit.”

Because DADS cannot close any of the centers without a legislative directive, the commission will take its decision on the recommendations to the Legislature.

Democratic state Rep. Richard Peña Raymond, who chairs the House Human Services Committee and sits on the Sunset Commission, said the recommendation to have fewer state-supported living centers might “make more sense,” but only if the state effectively improves living conditions at the remaining centers.

“We’re such a big state that the reality is that we’re not going to have [a center] in every county of the state,” he said, adding that he didn’t agree with those who argued the state should close all of its centers.

The Sunset staff’s report singled out the troubled Austin center for closure, setting a potential deadline of August 2017. 

In a May 27 letter to families of Austin center residents, DADS Assistant Commissioner Scott Schalchlin said the Sunset report would make retaining workers at the already understaffed center even more difficult. The Austin center spent $2.5 million in overtime for direct-care staff in the past eight months, he wrote.

After the release of the Sunset report, DADS decided to move more than 120 of the 274 Austin center residents out of that facility by next year. The Austin center stopped admitting new residents in 2012, and officials there have been slowly reducing the population by moving residents out of the center and into community homes for more than a year, DADS spokeswoman Cecilia Cavuto said in an email.

Now, the department is speeding up those efforts. About 72 residents will move out by Dec. 1, and another 50 will be out by next June, Cavuto said.

DADS is set to submit its response to the Sunset staff’s recommendations later this week, but Democratic state Sen. Carlos Uresti, who sits on the Senate Health and Human Services Committee, said in a statement that it’s too early to make any decisions.

“The Sunset staff report recommendation is a step in the right direction,” Uresti said. “But I believe it is premature to single out any specific location, or number of living centers to close.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.