Discharged?

Disability rights advocates try year after year to convince lawmakers to close Texas’ state-supported living centers — the large, institutional-care settings that have been targeted by the U.S. Justice Department for dangerous conditions. Every time, their efforts are rebuffed: by the adamant parents who rely on the facilities to care for their loved ones, and the lawmakers who count on them as economic drivers in their districts.

This session, advocates say they have a big plus in their column: the state’s giant budget crunch. They are hoping lawmakers, facing an estimated $18 billion to $25 billion shortfall, will have no choice but to shutter some of the facilities, which cost Texas a combined $500 million to operate every year.

“Does this economic reality make it easier for legislators to do it? I sure hope so,” said Amy Mizcles, governmental affairs director with The Arc of Texas, which wants people with disabilities to receive community-based care. “We keep hearing this fiscal responsibility mantra. We have a real opportunity to provide better quality care in a much less expensive setting.”

So far, there is little evidence state officials will take this course, even with the budget crisis. State Sen. Steve Ogden, R-Bryan, the key Senate budget writer who has been most open to downsizing the state schools, declined to comment.

Meanwhile, the Department of Aging and Disability Services, which operates the facilities, says it is prohibited by state law from closing any of the state-supported living centers without legislative direction.

“We can’t,” said Cecilia Fedorov, a spokeswoman for the department. “But that doesn’t mean the Legislature can’t.”

Even with the huge budget shortfall, advocates for shutting the state-supported living centers are not overly optimistic. Since state leaders ordered agencies to trim their budgets to close the shortfall, the aging and disability department has recommended cutting new community-based care slots and slashing Medicaid reimbursement rates for nursing home, group home and in-home facility workers. Meanwhile, funding for the state-supported living centers has only grown — a requirement of the state’s five-year, $112 million settlement with the Justice Department over conditions inside the facilities.

“I’ve heard that everything will be on the table,” Mizcles said. “But every bit of action that’s been taken thus far is completely to the contrary.”

Parents who rely on the state-supported living centers to care for their adult children say that is as it should be. They say the facilities are still working their way through the charges leveled by the Justice Department during the 2009 session but that the influx of funds is having an enormous impact.

The settlement agreement “has been a wonderful thing,” said Nancy Ward, with the Parent Association for the Retarded of Texas. “We need to give them a chance to keep on doing the improvements with the money they got.”

But advocates for community care say the state-supported living centers don’t make financial sense. Right now, they say, a third of the aging and disability department’s budget for people with intellectual and developmental disabilities serves the 4,600 people living in 13 state-supported living centers. A comparable sum funds more than 17,000 people receiving care at home or in small-group settings.  

Meanwhile, the annual cost per resident in a state-supported living center is roughly $120,000, compared to nearly $50,000 in community-based care.

Parents of patients at state-supported living centers say this is an unfair comparison, because the people currently remaining in the institutions have some of the most acute medical needs. “There are people who cannot survive without being in the state school,” Ward said.

But advocates for community care say many of these people can still be cared for far more efficiently in less-restrictive settings. In the wake of high-profile abuse in Texas’ institutions for the disabled — from physical beatings and restraints to medical neglect — state health officials have had to boost payments to the facilities by thousands of dollars per patient annually, a cost opponents argue comes at the expense of community-based care.   

“There’s a bell curve of people, from some who want to close them, to other people who think we ought to do more of them,” said state Sen. Bob Deuell, R-Greenville. “And they’ll all use the current situation to promote their agenda.”