Austin’s institution for people with intellectual disabilities will relocate about 45 percent of its residents over the next year, a decision that comes on the heels of a state report urging legislators to shutter the facility.
Officials at the Austin State Supported Living Center say they plan to move at least 120 of the 274 residents currently at the facility into community homes by June 2015. They’ll make that happen by closing several on-campus units and transferring people into group homes, nursing facilities and other such settings. Residents could also be sent to other state institutions.
Living center foes, who have fought for years to close the 13 state institutions, applaud the move. But despite repeated federal violations for poor medical care and treatment services at the facility, its supporters are fiercely opposed to the decision. They say their loved ones receive excellent care there. And there aren’t enough community facilities that accept people with serious medical or psychological conditions, said Linda Benskin, whose brother lives at the center.
“My brother has been turned down by countless private facilities,” said Benskin, whose sibling has intellectual and significant behavioral problems. “Where will he go?”
This isn’t the state’s first effort to reduce the number of people who reside at the living centers, which provide 24-hour care for people with intellectual and developmental disabilities. Over the years, it has slowly relocated residents at the direction of federal officials, who say fewer people should live in institutions.
But this most recent effort comes at a time when state officials say six of the 13 living centers should be closed by 2022 — and Austin’s center in particular is in the cross hairs.
The resident relocations are expected to happen in two phases, said Cecilia Cavuto, spokeswoman for the Department of Aging and Disability Services. About 72 people should be out by Dec. 1. Officials plan to move 50 others by June 2015. Between 150 and 160 residents would remain.
The decision was announced to residents’ guardians in a May 27 letter by Scott Schalchlin, assistant commissioner for Aging and Disability Services.
“We don’t make this decision lightly, but we strongly believe that getting the facility to a more manageable size is in the long-term best interest of our staff and, more importantly, the individuals we serve,” he wrote.
In late May, staffers for the Sunset Commission — a state body that reviews and offers suggestions for improving Texas agencies — recommended that six of the living centers be closed. The centers struggle to provide quality care, are too expensive to maintain, have crumbling infrastructure and are largely empty because more people are choosing to live in community settings, according to their report.
Although the attempt to move 45 percent of its residents is a big undertaking, it’s hardly the first effort to shrink the center. In a 2009 agreement with the U.S. Justice Department to improve care at the 13 facilities, the state promised to move more people into the community. In March 2012, the Austin center stopped accepting new residents. Since then, the population has dropped from 344 to 274.
While Sunset Commission staffers suggested closing six facilities, it only named one specifically: the Austin State Supported Living Center.
The facility, which employs about 1,200 people, has met just 20 percent of the Justice Department mandates, the Sunset report states. And since 2009, Medicaid regulators have threatened to eliminate funding to the Austin facility 33 times for violating federal standards. Meanwhile, in April, inspectors found that:
- A resident with chronic seizures had a history of broken bones, head injuries and other wounds because employees didn’t keep him safe during those episodes.
- Staffers moved a resident to the infirmary after inspectors voiced concerns for her safety in her home on the living center campus. But as soon as inspectors left, staff at the living center put her right back in the same home.
That April inspection was done, as usual, by Austin investigators. But in May — about a month after the Austin team slammed the facility — the state ordered a team from Houston to inspect the institution “in order to ensure the most objective survey process,” Cavuto said. That group gave the center a clean bill of health.
Living center supporters say the negative incidents aren’t representative of the overall care at the facility. Inspectors pick a sample of cases to review during their visits and can’t see how well all of the other residents are doing, said Marjorie Heaton, president of the center’s family/guardian association.
“Picking out, say, one or two instances out of 274 people isn’t right,” said Heaton, who has a close friend at the center.
Aging and Disability Services says the facility has struggled for years with serious staffing shortages. Over the past eight months, the center has paid more than $2.5 million in overtime for employees who worked an extra 187,000 hours.
The center also paid consulting group Columbus Organization more than $1.2 million to run the facility between May 2013 and January. But when it left, Medicaid inspectors found just as many problems as they did before Columbus got there.
In his letter, Schalchlin told guardians that they would have some say in the relocation process: “Please be assured that we will listen to concerns, answer questions and respect the choices of individuals and their guardians whenever possible.”
It’s the “whenever possible” part that worries guardians. Over the past few months, guardians have been losing their authority to make decisions for their wards, Heaton said. In one case described in the Medicaid inspectors’ April report, the facility tried to move a resident to another home without talking to the guardian first. That switch was halted after both the guardian and the staffers objected, saying the resident was making progress at his current home.
The 13 living centers operate on a $662 million budget. It costs millions of dollars each year — $9.4 million in 2013 — solely to repair their buildings and infrastructure.
Closing six centers would ultimately save the state $87 million a year and eliminate 4,404 jobs, more than one-third of the current living center workforce, according to the Sunset report. Selling the 93 acres of prime real estate on which the Austin center sits would bring in more than $25 million.
But state leaders need to realize that selling the property and shuttering the center completely isn’t the only option, Benskin said.
“Why take an all-or-nothing approach?” she said. “Why not keep the strip of land upon which the infirmary, administration building and current residences lie, along with a small buffer, and sell the rest of the land? Or they could build a new facility on less valuable real estate.”
Sunset staffers say much of the money saved by closing the centers should be used to develop new community homes and services for people with disabilities.
Disability rights advocates say trusting the state to do that would be difficult for center supporters. Some community homes are great, and some are not, said Joe Tate with the advocacy group Community Now. The state has failed to develop enough community options, and it can’t do that until it stops spending so much money on the living centers, he said
“It’s a scary situation to ask people to take a leap of faith,” Tate said. “It’s scary for the advocates, too, because we know we don’t have the infrastructure. But we can’t focus on two major issues at once.”
Tammie Parker — whose sister has Down syndrome, has complex medical problems and has lived in the Austin center since 1959 — says her sibling loves the facility, her roommates and her caretakers. She believes the center provides a calm, safe environment where her sister can get the medical care she needs.
“She is a lovely, vivacious lady in her 60s, and we attribute her longevity to the wonderful care she has received throughout her life,” Parker said.
CORRECTION: An earlier version of this story stated that the facility was cited by inspectors because a resident was overmedicated. While the center was cited for this, that decision was later overturned by the state's internal review process.
Demographics of residents at Austin State Supported Living Center
Number of people: 274
Gender: 54.7 percent male, 45.3 percent female
Age: 56.8 percent 55 and older
Severity of intellectual disorder:
57.9 percent profound
23 percent severe
10.8 percent moderate
7.9 percent mild
0.4 percent borderline
17.6 percent severe
23.7 percent moderate