The state had clear warning: come up with a plan to improve conditions at the Austin State Supported Living Center by June 17 or lose $29 million in federal assistance. June 17 came and went, but the facility is still out of compliance.
It is unclear, however, if the feds will make good on their threat to cut off the Medicaid funding. Though the situation is far from being clearly delineated, it would be wise for officials responsible for the operation of the Austin facility and 13 others like it scattered around the state to plan on how the lost funding will be made up — obviously the short-term solution. The longer term solution will be for the Legislature to take a long, hard look at fixing an obviously dysfunctional system of care for people with intellectual disabilities.
If that sounds like a firm grasp of the obvious, we repeat it because the Legislature has yet to grasp the obvious firmly. This isn’t a case of an overly aggressive federal bureaucracy picking on Texas because the state isn’t adroit enough in jumping federal hoops. The Austin facility has been warned repeatedly about conditions there. The latest threat to terminate the federal funding — one in a string of them — results from separate incidents that ended the life of one resident and resulted in severe injuries to two others.
The $29 million loss would be no small matter; it is just over half of the institution’s $50 million budget. As the American-Statesman’s Andrea Ball has reported, the other institutions like the Austin living center would have to share Austin’s pain. With the state budget now adopted, making up the Austin shortfall from the other centers would be the quickest fix.
The Legislature had plenty of time during the regular session to consider the prospect that the feds were seriously thinking of terminating the Medicaid money, but lawmakers ignored the warning. Even if Gov. Rick Perry were to place the matter on the special session agenda, the Legislature would have to act by Tuesday, when lawmakers hit the constitutionally mandated end of the 30-day special session. The governor could always call another special session to deal with the matter, but it far too early in the developing situation to assess the chances of that.
For the moment, at least, legislators — who bear ultimate responsibility for conditions at the living center — can continue to stand by with their hands in their pockets and pretend not to notice.
The facility’s federal funds have been on the chopping block before — enough so that perhaps officialdom is in denial that the money will really be lost. The financial threat followed reports by state investigators that a patient died at the living center in February as staff members ignored his worsening medical condition. Another man suffered severe burns when staffers bathed him. A third was seriously hurt after his roommate attacked him; investigators determined staff members had not done enough to protect him as the aggressive behavior escalated.
Investigators had previously noted serious deficiencies at the center, operated by the state’s Department of Disability and Aging Services. Despite its paternal acronym, the agency has had a tough time keeping the facility functioning efficiently. The U.S. Department of Justice has had all of the state’s living centers under scrutiny since 2009, when federal investigators found that residents were living in substandard conditions.
The state agreed to make improvements, but the progress has been slow. The institution has had three directors since March 2012 and suffers from chronic staff shortages.
Critics of institutions like the living centers use disturbing reports about conditions in them to urge moving residents to smaller, group home-type settings. Practical considerations dictated by everything from patient needs to neighborhood opposition complicate that scenario. In addition, the families of some of the institution’s residents fear that their loved ones would not adapt easily or well into the smaller group settings.
It’s a complicated situation, so hoping that it will somehow fix itself does not even remotely resemble a plan. Fixing it will take time, and it will take money.
For the time being, the Austin facility remains out of compliance, but it is far from certain what the consequences will be. Texans usually don’t like to borrow trouble, but in the operation of these facilities and others dedicated to delivering health care, the state has aggressively courted problems. They did it by ignoring the warnings. Now would be a good time to start paying attention.