The U.S. Department of Justice has raised red flags over how Gov. Greg Abbott’s hiring freeze will affect Texas institutions for people with intellectual disabilities, saying that potential staffing shortages could cause the state to violate its federal agreement to improve the facilities.
In a Feb. 7 letter to the Texas attorney general’s office, the Justice Department says that the state supported living centers, or SSLCs, already have serious problems with turnover and that a failure to fill jobs would put the facilities “on course to rapidly reach crisis levels of understaffing.”
“Thus the freeze threatens the basic health and safety of the people in the SSLCs’ care and, of course, potentially places the state in breach of its court-ordered commitments in this case,” Justice Department lawyer Benjamin O. Tayloe Jr. wrote.
The Health and Human Services Commission has a filed waiver request with the governor’s office, asking for permission to hire employees at the facilities.
“Providing safe, quality care at our state hospitals and SSLCs is our top priority, and we’ll continue to work with the governor’s office to ensure we take the best possible care of our patients,” commission spokeswoman Carrie Williams said.
The Centers for Medicare and Medicaid Services also registered their concern about the potential impact on the living centers. In a Feb. 8 letter to the state, associate regional administrator Gerardo Ortiz wrote that a failure to fill vacancies “could possibly translate into health and safety concerns for (intellectually disabled) patients in these State facilities.”
Abbott spokesman John Wittman said the governor’s office has already been working with state officials to ensure that the living centers aren’t negatively affected by the hiring freeze.
“The Justice Department’s letter clearly misunderstands the governor’s directive on the hiring freeze,” Wittman said. “The directive exempts from the hiring freeze ‘positions that have a direct impact on public safety.’ Safety obviously includes the well-being of patients and those being treated by state supported living centers.”
Last month, Abbott ordered state agencies to stop hiring people until the end of August, saying the move would free up about $200 million to get the state through to the start of the new biennium, Sept. 1. The freeze doesn’t apply to positions that have a direct influence on public safety, an exemption that includes Child Protective Services.
But the state’s 13 state supported living centers didn’t get a pass.
Texas’ living centers are state-run campuses for about 3,100 people with intellectual disabilities. Some residents live in a nursing home-style facility where they receive extensive medical care. Some live in houses with other residents, where they are supervised by staffers.
In 2008, a Justice Department investigation concluded that the living centers were plagued with problems such as poor medical care and a failure to adequately investigate allegations of abuse and neglect. Federal officials found that statewide, school residents ingested latex gloves, suffered preventable injuries from seizures and falls, and received inadequate preventive health care. State schools had liberally used restraints such as straitjackets, federal officials said at the time.
Texas later agreed to a $112 million, five-year plan to overhaul the troubled institutions. The plan required scores of changes to be made by 2014. The state, however, still hasn’t made all the required improvements, and the facilities continue to be evaluated by independent monitors.
Meanwhile, the centers have struggled to control a never-ending exodus of employees. More than half of the direct care staff at the facilities — those who feed, bathe, supervise, teach and perform other duties with patients at the institutions — leave each year. Turnover for all employees is 40 percent. About 1,300 jobs, 9.6 percent of the total, are currently vacant.
“We welcome your clarification that the freeze does not affect, or no longer affects, the SSLCs,” Tayloe wrote in his Feb. 7 letter to the state. “In the meantime, we will assess its impact on the health and wellbeing of the SSLCs’ residents, and the State’s related commitments in this case, and proceed accordingly.”
Williams said there has been no disruption to services since the hiring freeze began.
The Health and Human Services Commission has also filed a waiver request asking the governor to allow it to fill jobs at the 10 state psychiatric hospitals.
Those hospitals annually provide in-patient care to more than 9,000 people with severe mental health problems, including depression, schizophrenia and bipolar disorder. And, like the living centers, those hospitals have a turnover problem. About 34 percent of all psychiatric nursing assistants, who work directly with patients, quit each year. About 27 percent of all employees leave each year and there are currently 687 vacancies, which is 12 percent of the hospitals’ combined workforce.
The state psychiatric hospitals have had their own quality problems. Over the last few years, the Austin State Hospital on Guadalupe Street has been cited by the Centers for Medicare and Medicaid Services for major problems, including severe nursing shortages and restraint violations. At one point, the problems were so severe that the federal agency threatened to pull the hospital’s $7 million in annual funding. The issues were resolved, and the hospital kept its money.
Jim Pearson, a founding member of the Texas State Employees Union and an Austin State Hospital employee, said people on that hospital campus are worried about the potential fallout of the hiring freeze and hope that patients don’t feel the consequences of a weaker workforce.
“I think it’s shortsighted,” Pearson said of the hiring freeze. “I think it’s unconscionable because our job is to provide service to some of the most vulnerable Texans.”