On behalf of The Arc of King County, thank you for the opportunity to review and comment on the draft report regarding the Feasibility Study for the Closure of State Institutional Facilities.
We appreciate the work of the consultants who prepared the report, and the Legislature for funding the 11th study of this issue of where and how individuals with developmental disabilities, who are currently institutionalized, might best be served. The Arc of King County mostly supports the RHC Commission Report of October 14, 2009.
Our comments are as follows:
We agree that the overall direction of most of the recommendations acknowledge the challenges of addressing the political and programmatic concerns surrounding this issue.
As a collective, we represent thousands of individuals with disabilities and family members throughout King County, the majority of whom believe that people with developmental disabilities should live in ordinary neighborhoods, go to local schools, and enjoy community activities. We further believe that the state has an obligation to support individuals and families according to their individual needs. We believe that this can best be accomplished in community settings, such as family homes, or a home of their own, designed to meet the individual’s unique needs and desires, as the majority of people with DD are currently experiencing much success living within their communities. We further believe that it is more cost effective to do so.
We support the study’s conclusion that our state is well behind the national trend to close institutions and support people in their communities throughout the state. The fact is that we are 36th in overall spending on individuals with disabilities and 38th in its dependence on state run RHC’s.
The report is, however, misleading in its assumption that individuals with the most significant clinical needs should be supported in the RHC’s, nursing homes or community settings run by state employees. The majority of people who have the most significant needs are already living in the community, either in family homes or in Supported Living programs, throughout the state, quite successfully and at a much lower cost to the state. It is not necessary to transfer state employees to community settings. We feel this perpetuates the notion that individuals with significant challenges need this kind of staff to support them, when it is, frankly, not true. We suggest you recommend a more thorough assessment be implemented to determine who really has such complex medical needs that couldn’t be served by current Supported Living providers, who are successfully serving people with very complicated needs.
I am fully supportive of the need to develop the current infrastructure in the community and to increase the dollars that go to the hundreds of privately operated community programs that serve thousands of individuals. One of the main concerns families have is the high turnover rate in these community programs. These programs provide necessary, high quality services, but provide low wages to their employees. In study after study that the state has conducted, they have shown a direct relationship between low reimbursement rates (low wages) and high turnover rates. The state must, through adequate reimbursements, demonstrate to families their support of community based care.
We strongly recommend that the clinical services currently being offered in the RHC’s be transferred to DDD regional offices, and be offered to all people with DD living in the community.
We are concerned about the study’s reference to deaths among individuals who moved out of the state institutions. We recommend you incorporate the numerous studies that have been conducted, and the quality assurance reports, on many of the hundreds of individuals that have been successfully moved out of state institutions in the past decade.
It is critical that the state reinstate the very successful Voluntary Placement Program for children with significant challenges in the community. The elimination of this community based, cost effective, option is directly correlated to the expanded use of RHC’s for children.
We concur with the State Arc in recommending that “the way to save the most money is to close the entire facility as quickly and safely as possible. Focusing on a cottage here and there is not cost effective and we suggest you reconsider the schedule.
It would also be helpful to clearly state that the Heartland study for alternative uses for the RHC’s are not part of the report’s recommendations. You might want to consolidate the Heartland information into it’s own section.”
Thank you for your thoughtful work so far and we hope that all of the comments of the community will be taken into account. We have, collectively, a great deal of experience in developing community options and supporting people with a wide variety of needs in communities across the state.
Sylvia Fuerstenberg, MSW
Executive Director, The Arc of King County