Close Texas' troubled centers for people with disabilities

Photo by Caleb Bryant Miller

Earlier this year, Sean Yates, a 35-year-old resident of the state-supported living center in Corpus Christi, climbed the center’s fence and walked away. Nearly a month later, his body was found in the ship channel near the Harbor Bridge in Corpus Christi.

Yates had been living at the Corpus Christi facility for a decade. He was one of about 3,600 Texans with intellectual and developmental disabilities who live at 13 different state-run residential institutions, formerly known as state schools, scattered throughout the state.

About a week before his disappearance, the center’s staff reduced his level of supervision. An investigation found the staff had been negligent, and a federal monitoring report said the center responded with a “lack of urgency” in addressing institutional problems uncovered after Yates’ death.

For those familiar with Texas’ state-supported living centers, stories like this are sad but not surprising. In 2010, a 28-year-old resident of the state center in Richmond died of blunt force trauma to his abdomen. Two employees were fired and later indicted on charges of injuring a disabled person. Last year at the Austin center, a man who was supposed to be closely monitored died after he was left alone in a room, moaning in pain. When a staffer finally noticed him, the man had turned blue. He was dead an hour later.

Such incidents are one reason the state centers have been under a settlement agreement with the U.S. Justice Department since 2009 to improve conditions and ensure residents’ safety. But after five years, none of the centers have achieved more than 35 percent compliance with dozens of performance measures mandated by the settlement.

Quality of care remains a persistent problem. The state Department of Aging and Disability Services, which operates — and, unfortunately, also regulates — the state centers, sets targets for the number of confirmed cases of abuse, neglect and exploitation (unsettlingly referred to as “ANE incidents”) in a given budget year. Last year, there were 572 such incidents at centers across the state. In 2012, the number was 561 — more than double the target of 214.

Some argue that abuse also occurs in privately run group homes, not just in large state institutions. And they’re right. The difference is that group homes can be — and are — shut down by state regulators for serious violations. But state centers can never be shut down, no matter how bad they are, without legislative action.

That’s one reason the state still maintains 13 centers, even though the total number of residents has been declining for years as individuals and their families increasingly seek out home and community-based housing. Over the past 35 years, the average monthly population of Texas’ state centers has declined more than 70 percent.

As a result, costs have gone up. Last year, the state spent about $14,773 a month per resident. In 2015, average costs are projected to increase to $17,570. Compare that with the average monthly cost per resident in a private group home — less than $6,000.

The relationship between substandard care, declining numbers of residents and skyrocketing costs is something most other states have figured out. Over the past 50 years, the number of Americans with intellectual and developmental disabilities living in public institutions has dropped dramatically, while the number of those living in small, privately run group homes has risen steadily. More than a dozen states have managed to close all their public institutions, and others have managed to close most of them.

But not Texas. We have not closed a state-supported living center in 18 years, and we maintain more state-run institutions and house more people in each one than any other state.

It’s long past time for Texas to join the national trend of deinstitutionalization and begin closing and consolidating its state centers. Transitioning to a community-based system won’t be easy and it won’t be accomplished overnight, but it’s possible if lawmakers have the courage to act.

That will be difficult, in part because this is an emotional and deeply personal issue for some people. For families who placed their loved ones in an institution decades ago, believing it was the best option, it can be difficult to accept the reasoning behind calls for reform. Of course, some residents will choose to remain in a state center — and they should be allowed to do so. But that shouldn’t stop state leaders from doing the right thing.

The Sunset Advisory Commission staff has recommended closure and consolidation, and the commission could take up those recommendations this week. So the issue is coming to a head one way or another — and it isn’t a question of choosing between a conservative policy and a liberal policy. On this matter, the Texas Public Policy Foundation is in rare agreement with leading disability advocacy groups.

Texas’ state-supported living centers are closing through attrition. Lawmakers can keep trying to maintain a troubled, costly system that provides substandard care, or they can step in and manage the process of transformation that’s already underway. 

John Davidson

Senior health care policy analyst at the Texas Public Policy Foundation