As federal monitors begin the fifth and penultimate visit to state-supported living centers, Texas senators wrestled this past week with what has been reported so far: None of the state’s 13 centers has achieved substantial compliance with mandated standards of care.
Members of the Texas Senate’s Health and Human Services Committee pressed representatives from the Departments of Aging and Disability Services on the lack of progress during a committee hearing last week in Austin that included other public testimony. The committee is expected to prepare its own report on the federal monitoring before the next legislative session.
Health and Human Services Commissioner Chris Traylor told senators that, although he was not a commissioner at the time the settlement agreement was negotiated between state and federal officials, he believed that the centers would have been — by now — further along in achieving compliance.
In 2008, the U.S. Justice Department discovered abusive conditions at Texas state schools, as the centers were then called. After news reports of a “fight club” at the Corpus Christi State School, with the problems gaining widespread attention, the federal government sued the state under civil rights statutes.
In a 2009 settlement agreement, Texas agreed to meet 171 standards of care for nearly 4,000 people with disabilities living in 13 centers, including the Denton State Supported Living Center. Federal monitors have been evaluating each center every six months since. After the sixth and final visit, monitors are expected to prepare their own final report for the judge supervising the settlement.
Traylor told the state senators that he did not believe federal monitors had anything in mind other than the quality of life for people living in the centers. However, coming into compliance with the new standards of care was proving to be more difficult and complex than originally thought.
Other states have had such monitoring, but at only one or two facilities. The number being monitored in Texas — 13 centers in all — was unprecedented, Traylor said.
Traylor told the senators that up until the settlement agreement was drafted, the culture at the living centers had been one of custodial care. The shift needed in organizational culture at the centers — to one that focuses on the residents’ quality of life — has been slow in coming even though employee turnover has been high.
More than 30 percent of both direct and clinical employees leave each month, according to state records. While the Denton center has been able to recruit and retain psychiatrists, and many of the centers have been able to retain qualified primary care physicians, turnover and vacancies in other clinical care positions plague the system.
That is partly because even though they are highly skilled and trained, they are unprepared to deal with the challenges presented by people with disabilities, according to Chris Adams, the outgoing assistant commissioner who oversees the centers.
Sen. Jose Rodriguez, D-El Paso, questioned whether some of the standards shouldn’t be weighted more than others. Specifically, he urged the leadership to do more to reduce abuse and neglect over other tasks, such as meeting recordkeeping requirements.
Overall, confirmed reports of abuse and neglect have dropped from May 2011 to May 2012, state records have shown, but problems are still surfacing. Recent allegations of abuse and neglect at the El Paso State Supported Living Center triggered the July 23 resignation of the center’s director.
State centers in Lubbock and Denton appeared to be making the most progress, with Lubbock making progress toward compliance in 60 percent of the standards, achieving compliance in 18 percent. The Denton center was making progress toward compliance in 58 percent of the standards, achieving full compliance with 16 percent at its last review.
The settlement agreement provides for an extension of the federal monitoring if any of the centers are not in full compliance for a full year before the end of the agreement in July 2014.
Senators focused questions on what it would take to achieve the various standards, which touch not only on preventing abuse, but also on nearly every area of care, from medical and psychological services, to programs that help residents build life skills — many with the ultimate goal of returning to life in the community.
Traylor and Adams offered few suggestions.
Substantial public testimony offered many suggestions to the senators. One person suggested more transparency when reports of abuse surface, since family members and guardians are not always notified when a report of abuse or neglect first surfaces. One urged better pay and training for direct care workers in order to reduce turnover. Another person urged officials to interview doctors, nurses and other clinicians who quit the centers, suggesting that the exit interviews may provide clues to the systemic difficulties for practitioners, including the lack of electronic medical records.
Many people came to support the continued funding of the centers despite the problems, including family members of Denton center residents.
Representatives of Community Now!, a nonprofit organization that advocates serving people with disabilities in the community, asked the committee to de-politicize the issue of closing the centers and reintroduce legislation that funds other options for people with disabilities than living in an institution.
PEGGY HEINKEL-WOLFE can be reached at 940-566-6881. Her e-mail address is email@example.com.
ON THE WEB
Video of the Tuesday meeting is archived and can be watched online at www.senate.state.tx.us/avarchive/?yr=2012. The portion of the meeting on state-supported living centers begins at about 4 hours, 37 minutes.