Gains made, but center still falls short

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Residents of the Denton State Supported Living Center create ceramic Christmas trees at Impressions Handmade Ceramics on the Square, part of a program to help bring the center into compliance with new standards of care. Federal monitors have been evaluating the center against those standards for three years.
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Federal monitoring continues as campus works toward reforms

The Denton State Supported Living Center has come up short again in achieving required reforms after three years of federal monitoring.

Denton’s center, home to more than 400 people with disabilities, is among those making the most progress of the 13 state centers being monitored by the U.S. Department of Justice, state officials say. Denton’s center gained compliance in 20 standards of care and maintained compliance in 29 others.

But the latest report from federal monitors, released late last week, also shows that the Denton facility was compliant with fewer than 30 percent of 171 required standards of care. Those standards are part of a 2009 settlement agreement between Texas and the U.S. Department of Justice.

The final monitoring report for all 13 state centers was due to a federal judge in June, but that has been delayed until June 2014, according to Melissa Gale, a spokeswoman for the Texas Department of Aging and Disability Services.

A seventh round of monitoring visits has already begun and federal monitors will be back in Denton in January, Gale said.

In a prepared statement sent in response to questions from the Denton Record-Chronicle, Gale said that totaling up those standards that are in compliance is not an accurate measure of progress because the standards aren’t equal in weight or complexity.

“Some require significant systemic change to a number of processes, whereas others require only the facility to implement a single action,” Gale wrote.

In 2008, federal officials found abusive conditions at Texas state schools, as the state supported living centers were then called. The Department of Justice sued Texas under civil rights statutes.

After news reports of a “fight club” at the Corpus Christi facility emerged, Texas agreed to meet 171 standards of care for people still living at the centers as part of a settlement deal. Federal monitors have been evaluating each of the 13 centers every six months since then.

The report, released Saturday, covered a visit to Denton in July and noted, in particular, that cases of abuse and neglect there had decreased significantly. From June 2012 to June 2013, the center had confirmed eight cases of abuse and neglect, compared to 20 cases the year before. In addition, the center has greatly reduced its use of restraints, with just nine instances of restraints being used in the previous 12 months.

During the monitoring period, the center opened a store on the Square, where residents come to make ceramics and other art objects for sale. But the monitors said the Denton facility must still improve its support of residents who want more choices to live and work in the community.

Other areas, such as clinical care, medical care, integrated clinical services and other integrated protections and services, had not achieved any substantial compliance, though there, too, the center made progress, according to the report.

Only one center has achieved compliance with more standards than Denton, and that’s Lubbock, at 52. Only one center has achieved compliance with an entire section of standards, and that’s Brenham with the standards of care in the pharmacy section. In order to be released from a section of the settlement agreement, a facility must be in compliance with the standards in that section for a year.

Stephen Gersuk, head of the Volunteer Services Council for the Denton center and whose son lives there, said it’s clear to him that the facility has made significant progress over the past four years. However, he feels invisible to the Department of Justice and the issues that the department’s monitors are examining.

“I’d like the community to know how highly we regard it [the center] and what a gift they are to our families,” Gersuk said. “They are being asked to meet criteria that exists no place else in the system — it wouldn’t be provided in a community setting.”

In July, two adults with disabilities, who lived not in state centers but in small group homes, died after being left behind by caregivers in hot vans. Rebekah Harkins survived for about a month on life support in a Houston hospital after being left in a van for five hours. Terrance Sanders was found in the back of a sport utility vehicle in July. He was dead when Arlington police arrived. Caregivers estimated he had been there about six hours.

But advocates criticize the amount of money Texas commits to the centers, given their inability to meet the monitoring criteria.

“They think they all are doing better than they are really doing,” said Cindi Paschall, of Community Now!

That nonprofit advocacy group was one of nine agencies that joined with Disability Rights Texas to call for a moratorium on new admissions to the state centers.

Recent reforms by the Texas Legislature to the state’s Medicaid waiver programs were meant to address the state’s notoriously long waiting list for the programs. Advocates have found that Texans who do not live in the state centers can wait seven to nine years to get into waiver programs that help them pay for services they need.

But those reforms, primarily through Senate Bill 7, didn’t address the elephant in the room, Paschall said.

“They ignored the biggest burden on the budget,” Paschall said.

About 3,600 people live in the 13 state supported living centers, at an average monthly cost of more than $15 million.

By 2015, that monthly cost is expected to reach $17 million, while the number of residents being served drops to less than 3,200.

Statewide, the population living at the state centers has dropped from about 4,300 since monitoring began in 2010.

At the time of the monitor’s visit to Denton in July, 484 people lived there. When monitoring began, more than 500 people lived at the Denton center.

State and federal officials have ongoing discussions about improving compliance with the settlement agreement, Gale said, but there have been no talks of closing any of the state’s 13 centers.

PEGGY HEINKEL-WOLFE can be reached at 940-566-6881 and via Twitter at @phwolfeDRC.

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