Monday, March 20, 2017

Close, extend or reimagine: What's the plan for DD institutions?

Last week, the state Senate's Ways and Means Committee heard public testimony on several bills dealing with two of the state's remaining residential habilitation centers (RHCs).

Two addressed Fircrest's closure or possible alternative future use. Two addressed keeping the Yakima Valley School open, as either a crisis stabilization and respite center, or as an RHC.

Two of the bills-SB 5646, Concerning services provided by RHCs; and SB 5594, Concerning transition services for people with developmental disabilities-were passed out of the Ways and Means committee March 20.

Neither particularly advances what a 2013 state audit on DD services calls the ‘gold standard’ in the United States: the opportunity for people with developmental disabilities to live in places that offer them the greatest opportunities for interacting with the community at large.

SB 5646 keeps open the Yakima Valley School as a planned respite and crisis stabilization center, even though most people with I/DD live nowhere near the facility and local communities lack such options.

SB 5594 would close Fircrest in 2022 and funnel any profits from land sale or lease back into a trust account for people with I/DD, but there is no vision for developing new residential or community-based crisis care options, and in the interim money would be spent remodeling part of the institution to act as a temporary nursing facility for people with I/DD.
Weighing in is easy:To comment on any bill, click on the number. That will take you to the bill page. Once there, click on “Comment on this bill” button. (Hint: Legislative staff said some users have reported problems with the “verify district” step when using phones or handheld devices. You need to double click that button. Also, be sure the state is “WA” and not “Washington.”)

Background on our state DD services:

In Washington State, about 4 percent of individuals receiving developmental disability services get them in institutional settings. (Nationally the figure is about 3 percent.)

Washington is different from the rest of the nation in that we have both more people in institutions and more people being cared for by families. We have far fewer people served in group homes than the national average (12 percent v 27 percent, in 2013.).

And while the RHCs do serve people with high acuity, many more people with the same high level of need live in the community (often in their family home) and need access to care and support in their local communities.

From the audit:
  • For every person with a high "activities of daily living" acuity level living in an RHC, 12 people live in the community
  • For every person with a high behavior acuity level living in an RHC, 13 live in the community
  • For every person with a high medical acuity level living in an RHC, 17 live in the community

There is no question that the people living in RHCs need the level of care they receive. But there is nothing essential about those locations. The same services can be provided in smaller-scale community settings.

The 2013 state auditor's report on DD services noted supporting a client at an RHC incurs twice the average cost of the most expensive community-based residential service option, and about ten times the average cost of a client living in their own home or with family. Even clients with the most complex needs can be served in the community at a fraction of the cost of RHC care.

So at The Arc of King County, when we talk about supporting people with intellectual and developmental disabilities we advocate for placing service options where the clients are -- in local communities across the state.

This includes providing access to care facilities like crisis stabilization, planned respite, nursing care, and state operated living alternatives (SOLAs).

It also includes building communities that are ready to be inclusive, with affordable housing options, accessible transportation and inclusive recreation, education and employment opportunities.

Our testimony:

Following is a follow-up letter to live testimony given in Ways and Means on March 15.

To: Senate Ways and Means
  • No, SB 5646 (Crisis and respite care should be community-based and resources put into community options)
  • Supportive, SB 5594 (We need facilities that align to current and future needs of the I/DD community and that honor the option of people with I/DD to decide where and how to live their daily lives) 

Dear Chair Braun and committee members

At The Arc of King County, we serve people with I/DD, including 45 in our supported living program. We also support family members of people with I/DD, and protect and promote civil rights. Thank you for considering a variety of bills to support people with I/DD. We are supportive of SB 5594. We oppose SB 5646.

  • We support consolidating state-operated residential habilitation centers and closing Fircrest as an RHC. 
  • We support placing essential supports in the community. These include but are not limited to mobile care units; smaller state-operated facilities, such as a SOLA; community-based crisis care and respite services. Our concern is that care needs to be where people are living their lives.
  • Any savings or profit from consolidating RHCs or selling or leasing land should be put back into supporting people with intellectual or developmental disabilities in their communities. Resources should not be repurposed away from people with I/DD.
  • We are not opposed to repurposing Fircrest and establishing care facilities or housing for people with I/DD that are appropriate to their needs; we are open to inclusive, multi-purpose ideas. 
  • We support the autonomy of individuals to make decisions about their life and care, including where and how they want to live.
Where and how people with I/DD live is much different today than when the institutions opened, as are expectations for what people with I/DD can achieve in their lifetimes -- even people with significant disabilities.

We see the phasing out of old-style institutions as having two aspects:
  1. Closing and consolidating the RHCs and creating versatile, smaller-scale community-based options
  2. Ensuring a strong, stable community infrastructure
On the community infrastructure, we ask that you consider access to affordable housing for people with I/DD. Please invest in the Housing Trust Fund and please return the set-aside for people with I/DD so they can find stable homes in the community.

Please address the residential provider rates. Supported living is an excellent option for people, even people with high acuity, but stable staffing is essential. Current low rates have caused high turnover in the field.

Please make sure there is a “zero reject” option in the community, such as a state operated living alternative (SOLA).

Finally, we encourage the state to partner with the counties to ensure a continuum of services and strong safety net that includes accessible transportation, affordable housing, access to health care or crisis care, and inclusive recreation, education and employment opportunities.


Ramona Hattendorf, Director of Advocacy
The Arc of King County