Monday, April 10, 2017

Closing institutions and bolstering supports for all

A bill in the Senate, calls for closure of the intermediate care facility at Fircrest School by the end of 2022. We posted a blog about this bill on April 7. Generally, we support it; but closure needs to come with additional investments in residential and community supports. A question was since posted on our Facebook page asking how the state plans to support people affected by a Fircrest School closure.  We answer, below; adding context for those looking to share resources with legislators and others who may not be grounded in the state’s system of supports for people with I/DD.

A balancing act:  Expanding options, while safeguarding people in transition

In Washington and across the nation, most people with intellectual and developmental disabilities (I/DD) live, work and play in the community. Many need various supports - from personal care, to therapies, to residential and employment support. They get them, mostly, in community settings. In fact, in Washington more people with high acuity are served in community settings than are in the state residential habilitation centers (RHCs).

But this does not mean we can relax about community supports, or assume that an individual’s transition needs will be met when he or she leaves an RHC. One of reasons we like the bill is the attention to transition for both the individuals with I/DD and their families.

We also like that the bill specifically calls out the need to increase state operated living alternatives (SOLAs), and emphasizes that the Department of Social and Health Services (DSHS) shall provide opportunities for RHC employees to obtain jobs in SOLAs. Continuity of care is important.

With this legislation, The Arc of King County is asking legislators to focus on the needs of people with I/DD first and foremost, and to consider that the transfer of resources from aging institutions to community options will give individuals with I/DD more options.

Residents of Fircrest School absolutely need the level of care they are getting, but there is nothing magical about those particular walls.  Washington’s ongoing challenge – outlined in a 2013 report from the state auditor – is making sure equitable services are available to all eligible people with I/DD.  Part of the solution is creating service delivery options that more people can access.

QUICK BACKGROUND: Fircrest School is one of the last four residential habilitation centers (RHCs) operating in Washington. It provides support to about 200 people and dates to the late 1950s, when many people with developmental disabilities were placed in institutions designed to serve thousands. Over the years, Fircrest School evolved from providing only care and health services to one that promotes habilitative supports.

During those same years, however, more families opted to keep their children at home, and the state transitioned to home- and community-based supports to serve people of all ages with I/DD. More adults in RHCs also opted to move into community settings.

The population living at the four RHCs, combined, dwindled to less than 800. Today, there are likely 115,000 people with I/DD in Washington, with about 43,000 either getting home- and community-based services through the state Developmental Disabilities Administration, or waiting for services.

Today, most people, even individuals with high acuity, live with their families at home or in some other community setting.  The move to consolidate the institutions is part of an effort to expand access by bolstering the system of community supports. The goal is to serve people where they live, and not require them to be isolated in institutions.

This aligns with recommendations made in 2013 by the state auditor. They include:
  • Reducing the number of Residential Habilitation Centers.
  • Expanding crisis stabilization and emergency respite services in the community, relying less on Residential Habilitation Centers for these services.
  • Providing resources to build peer support networks in the community to aid clients and their families with such needs as transportation, respite, and day activities.

SUPPORT FOR PEOPLE AFFECTED: Senate Bill 5594 funds transition services, person-centered planning and other supports to aid residents of Fircrest School as they review options and move into new placements, whether they be in a community setting or another RHC. (Transition services are highlighted in this blog post).

Continuity is important, and the bill works to include Fircrest School employees in the transition process for residents, as well as provide for family-to-family mentoring.

Another positive: Once the facility is closed, employees can be deployed in the community, working in State Operated Living Alternatives (SOLAs) or other community residential options. This bill is not about reducing services, but rather updating where services are delivered to ensure more people have access to them. In fact, language in the bill specifically calls on DSHS to provide Fircrest employees options for employment in SOLAs.

SAME LEVEL OF ACUITY CARE, UPDATED SYSTEM: The Arc of King County supports consolidating aging institutions and bolstering community-based options. We want to make sure the state is reaching more people where they live.

A common misconception persists that we need the RHCs for people with high acuity. We absolutely need facilities and service options for people with high acuity, including “zero reject” options so everyone is guaranteed a home and access to support. But a state audit in 2013 found that more people with high acuity were, in fact, in living in the community. A lot more.

Specifically, the audit found:
  • 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.
Research also shows that moving from institutional settings into smaller, community-based ones leads to better outcomes for people with I/DD.

For this reason, we have testified that closure of Fircrest must go hand-in-hand with increased investment in community supports. These include crisis stabilization services, respite care, nursing facilities, and expansion of habilitative therapies. It also includes partnerships with counties and other agencies to ensure transportation, employment support and recreational activities to meet the needs of people with I/DD.

Senate Bill 5594 calls for the state to establish regional or mobile specialty services that are evenly distributed across the state and that can provide services such as dental care, physical and occupational therapy, and specialized nursing care.

The nursing facility portion of Fircrest School will continue to operate until it reaches 16 residents. As part of the proposal, DSHS may remodel an existing building to accommodate the nursing facility population.

Finally, DSHS must study and make recommendations on developing and building a federally qualified health center to provide dental and medical care, habilitative therapies, crisis stabilization and specialty nursing care.

Proceeds from sale or lease of land at the Fircrest School would be put into the developmental community trust account and could be used for family support, employment or day support, and residential living options.

Other proposed legislation coming from the House - separate from this bill but, in our opinion, needed alongside it - would make needed investments in salaries for Supported Living providers to stabilize that popular residential choice, as well as a significant investment in the Housing Trust Fund and a 5 percent set aside within that fund to protect or create affordable housing for people with developmental disabilities.

IDENTIFYING AND SERVING THE NEED:  Statewide, there are likely about 115,000 people with a developmental disability, according to research and data from the U.S. Census and the National Health Interview Survey on Disability (NHIS-D) used by the U.S. Department of Health and Human Services.

In King County, there are likely 34,000 individuals with I/DD.

While some of these individuals may have access to Medicaid personal care supports, most – nearly three-quarters – do not have access to Medicaid supports through DSHS that specifically benefit people with impairments in reasoning, learning and problem solving, or habilitative therapies that help them keep, learn or improve skills and functional abilities that may not be developing normally and are needed for daily living. Even with recent investments in the Basic Plus and the new Individual and Family and Services Medicaid waivers, tens of thousands of individuals with I/DD in our state are underserved or not served at all.

Bolstering community options and investing in facilities that can better serve people in a variety of settings helps the state better serve the spectrum of support needed to help people with I/DD thrive, including the 200 with high acuity needs currently at Fircrest School.

We encourage community members and decision-makers to review the 2013 State Auditor’s Report on the Developmental Disability Administration and familiarize themselves with its data and recommendations.

FINALLY … ABOUT THAT MASTER PLAN: There is a Fircrest Master Plan and some legislators have asked why not just follow that.

It is a legitimate question and one we pose right back to legislators – the Master Planning process has been going on for several years and it does not seem to impact any of the proposed planning or legislation regarding RHC consolidation or closure.  It is a head-scratcher.  The Master Planning process seems to live separately from legislative or administrative planning or action.

If SB 5594 or accompanying legislation does not include sufficient funds for community residential expansion, the Fircrest Master Plan is still a good process and has several recommendations that the I/DD community would and should embrace. 

- Ramona Hattendorf,
Director of Advocacy, The Arc of King County