Message from VOR to Congress: "Build Back Better", but don't ignore the needs of our family members with the most severe intellectual and developmental disabilities

VOR (a Voice Of Reason) held its annual Legislative Initiative last week, not in-person in Washington, D.C. as it is usually done, but virtually with Zoom meetings, emails, and good old-fashioned telephone calls. The message was clear and easy to understand: the ideology that "everyone does better in the community" is not universally supported within the disability community and it is not the reality that VOR families experience when programs and residential options are undermined or eliminated in the name of integration and inclusion.

The following is from the VOR Weekly News Update for May 21, 2021.

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Why Do Good For Some? Why Not Everyone?

VOR's Legislative Initiative has been in full swing over the last week, and our meetings with people in congressional offices are likely to continue through next week and beyond. One theme that has come up over and over has been the idea that the Administration and members of Congress plan to make major changes, many would say long overdue changes, to the system that deals with services, supports, and employment opportunities for people with I/DD, and that we don't want our loved ones, and our choices for their care, to be swept aside in this effort to do good things.

We worry that the effort to rebuild the system is aimed at only supporting one ideology, the "everybody does better in the community" ideal, or the notion that HCBS [Home and Community-Based Services] services provide a level of care equal to that of Intermediate Care Facilities (ICFs). We know, from our own experience, that neither of these statements are true.

[ICFs/IID or Intermediate Care Facilities for Individuals with Intellectual Disabilities are federally-licensed and Medicaid-funded residential facilities, some as small as 4-bed group homes up to much larger settings. They serve people with the most severe degrees of I/DD and autism, and their families and guardians. These residential facilities offer a full range of services and 24-hour-around-the-clock support to meet the residents considerable needs.]

So we ask that our choices be supported in this effort to do good. The Biden Administration speaks about building back better. We'd like to take it one step further: Let's Build It Right, this time. Stop pitting the interests of one group of people with I/DD against the interests of another. Stop talking about a non-existent "institutional bias" while you are closing institutions and increasing funding for HCBS.

We support the idea of taking people off of waiting lists. But give them CHOICE. Support all options, and give people the opportunity to use whichever option best suits their needs, at this point in their lives. And if and when their needs change, let them then choose an appropriate option to meet their needs at that point in their lives. Just like our society does with non-disabled individuals.

The first two articles in this week's newsletter exemplify what we encounter daily. The Biden Administration, through the American Rescue Plan as passed by Congress, is giving states flexibility to expand disability services in the wake of the COVID-19 pandemic. But the money is only supposed to go to HCBS services. People in ICFs got COVID, too. The staff of ICFs got COVID, too. Why is the Federal Government only giving extra money to the recipients of HCBS services and their staff?

Again, we see that 500 CEO's have committed to programs that advance inclusion for people with disabilities. That is certainly laudable. But why are people still trying to shut down opportunities that people with I/DD currently enjoy, and thrive under, that do not fit the criteria of "integrated employment"?

Why are there no companies trying to create opportunities for people who have skills and the desire to work, but who are, for one reason or another, not candidates for succeeding in a competitive, integrated environment?

We ask that all people be included in the solutions, and that all options be funded. If there is going to be a $400 Billion increase in spending on disability services, shouldn't it be spent on the people who receive the services, and not divided according to the different ideologies or separate funding streams that have turned our systems into a them vs us system?

Let's build it right this time. Let's provide funds to meet the needs and aspirations of all individuals with I/DD, and let's make sure we fund all of the options that meet the needs of this diverse community.

Abelone Kelley May 28, 2021 0

Pennsylvania legislators propose a moratorium on the closing of two state facilities for people with intellectual disabilities

Residents and families of two Pennsylvania state-operated ICFs/IID will get a reprieve from closure. See blog post on the decision to close White Haven and Polk Centers.

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House Co-Sponsorship Memoranda

House of Representatives

Session of 2019 - 2020 Regular Session

MEMORANDUM

Posted:	September 25, 2019 11:22 AM
From:	Representative Gerald J. Mullery and Rep. Tarah Toohil, Rep. R. Lee James
To:	All House members
Subject:	Moratorium on Closing of White Haven and Polk State Centers

Fear of the unknown can be deeply debilitating and a feeling with which we are all familiar. Today, hundreds of families across this Commonwealth are grappling with the fear of their loved one being forced from the place they have called home for a large portion of their life. For others, they are struggling to find an alternative facility that will match the immense needs of their family member before time runs out. We support the integration of those living with intellectual disabilities into the community where they can thrive and become more independent. But for the residents of the White Haven and Polk State Centers, that is simply not a compassionate option. Many of these individuals require 24/7 attention and extensive medical care morning and night. Closing these facilities forces families to make excruciatingly difficult emotional and financial decisions for individuals whom we have vowed to protect. For some of these residents, the closure and forced exit could be incredibly damaging and traumatic. Before we uproot the lives of these vulnerable Pennsylvanians, we must truly understand the impact the decision may have on the remaining time they have and make readily available the resources to seamlessly continue care. That is why we are taking swift action to introduce legislation that would enact a moratorium on the closing of these facilities until we are better prepared as a state to respond to the impending result. Please join us in supporting this legislation and this critical decision to buy more time for the residents of White Haven and Polk and their families.

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Abelone Kelley September 30, 2019 0

PA Governor announces final decision to close two of four state operated facilities for people with IID without consulting residents, families, or state legislators

Polly on hiatus

After a long hiatus from The DD News Blog, I am picking up where I left off with Susan Jennings' compelling testimony before the federal Interagency Autism Coordinating Committee on July 23, 2019. 

Susan Jennings' severely autistic son suffered for years in abusive community care, often in a toxic over-medicated state, until the Jennings went to court and gained admission for their son to an Intermediate Care Facility for individuals with intellectual disabilities (ICF/IID). White Haven Center in Luzerne County, Pennsylvania, has the right combination of services to control his maladaptive behaviors and a setting that provides close supervision and the safety he needs to thrive. [See "Joey's Journey" for a full account of the ordeal that led to White Haven Center]

Three weeks later,  according to an AP report on August 14, 2019, the Pennsylvania  Department of Human Services (DHS) announced plans to close two of the remaining four state centers for individuals with intellectual disabilities, including Joey's home at White Haven Center: 

"The Department of Human Services said Tuesday that public meetings will be held next month to gather comment on the plans to close the Polk State Center in Venango County in western Pennsylvania and the White Haven State Center in northeastern Pennsylvania's Luzerne County"

The DHS declared that the decision to close these two facilities is final, but also admitted at a legislative hearing on 9/24/19 that the decision was arrived at without consultation with residents, families, facility staff, or legislators. 

The Pennsylvania DHS, according to the AP account, "....promised to work with residents and families, meet with potential community service providers and come up with 'individualized transition plans.' Officials said every Hamburg center [which closed in 2018] staff member who expressed interest in continued work for the state was offered a job prior to closure or in the one-year contractual placement period afterward." 

Residents and families, however, have the option of choosing to continue to receive ICF care if they disagree with the decision to move residents to community placements. This is a holding of the 1999 Supreme Court Olmstead decision that states that a person in institutional care may be moved to community care as long as the affected individual does not oppose treatment in the community. This stipulation is largely ignored by state agencies and advocacy groups who ideologically oppose institutions and tout the overwhelming success of community placements for people with IID. 

According to the Pittsburgh Post Gazette, 8/14/19, Peri Jude Radecic, CEO of Disability Rights Pennsylvania (Pennsylvania's Protection and Advocacy agency) approves of the facility closures and states that, “The Americans with Disabilities Act sought to end the isolation and segregation of persons with disabilities. Court decisions have affirmed the right to move and live in the community. For decades, our Commonwealth has demonstrated that state operated institutions can close and individuals can be moved into the community thoughtfully and safely.”  The Pennsylvania ARC has also expressed enthusiasm for these closures.

For a more accurate interpretation of the ADA according to the 1999 Olmstead decision, VOR has put together passages from Olmstead protecting choice with this introduction:

"...There is no inclusion mandate in Olmstead. Rather, the Court’s determination in Olmstead supports both the right to an inclusive environment and the right to institutional care, based on the need and desires of the individual. Olmstead guarantees choice for all
individuals, their parents, and guardians. Olmstead requires that those who are moved from institutional care to smaller, community-based group homes meet three distinct criteria to determine the appropriate residential setting. There is no mandate to deny access to institutions, to close institutions, nor to place at risk any individuals who need and choose institutional care."

The views of residents and families and others supporting Pennsylvania state facilities are expressed here, on the KIIDS website, ("Keeping Individuals with Intellectual Disabilities Safe...") and at a legislative hearing on "Open the Doors to Dignity" held on April 30, 2019.

The legislative hearing held on 9/24/19 included both support and opposition to the closing of state facilities. Highlights include testimony from John Hirschauer at 1:06 followed by Susan Jennings (White Haven), Irene McCabe (Polk Center), and Hugo Dwyer from VOR from 1:17 to 1:45.

Other interesting moments: 

There were numerous references in the DHS testimony to the amazing success of the closure of Hamburg Center last year. According to a report on the hearing from the Standard-Speaker, Hazelton, PA, 9/25/19, Celia Feinstein from the Institute on Disabilities at Temple University was one of only two witnesses from outside the DHS to testify in support of closure of the state facilities. She said Pennsylvania lags behind other states in moving people out of centers.

"She also said Temple followed people after they left the state Pennhurst Hospital that closed 32 years ago to find out if the move benefited them.

"'After many years of study, I can answer with a resounding 'yes,' Feinstein said. 'In every way we were able to measure it, people are better off.'"

Others were more concerned about the possibility of less than adequate care that residents might receive in community settings and were focused on the fact that of the 80 people moved from Hamburg Center that closed in 2018, 15 have died. 

One rationale given by DHS for not having consulted with residents, families, facility staff, or legislators before deciding to close two centers was that when the DHS floated the idea of closing Hamburg Center, it spooked workers into quitting and leaving residents insufficiently cared for. Apparently it has not dawned on the DHS that this could happen again, now that the centers that they want to close have been identified. To have care deteriorate as a center is closing is a familiar pattern that has been observed before. It has even been used as an impetus to families to move quickly in selecting a community provider, before all the "good ones" are taken.

There are 13,000 people on waiting lists in Pennsylvania for community services. Hugo Dwyer from VOR pointed out that people coming out of state facilities will be first in line to receive Medicaid Waivers to fund community services, thereby putting more strain on the system to serve people in community settings. According to the UCP Case for Inclusion 2019, page 9, although spending doubled on Home and Community based services from 2006 to 2016 and the number of people living in larger state institutions was cut in half, waiting lists for services tripled.

How have people with IID fared in other states when facilities closed?

Michigan closed its last state-operated ICF in 2009. The promise of appropriate care for everyone with a developmental disability in a community setting has not been fulfilled. "Michigan’s mental health system is failing many with severe autism" gives several examples of how people with severe autism who might have been better served in an ICF/IID are falling through the cracks and facing institutionalization in jails and psychiatric hospitals.

Georgia: The Augusta Chronicle has been following the tragic consequences of forcing people with developmental disabilities and mental illness out of institutions and into communities that are not prepared for them and are unable to meet their needs. "Report: Deaths, lack of housing plague Georgia system for disabled, mentally ill" by Tom Corwin, 8/26/19, relates how "An independent reviewer found that despite Georgia’s claims of compliance, a state health care system for the developmentally disabled and mentally ill is still inadequate." 

In 2010, Georgia reached a settlement with the U.S. Department of Justice to move residents of state facilities to community settings. According to the article, 

"An Augusta Chronicle investigation in 2015 found nearly 1,000 deaths among those patients in community care in both 2013 and 2014, and the state has twice halted moving them from state hospitals into community care over the lack of adequate care among those providers. In its last Annual Mortality Review that covered fiscal year 2017, Jones [the independent reviewer] noted that the death rate has continued to climb each year, from 12.5 per 1,000 in fiscal year 2015 to 16.4 per 1,000 in 2017.

“'Perhaps most significantly,' Jones notes, the death rate for those the state has already identified as high risk is anywhere from twice to four times as high."

Washington State: from Because We Care -- Beyond Inclusion 

in a series of Blog posts - "Stuck in the Hospital"

California: "Falling Through Cracks: When The Safety Net for Young Adults With Autism Spectrum Disorder Fails" by Eva Loeffler, 2/25/19

In Pennsylvania, there is bipartisan support from legislators, especially those from the affected counties, to have the state legislature review the decision by DHS to close two of its state-operated centers.

See also full coverage of the PA legislative hearing from the Standard-Speaker from Hazelton, PA:  "Advocates, Opponents Of White Haven Center Closing Head To Harrisburg For Hearing", 9/25/19.

Abelone Kelley September 30, 2019 0

From the Interagency Autism Coordinating Committee on Autism Housing Needs, 7/23/19

This is from an account of the Interagency Autism Coordinating Committee meeting on 7/23/19 by Jill Escher: 

Susan Jennings, founder of Keeping Individuals with Intellectual Disability Safe (KIIDS) shared an oral public comment that her son is one of those who kicks down doors and elopes into traffic. He has been discharged from six different group homes, as none could manage his challenging behaviors. She cited systemic shortcomings to community group home, including severe abuse and toxic over-medication. His salvation was an ICF, and she laughed at the idea of “forced institutionalization” since “You can’t force your way” into an ICF since “they are closed or closing.”

She said her son is far from an anomaly. About 40% of the autism population exhibits severe challenging behavior. Because of the lack of options, these adults often languish in psychiatric facilities, hospitals, or jails. The Olmstead Supreme Court decision recognizes that the ADA does not impel states to close institutions, and indeed that some individuals may need these setting for crisis periods or permanently. They must remain available, as they offer a superior form of care for a segment of the population, she said. There are very high costs to keep some adults “in the community” with too little assistance and supervision. “The state center is a bargain compared to the community,” and also provides her son a much greater degree of personal freedom. Also, unlike community settings, ICFs must meet rigorous standards to be certified. She drew attention to the direct service provider (DSP) shortage: “You are asking people to handle life-and-death emergencies at fast-food wages.” Finally she denounced the “cruel movement afoot” to defund out-of-home options. If parents do not have the ability to care for severely affected adults — who does? We must offer a full range of services.

Abelone Kelley July 27, 2019 0

Tom Dwyer's message to the President's Committee for People with Intellectual Disabilities

Hugo Dwyer is the Executive Director of VOR, a "Voice Of Reason speaking out  for people with intellectual and developmental disabilities". He traveled to Washington, D.C. in November to deliver a birthday message about his brother Tom, a resident of Southbury Training School in Connecticut, an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). This appeared in the Winter 2018 edition of the VOR Voice.

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Executive Director’s Message: Tom Dwyer Speaks to The President 

My brother Tom turned 62 on November 8th of this year. He lives at the Southbury Training School, a state-operated ICF in Connecticut. STS has been Tom's home for his entire adult life, and I can honestly say that I don't believe Tom would be alive today without the quality care, love, and community that STS has given him.

Tom probably doesn’t know what a birthday is. He is severely developmentally disabled. Tom has autism, bi-polar disorder, Pica, Parkinsonism, and what was once called profound mental retardation. He has one detached retina and his vision is poor. He uses a wheelchair but he can be walked with a gait belt. And Tom is non-verbal.

I did not go to Connecticut to bring him his birthday present that day. Instead, I took a train down to Washington, D. C. to give him his gift. I went to Washington, D. C. to give Tom a voice.

I attended a meeting of the President’s Committee for People with Intellectual Disabilities (PCPID), hosted by the Administration for Community Living (ACL). I addressed the committee on behalf of Tom and on behalf of all of our loved ones with severe/profound intellectual and developmental disabilities. My voice, Tom’s voice, your voice, was the only voice that spoke on behalf of the most severely impacted members of the I/DD Community.

No one told me that the public wasn’t allowed to address the Committee at this meeting. Fortunately, no one had told the first speaker that either. When the Liaison from the Office of Health and Human Services to the Office of the President finished his opening remarks, centered around the committee’s intent to speak about Competitive Integrated Employment, he asked if there were any questions. I put up my hand, and not knowing any better, he picked me.

I introduced myself to the committee, and told them about Tom, that it was his birthday and I was there to speak for him, and for our VOR families with loved ones who need and want services in Intermediate Care Facilities (ICFs). I told them that our families have been marginalized and overlooked for decades, our preferred services closed down or cut back, that admissions to ICF’s have been closed in many states, including at STS. I told them that we were being denied our right to choice, and that as parents and siblings and guardians, we had the right to make these choices. I went on to say that many other individuals with intellectual disabilities are being denied the opportunity to work in center-based employment with specialized wages. The choice of sheltered work environments is being denied by people who see this as detrimental to the wishes of those who seek competitive employment. I told them that our voices have not been heard in their meetings, and that I was there in hopes that the more severely intellectually disabled populations would have a seat at the table at the President’s Committee for People with Intellectual Disabilities.

After I spoke, the committee announced that members of the public were not to be granted the opportunity to speak at this meeting. Except for two women who had been hired as ASL interpreters if needed, I was the only person attending as a member of the public. But I stayed and watched and introduced myself to individual members when on breaks. I made sure the members of the committee were very aware of who I was and who I was there to represent.

The President’s Committee appears to have already set their agenda. It will focus on the less severely impacted members of the community, their hopes for inclusion, for integrated competitive employment, even for attending college. These are all noble, admirable goals. We all want all of these things for all of these individuals and their families. Inclusion is fine, but we want our loved ones to be included, too. A report to the President of the United States about the community of people with intellectual disabilities is not complete if it excludes the most severely intellectually disabled.

I hope that the Committee did hear Tom’s voice that day, and that they will see fit to invite our families to be part of their discussions next year. And I hope that maybe someday, Tom’s voice will be heard by the President himself. Or herself, if it takes that long.

Hugo Dwyer

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See also, 

"Disability Housing: Institutional Avoidance" by Micaela Connery, The Huffington Post, 12/6/17: "Institutions aren’t a failure of the past, they’re a reality of the present."

Southbury Home and School Association

Abelone Kelley December 22, 2018 0