The fight over the future of the state’s institutions for the disabled picked back up this week as lawmakers considered a proposal to shutter six of Texas’ 13 state-supported living centers.
Over two long days of public hearings, state legislators and citizens appointed to the Sunset Advisory Commission mulled over a recommendation from the commission’s staff to close the Austin State-Supported Living Center and to form a panel to select five other centers in the state for closure.
“As long as I’ve been in this Legislature, we have been having this discussion and struggled with these issues,” said Republican state Sen. Jane Nelson, chairwoman of the commission, which is charged with periodically reviewing state agencies and recommending changes in how they operate.
Sunset staffers indicated that the state “can no longer afford” the cost of operating all 13 facilities, providing advocates for community living with new ammunition to push for the closure of the institutional facilities they argue are dangerous and take state dollars from community-based services.
“The Arc of Texas supports the recommendation to really look at right-sizing the state-supported living center system” to consider the thousands of individuals on waiting lists for community-based care, said that group's director of government affairs, Jeff Miller. The organization opposes institutional care.
Meanwhile, supporters of the centers said they will fight to keep them open, arguing that individuals with profound medical and behavioral disabilities are best cared for at the state-supported living centers.
Several family members of center residents spoke in favor of maintaining the centers they say properly serve their loved ones. Sarah Searight said her sister Mary, who has lived at the Austin State-Supported Living Center for more than 40 years, has thrived within the center's campus, where she benefits from "amazing staff" who care for her.
"She's asked every year if she wants to move away, and every year she says, 'No, I want to stay at home,'" Searight said.
Amy Trost, a senior policy analyst for the Sunset Commission, told the panel of lawmakers that the cost of caring for the centers’ residents continues to grow even as the population declines at the 13 centers statewide.
In fiscal year 2013, operating the centers cost the state $661.9 million. As of September 2013, a total of 3,649 Texans with disabilities lived at centers statewide — down from about 5,000 in 2003.
“Clearly these are terribly difficult decisions to make, but as the number of residents at the centers continues to decrease and cost continues to rise … this will ensure they receive better care,” Trost said.
Sunset staffers have suggested moving more resources toward community-based care and estimated that the staggered closure of six of the state-supported living centers would result in savings of about $7.3 million in fiscal year 2016 and would grow up to $97.9 million by 2020.
The state’s 13 state-supported living centers, formerly known as state schools, have been under scrutiny since 2009, when lawmakers agreed to a $112 million settlement with the U.S. Justice Department over extensive abuse and neglect at the taxpayer-funded facilities. For years, the state has attempted to prop up the centers and improve conditions by calling for increased per-patient funding and overhauling the oversight system for employees of the facilities.
Lawmakers questioned Sunset staff about the number of state-supported living centers recommended for closure. State Rep. Richard Peña Raymond, D-Laredo, asked why the staff’s recommendation did not call for closing more than six centers.
Ken Levine, director of the Sunset Commission, said the Sunset staff’s analysis indicated that more than six closures would border on “almost forcing people into the community.”
“The number we chose was as high as I was willing to go,” he said.
Nelson said she agreed with Sunset staffers’ recommendations to close down the state-supported living center in Austin but added that she is “uncomfortable” with closing five other facilities.
“We wouldn’t be doing our job if we ignored the growing costs of maintaining these facilities,” Nelson said. “But I think it goes way beyond dollars and cents.”
Nelson ultimately appointed a workgroup to consider the closure recommendation and charged its members with presenting a modified proposal at the commission’s next hearing in August.
“We need a plan that recognizes the value of our state-supported living center and respects individual choice and addresses the real issues we face with quality of care, aging infrastructure and growing costs,” Nelson said.
This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.