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Institutions for Disabled Unlikely to See Major Cuts

Advocates for shuttering Texas’ institutions for the disabled thought they had the numbers on their side: a budget crisis so severe that lawmakers would have to close some state-supported living centers. With less than a month left in the session, their hopes are largely dashed.

Austin State-Supported Living Center employee Tamika Mays is shown with resident Rebecca Hadnot in 2011.

Advocates for shuttering Texas’ 13 institutions for the disabled thought they had the numbers on their side: a budget crisis so severe that lawmakers would have no choice but to close some state-supported living centers. 

But with less than a month left in the legislative session, their hopes of closing more than one facility and establishing a moratorium on new admissions are largely dashed. Even with a $15 billion to $25 billion budget shortfall and a series of blunt recommendations from the Legislative Budget Board, lawmakers say there isn't the political capital to move the ball far.

“The politics sometimes trumps the policy,” said Rep. Charles Schwertner, R-Georgetown, whose House Bill 2536 — which would halt new admissions until the facilities drop to 3,000 total residents, and establish a commission to make recommendations on closure or consolidation — has not moved out of committee. 

“There was a point at the beginning of the session where we thought there wasn’t sufficient enrollment, and it would be a budget decision,” said Sen. Jane Nelson, R-Flower Mound, the chairwoman of the Senate Health and Human Services Committee. “That hasn’t been the case.”

Opponents of institutionalized care for the disabled have pushed unsuccessfully for years to close Texas' state-supported living centers, which have come under intense scrutiny by the U.S. Department of Justice because of reports of abusive conditions. Families of residents at the facilities have fought back hard — defending the care their loved ones receive, and saying conditions are no better, or maybe even worse, in group homes in the community. 

Facing a massive budget hole, the Legislative Budget Board released a report in January recommending the closure of at least one facility by 2013, and the establishment of a commission to consider future closures. The report raised a series of concerns about the cost efficiency of the facilities, which serve 15 percent fewer residents than they did in 2000, but have seen their appropriations grow by 93 percent in the same time period. Despite an influx of funding, the Legislative Budget Board found, confirmed allegations of abuse, neglect and exploitation at the facilities have risen 65 percent since 2006. “Additional funding is unlikely to resolve many of the operational challenges confronting” state-supported living centers in the near future, the report states.  

In the 2012-13 budget approved by the House, lawmakers have taken one of these recommendations — closing a single state-supported living center, to be selected before the budget is sent to the governor. The Senate draft talks less specifically about managing the census of the state-supported living centers. But what advocates want even more — a commission to take a longer-term approach to determining the facilities' future — has gotten no traction, despite bills filed by Schwertner and Sen. José Rodríguez, D-El Paso, to establish one.

Republican Rep. Drew Darby, who has one of the facilities in his San Angelo district, said that's because the state-supported living centers serve a “vitally important function” for the roughly 4,000 people who live there and for their families. “We recognize the budget situation, which is why we authorized the closure of one” in the House budget, he said. “I would [resist] any attempt to arbitrarily, capriciously decide to eliminate any more state-supported living centers.”

Nancy Ward, with the Parent Association for the Retarded of Texas, said she hopes lawmakers are still listening to the families of people living in the state-supported living centers, who strenuously oppose consolidation or closure of even one facility, and argue the long-term savings simply aren’t there. “I believe we need community care too,” Ward said, “but not at the expense of closing state schools.”

But Amy Mizcles, director of governmental affairs for the The Arc of Texas, which opposes institutional care, said lawmakers continue to talk about belt-tightening and eliminating nonessential services — yet won’t acknowledge how inefficient the state-supported living centers are. While Texas’ institutions face budget cuts below 16 percent, in-home and community-based care programs — which she said are far less costly than institutional care — are poised to take a 30 percent to 70 percent hit. “With the budget reality, and the hard look legislators are giving every line item, it just is frustrating that we continue to protect these institutions,” she said. “I don’t know what else the Legislature needs.”

Families of those living in these centers contest the Legislative Budget Board’s recommendations as well as the analyses showing institutional care is less cost-effective than community care. (They’ve run their own numbers, they say, and found the costs are more or less the same.) They say the state-supported living centers provide all-inclusive care, from room and board to medical treatment, and are responsible for residents with the most profound and life-threatening disabilities. “What’s sad," Ward said, "is that we have to keep defending them."

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Health care Charles Schwertner Department of State Health Services Drew Darby Jane Nelson