Fw: PFA Speaks: Push For Access Monthly Newsletter for November 2011

[Guest guest]

PFA Speaks: Push For Access Monthly Newsletter for November 2011I think this

helps to provide a frame of reference and perspective on the subject of state

facility closures.

Ellen

Ellen Garber Bronfeld

egskb@...

PFA Speaks: Push For Access Monthly Newsletter for November 2011

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PFA Speaks

The Push For Access Monthly Newsletter

May 2011

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Do We Have a Plan?

Illinois’ system of care for individuals with disabilities is in

serious jeopardy. In response to what he has deemed an inadequate budget

Governor Pat Quinn initiated a series of budget management strategies, which

included a proposal to close seven state-operated facilities – including two

correctional facilities, three mental health hospitals and two developmental

centers. Quinn’s proposal was met with strong opposition from community

activists over ill-conceived time lines and poor resource allocations. This

opposition should come as no surprise to the Governor, as his actions were quite

different than his self-proclaimed intentions. Speaking of community care and

de-institutionalization Quinn stated, “… that (transition to community care,

or de-institutionalization) doesn’t happen overnight, and we don’t do this

where we just push vulnerable human beings out on to the street without proper

planning and coordination, it may take more than one fiscal year, uh, but

we’re going to do this in Illinois and I look forward to doing it.†Perhaps

the Governor has come to realize his proposal will not lead to individuals with

disabilities living a “fulfilled life to the best of their abilities…â€

Yesterday, Quinn’s office released a long-term rebalancing initiative which

seems more focused on the long-term aspect of successful

de-institutionalization.

The release of the long-term re-balancing initiative came just

before the Commission on Government Forecasting and Accountability (COGFA) will

cast its final votes for the last three remaining facilities slated for closure.

The Commission has already voted to reject closing four of the state-operated

facilities – Chester and Singer Mental Health Centers, Jack Mabley

Developmental Center and Illinois Youth Center at sboro. Earlier this

week formal recommendations were filed by the Commission which provided

reasoning behind its decisions to reject the closures. In their explanation

COGFA members noted concern with the lack of safety in the transition plans.

Those concerns were centered around funding and its affect on the community’s

capacity to provide the necessary supports, the main point raised by many

community activists.

The re-balancing initiative does vary considerably from the

Governor’s original proposal. For starters, it will look to close four

developmental centers, as opposed to two. The selection of those two additional

facilities will be determined during the General Assembly’s next Spring

session. Tinley Park and only one other mental health facility to be determined

are planned to close throughout fiscal years 2013 and 2014. According to the

initiative, the Governor’s office looks to capitalize on the Affordable Care

Act reducing the need for state psychiatric beds as more and more individuals

who currently seek care from state hospitals will be covered under private

insurance and Medicaid, which will make them more appealing to a private

hospital. Also, the two correctional facilities have been taken off the books.

The time lines for the closures have been extended, which will give lawmakers an

ample amount of time to allocate necessary funding.

The main problem with the Governor’s original proposal was a

fundamental one in that a major policy decision such as the closure of

state-operated facilities for individuals with severe disabilities should not be

strictly budget driven. It is a process that requires strategic planning,

appropriate community investment, adequate rate adjustments, and a high level of

public involvement to ensure a strong network of community support is available.

A host of community providers are capable and willing to serve those

transitioning individuals, but they need the state to commit to properly fund

the needs of those making the transition, whether that is specialized medical or

behavioral supports or living arrangements.

The Department of Human Services’ Division of Mental Health

proposed restructuring its system of care as a long-term policy goal, as opposed

to the closure of three state-operated mental health facilities, which is purely

budget driven. The state is statutorily mandated to provide forensic mental

health care – care for the criminal mentally ill – so that is where its

focus will remain, while much of the acute and long-term care services will be

transitioned to community providers. However, the time frame initially proposed

to drive this process would result in a dramatic loss of psychiatric beds

available to the 18% of Illinoisans that suffer from mental illness, as there

currently is no plan in place to address this particular issue. Three less

state-operated mental health facilities will mean that many fewer beds are

available to assist individuals with serious mental illness if/when they have a

crisis, which is a detrimental effect on their ability to receive care for an

acute episode. A more reasonable alternative would be to establish a long-term

strategic plan to safely transition those individuals by utilizing governmental

cooperation and facilitating community involvement. For example, recently

passed legislation requires the Division of Mental Health to create a Mental

Health Services Strategic Planning Task Force that is charged with creating a

comprehensive 5-year strategic plan for Illinois’ mental health system of care

by 2013. If its early discussions are focused on the role of state-operated

mental health facilities in the system of care, then recommendations can be

implemented to properly address necessary system restructuring, community

provider capacity, reimbursement rate adjustments, etc.

The Director of the Division of Developmental Disabilities admitted

his concern with the transition of individuals from state-operated developmental

centers to community-based providers is that the rate paid per individual at a

center for independent living is inadequate already, and nearly half of what was

paid in his previous home state of Pennsylvania. Combine that fact with the

influx of individuals transitioning from the State-Ops, and it is hard to

envision a safe and smooth process. Community-based providers have no doubt in

their ability to care for those individuals given appropriate resources.Their

apprehension lies in the State’s ability to hold up its end of the bargain.

Historically, the state has been less than reliable when it comes to properly

allocating resources, let alone in a timely manner, which only compounds their

anxiety. The state must first assure funding for those providers will be

available, and that the closure time frames will be driven by the needs of the

individuals.

It is important to note that COGFA’s recommendations are not

binding. Spokespersons for the Governor have stated his recently released

long-term re-balancing initiative has been their preferred course of action from

the beginning. However, if budget re-allocations are not made to allow the

facilities to remain open for the rest of this fiscal year, then they say there

will be no choice but to go through with the original proposal. In the past,

COGFA recommendations have always been followed, so deviation from past practice

could prove detrimental to a Governor that relies on public support.

Community stakeholders must be vigilant in holding State government

accountable and to be sure any facility closure is done for the right reasons in

a reasonable timeframe. Only time will tell if our government leaders will

follow through with a strategic approach, or if we will have once again missed

out on an opportunity to make Illinois a leader in providing high quality

community supports and services to individuals with severe disabilities in the

most integrated and appropriate setting.

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