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Lubbock, Denton

facilities make the most progress toward meeting standards

http://www.dentonrc.com/incoming/20120804-state-living-centers-still-far-from-compliance.ece

By Peggy Heinkel-Wolfe

/ Staff Writer / Denton

Record Chronicle

As federal monitors begin the fifth and penultimate visit

to state-supported living centers, Texas

senators wrestled this past week with what has been reported

so far: None of the state’s 13 centers has achieved

substantial compliance with mandated standards of care.

Members of the Texas Senate’s Health and Human

Services Committee pressed representatives from the Departments of Aging and

Disability Services on the lack

of progress during a committee hearing last week in Austin that included

other public testimony. The committee is expected to prepare its own report on

the federal monitoring before the next legislative

session.

Health and Human Services Commissioner Traylor told

senators that, although he was not a commissioner at the time the settlement

agreement was negotiated

between state and federal officials, he believed that the

centers would have been — by now — further along in achieving

compliance.

In 2008, the U.S. Justice Department discovered abusive

conditions at Texas

state schools, as the centers were then called. After news reports of a

“fight

club” at the Corpus Christi State

School, with the problems

gaining widespread attention, the federal government sued the state under civil

rights statutes.

In a 2009 settlement agreement, Texas agreed to meet 171 standards of care

for nearly 4,000 people with disabilities living in 13 centers, including the

Denton State

Supported Living Center. Federal monitors have been

evaluating each center every six months since. After the sixth and final visit,

monitors

are expected to prepare their own final report for the

judge supervising the settlement.

Traylor told the state senators that he did not believe

federal monitors had anything in mind other than the quality of life for people

living in the centers.

However, coming into compliance with the new standards of

care was proving to be more difficult and complex than originally thought.

Other states have had such monitoring, but at only one or

two facilities. The number being monitored in Texas — 13 centers in all — was

unprecedented, Traylor

said.

Traylor told the senators that up until the settlement

agreement was drafted, the culture at the living centers had been one of

custodial care. The shift

needed in organizational culture at the centers — to

one that focuses on the residents’ quality of life — has been slow

in coming even though employee

turnover has been high.

More than 30 percent of both direct and clinical employees

leave each month, according to state records. While the Denton center has been able to recruit

and retain psychiatrists, and many of the centers have

been able to retain qualified primary care physicians, turnover and vacancies

in other clinical

care positions plague the system.

That is partly because even though they are highly skilled

and trained, they are unprepared to deal with the challenges presented by

people with disabilities,

according to , the outgoing assistant

commissioner who oversees the centers.

Sen. , D-El Paso, questioned whether some of

the standards shouldn’t be weighted more than others. Specifically, he

urged the leadership to

do more to reduce abuse and neglect over other tasks, such

as meeting recordkeeping requirements.

Overall, confirmed reports of abuse and neglect have

dropped from May 2011 to May 2012, state records have shown, but problems are

still surfacing. Recent

allegations of abuse and neglect at the El Paso State

Supported Living

Center triggered the July

23 resignation of the center’s director.

State centers in Lubbock

and Denton appeared to be making the most

progress, with Lubbock

making progress toward compliance in 60 percent of the standards,

achieving compliance in 18 percent. The Denton center was making progress toward

compliance in 58 percent of the standards, achieving full compliance with

16 percent at its last review.

The settlement agreement provides for an extension of the

federal monitoring if any of the centers are not in full compliance for a full

year before the

end of the agreement in July 2014.

Senators focused questions on what it would take to

achieve the various standards, which touch not only on preventing abuse, but

also on nearly every area

of care, from medical and psychological services, to

programs that help residents build life skills — many with the ultimate

goal of returning to life

in the community.

Traylor and offered few suggestions.

Substantial public testimony offered many suggestions to

the senators. One person suggested more transparency when reports of abuse

surface, since family

members and guardians are not always notified when a

report of abuse or neglect first surfaces. One urged better pay and training

for direct care workers

in order to reduce turnover. Another person urged

officials to interview doctors, nurses and other clinicians who quit the

centers, suggesting that the

exit interviews may provide clues to the systemic

difficulties for practitioners, including the lack of electronic medical

records.

Many people came to support the continued funding of the

centers despite the problems, including family members of Denton center residents.

Representatives of Community Now!, a nonprofit

organization that advocates serving people with disabilities in the community,

asked the committee to de-politicize

the issue of closing the centers and reintroduce

legislation that funds other options for people with disabilities than living

in an institution.

PEGGY HEINKEL-WOLFE can be reached at .

Her e-mail address is

pheinkel-wolfe@....

Video of the Tuesday meeting is archived and can be

watched online at

www.senate.state.tx.us/avarchive/?yr=2012.

The portion of the meeting on state-supported living

centers begins at about 4 hours, 37 minutes.