MILLEDGEVILLE — A landmark October 2010 settlement between the State of Georgia and the U.S. Department of Justice addressed perceived failures of state hospitals to adequately serve individuals with developmental disabilities and mental illness in the most integrated setting appropriate to those needs.
Along with a national push, Georgia is currently in the middle of the switch from institutionalized to home- or community-based care. Central State Hospital, once the largest mental facility nationwide, has taken a gigantic hit with closures.
The James B. Craig Nursing Center is next up for the state's battering ram. The skilled nursing center will close by Dec. 31, 2013.
CSH Regional Hospital Administrator Dan Howell said in Wednesday's hospital development authority meeting the state Department of Behavioral Health and Developmental Disabilities (DBHDD) made the call backed by the industry and the DOJ approach that no one should live in an institutionalized setting.
“Two weeks after I came, it was announced the State of Georgia would be getting out of the nursing home business. The DBHDD made the decision, which would in essence close the Craig Nursing Home,” Howell said.
In addition to a job loss for more than 300 employees, a current list of 123 severely disabled consumers must move outside the only walls many have ever known.
“There is technology and opportunities available for everybody to live in a smaller environment,” Howell said. “The population at Craig is no different than the population we supported in other states.”
Many former employees, advocates, families and local residents are not convinced the Craig Center closure is the best move.
While some individuals may flourish when moved to a community care home or back with families, more often than not the story isn't as bright. Those with profound intellectual and developmental disabilities cared for at Craig need to stay there, according to two families.
Ann Cox said her daughter Elizabeth, who suffered a brain injury at 2 years old from encephalitis, moved to the Craig Center at age 4. Even as a registered nurse, Cox could not deliver the adequate 24-hour-care Elizabeth demands.
Cox praised the excellent care her daughter has received over the last 24 years.
“Elizabeth can't walk, talk or recognize me. All she knows is if she's well taken care of. Here (Craig Center) they have checks and balances. If you don't do one little thing, somebody is going to catch it. She has never had a bed sore, which is phenomenal for a bed-ridden patient like my daughter,” Cox said recently.
Residential care concerns the skilled nursing patient's mother, who believes the ordered transition attacks society's most fragile, vulnerable people.
“This is her family. This is her home, and they are ripping it out from underneath them. She won't last two weeks,” Cox said.
Bill Jenkins and wife Faye's 47-year-old son was injured at 25 by brain aneurysm at another facility.
“I would say he has the mind of a 10- to 12-year-old child,” Jenkins said. “If you put him out on the street, he will just keep going unless somebody is around to say 'hey turn around and come back.'”
The couple tried caring for their son themselves, but he would act out uncontrollably, setting fire to the family home three times, they said.
Faye Jenkins said group homes are not for her child. Jenkins is understandably frustrated with the idea, mentioning that having a severally disabled child is foreign to most people.
“Doctors write unable to function in open society repeatedly. Must be institutionalized. Now they tell us 'ohh he can function good out there',” Jenkins said. “Once they leave this facility and it doesn't work, you don't have any back up. You are left on a limb to fight the battle yourself.”
Central State Hospital Local Redevelopment Authority Executive Director Mike Couch acknowledged the family concern around the impending Craig closure Wednesday. Maybe a section of the population needs to be looked at differently, according to Couch.
CSH authority board member Dudley Rowe echoed the prevailing sentiment.
“I'd like to have some satisfaction that we've exhausted all the processes and this is the only solution open to us,” Rowe said.
Evaluation of action
Family stakeholders affected by the Craig Center action contend they have largely been in the dark, having no influence on the placement of their loved ones. A meeting held for families Monday did little in the way of providing reassurance, according to the Jenkinses or Coxes.
Director of Government Relations and Advocacy for VOR, a national organization that advocates for high quality care and human rights for people with intellectual and developmental disabilities, Tamie Hopp, said the group in question counts on their families who know them best to arrange adequate care.
“Parents weren't consulted during any part of the process. They were simply told after it was a done deal that their children's homes would close. It's remarkable how uninvolved the families have been,” Hopp said.
The move away from institutional treatment is lauded as cost saving, with some estimates claiming more than $100,000 average savings per patient.
An April 2003 article “Cost Comparisons of Community and Institutional Residential Settings: Historical Review of Selected Research” findings do not support the position that community settings are less expensive than institutions and suggests staffing issues play a major role in any cost differences.
With the state seemingly resolute facilities like Craig aren't the best option, former teacher at the CSH center, Baldwin County Commissioner Faye Smith, questions whether there are enough places to provide good care to these individuals.
Smith taught at the Craig Center from 2006 until June of this year. She remembers parents and employees voicing fears during the transition.
Community-based homes, frequently money-driven, often fall woefully short of the specialized care Craig provides, according to Smith.
“The word institutionalized gives the folks the idea these people have been mistreated over the years. When I was there, I don't know of any time that I didn't see a client well taken care of,” Smith said. “Those folks were as much a part of (the consumers’) families as their own. The care is what they are there to do, and they do it.”
Hopp referenced countless tragedies inside small service settings.
Though people mean well, few are trained to handle the intense care regiments consumers require.
“What we see when somebody is moved from that intensive care setting into something far less structured, and they are being cared for by well-meaning people who do not have the experience to deal with fragile care needs, it's a recipe for disaster,” Hopp said.
Second Year Review
Independent reviewer Elizabeth Jones published a Sept. 20, 2012 report evaluating Georgia's adherence to mandated community placement. A random sample of 48 developmentally disabled were evaluated.
The report applauds the DBHDD for exceeding numerical targets with home and community based waiver services though it cites recurring problems addressed in the previous year's report.
“The failures to provide meaningful and adequate day programming, to fully monitor health care and to obtain informed consent for psychotropic medications and behavioral support plans again were noted for some of the individuals placed from state hospitals,” the Jones report said.
Mentions of rights violations, unsanitary environments and inadequate staffing aren't lost on critics.
Concerning house support for consumers, the report commended Atlanta and Macon sites for appropriate case management and Assertive Community Treatment.
This backs Howell's claim that the transition plan at Craig can continue to work given the proper supports. Georgia still needs more capacity to handle these special needs.
“We are working as hard as we can to build capacity,” Howell said. “The current capacity may not exist for the people at Craig, but we have 13 months to figure that out.”
The answer to describe this capacity creation scared Cox. She said an official likened the process to building an airplane in mid-flight.
“My daughter is not going to be on an airplane like that,” Cox said.
Hopp and others opposed warn that when something like the Craig closure is quota- and data-driven it won't end well.
With the shuttering of the Craig Center on track for next year, interested parties have little hope to save the place. Jenkins said he thinks the decision-makers should spend a day with people like his son for some perspective.
“The people making the decisions need to come down and see or at least have a sympathetic ear to our cause,” Jenkins said. “It's tragic the state of Georgia is doing this to it's tax payers. It's unforgivable what they are doing to these people.”
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