Time to close state residential habilitation centers
As a single mother of two teenage daughters, both with disabilities, and someone who has worked in the disability rights field for 10 years, I have for too long watched the struggle over what to do with Residential Habilitation Centers (RHCs).
Washington is far behind the national curve of deinstitutionalization. Providing services in large institutional facilities, with high overhead costs and less tailored services is an outmoded service delivery model. People with very complex medical needs and significantly-involved disabilities can be, and are, served in the community, and studies show these community-served individuals have a greater likelihood of adaptive behavior skills[i] and greater freedom and autonomy.[ii]
The RHC downsize opposition swell is generated by guardians or family members of those who are institutionalized, and from unions and employees who are holding on to jobs. They have fought vehemently, saturated the media; but they do not see another way. Studies that claim increased mortality rates upon transfer from RHCs are unsubstantiated.[iv] Additionally, research shows that parents who were often as a group initially opposed to deinstitutionalization were almost always satisfied with the results of the move to the community after it occurred.[iii] I have yet to meet a parent who wanted to place a child in an institution. This decision comes when one is at the end of his/her proverbial rope, when no known alternatives exist. The myth that complex disability needs cannot be met in the community is perpetuated; but each time I have visited residential habilitation centers across the State, I’ve run into institutionalized individuals with disabilities less significant than those of my daughter, with a purported IQ of 23, who receives all of her services in the community.
Our state has not yet discerned that it is a discriminatory business practice to balance economic policy on the backs of individuals with disabilities. Regardless, state-operated living alternative facilities (SOLAs) and other skilled and highly-varied job opportunities will foster a community with appropriate, flexible, community-based supports for those who move from institutional settings. These jobs can and MUST be moved into the community.
It is true that there are initial costs associated with downsizing; but study after study shows that in the long run, savings are generated. The Feasibility Study for the Closure of State Institutional Facilities cites a savings of 47 million per state fiscal year after 2018 with responsible downsizing and consolidation of our residential habilitation centers.
These facilities will be closed eventually. It is inevitable. Continued fear-based policy decisions, and posturing community services against institutional services serves no one in the end. Instead, we could all work together to realize a robust community service system that meets the very diverse needs of persons with complex disabilities via a highly skilled and engaged work force. This would, for many individuals and their families, create an opportunity of autonomy and independent living previously unthought of.
[i] Kim, S., Larson, S.A., and Larkin, K.C. (1999). Behavioral outcomes of deinstitutionalization for people with intellectual disabilities: A review of studies conducted between 1980 and 1999. Policy Research Brief (University of Minnesota, Institute on Community Integration), 10(1).
[ii] Heller, T., Miller, A., Factor, A. (1999). Autonomy in residential facilities and community functioning of adults with mental retardation. Mental Retardation 37, 449-457
[iii]Kim, S., Larson, S.A., and Larkin, K.C. (1999). Behavioral outcomes of deinstitutionalization for people with intellectual disabilities: A review of studies conducted between 1980 and 1999. Policy Research Brief (University of Minnesota, Institute on Community Integration), 10(1).
[iv] Lerman, P., Hall Apgar, D., and Jordan, T. (2003). Deinstitutionalization and mortality: Findings of a controlled research design in New Jersey. Mental Retardation 41, 225-236.