Back to Petitioning the
General Assembly
Can
cities make a dent in long waiting list for those seeking human services?
By
Rita Frankenberry
The
Beacon
February
19, 2006
When the Southeastern VA Training Center was
built in Chesapeake 30 years ago, it illustrated out-of-the-box thinking for
housing mentally disabled patients.
The regional facility at 2100 Steppingstone
in Chesapeake, incorporated a cluster of brick and wood residential cottages in
its design rather than the simple large building typically found at other
facilities such as Southeastern.
“That’s just the way institutions were
built back then,” said Sherwin Davis, who has served as the center’s
residential director since Southeastern opened in 1975. “Southeastern’s design
was a good step beyond that.”
Although the facility represented
forward-thinking back then, by creating a more homelike, less institutional
feel for its patients, it’s considered cramped and outdated for meeting the
needs of today’s residents. Davis and Executive Director Robert Shrewsberry
look forward to a rebuilt Indian River center if the state legislature approves
a $458 million proposal by from Gov. Mark Warner to improve state mental health
facilities and services.
“The next step is to maintain the homelike
cottage setting with modern technology, to meet the needs of individuals in the
next 20 years,” Davis said.
As a part of Warner’s mental health
initiative, he proposed the replacement of four state facilities, Western State
Hospital, Eastern State Hospital, VA Training Center, and Southeastern in
Chesapeake, at a combined total of $290 million. To raze and rebuild
Southeastern, as Warner proposed would cost $55 million.
There’s a catch though.
If the Chesapeake facility is rebuilt, the
new building would have 100 beds, half as many as it has now. It would send
many residents back into their community service boards, the agencies in each
city responsible for serving residents with mental illness, mental disabilities
or substance abuses. Warner proposed adding about $200 million so the local
boards can deal with the centers’ downsizing.
That piece of the puzzle, Shrewsberry said,
is integral to making the mental health initiative work.
“The $200 million is to increase the
Medicaid waiver slots and the amount a provider gets paid,” Shrewsberry said.
“Those are the two things that make it go.”
Medicaid waivers are used to help
community services boards place patients in privately run programs because
cities can’t provide enough services on their own. It’s a way of channeling
federal Medicaid money to local nonprofit and for-profit companies that offer
residential, vocational and treatment programs to the mentally disabled.
Community services boards provide oversight so the money and services are
matched with patients who have the greatest needs.
The local boards maintain lists of clients
who often wait up to several years for services to become available due to a
lack of funding.
Shrewsberry estimates 50 percent of the
Southeastern Virginia Training Center’s residents don’t need to be there. If the
proper community service programs were available, he said, many of them could
live within the community.
“There isn’t anybody here who needs to be
here if the supports in the community were there,” Shrewsberry said. “There
isn’t anything magic about the supports we provide other than money and the
political will to do it that way.”
Initially after Southeastern opened, Davis
said, residents typically stayed a year before learning life and job skills at
the facility, then moved on. This changed shortly after Shrewsberry became
director at the facility.
“When I first came here in 1981, we
discharged 101 people and admitted 103,” Shrewsberry said. “Over the course
from 1981 to 1985, we saw a fairly steep, but regular decline in the number of
discharges because perhaps the community infrastructure wasn’t growing as
rapidly as it did early on. They didn’t have the money to grow it, and they
were full. To complicate it, we began to get the more severely involved
individuals.
“The vast majority of the residents that
were admitted were ambulatory, relatively high-functioning, had few medical
issues, and over the course from ’81 to ’85, the community services people
began to be able to handle those people nicely in their programs, leaving the
more disabled, more involved individual, more difficult to serve individual,
for us to care for. So our population got much more medically involved, much
more behaviorally involved.”
Now, many of Southeastern’s patients
suffer from cerebral palsy and other physical disabilities that confine them to
wheelchairs and require around-the-clock care.
To handle this population, Shrewsberry
said, the center needs to be rebuilt. Hallways and doorways need to be widened
to allow for wheelchairs, rooms need to be enlarged, hydraulic lift tubs need
to be added and support equipment needs to be updated.
“If we rebuilt the facility, for the
people who would come to us, it would make their lives better because we would
be able to serve them in a more appropriate environment,” he said.
Community services directors agree the
facility needs to be rebuilt, but they are concerned that rebuilding the
centers to serve fewer people will overburden their existing resources.
“The number of people we already have on
waiting lists will not be significantly assisted by this proposal,” said Terry
Jenkins, director of human services for Virginia Beach. “There are thousands on
waiting lists already. Of the thousands on waiting lists, the budget indicates
only 149 will be served next year.
“So what the budget does is say for those
coming out of Southeastern, there will be services waiting for you. For those
already waiting, there’s very little in the budget for them, and that’s the
problem.”
This year the Norfolk Community Services
Board has 37 residents on its “urgent waiting list.” And there are no openings,
said George Pratt, executive director of the Norfolk board.
“Last year, we only had two openings, and
that’s because of death,” Pratt said. Funding, and how far the proposed amount
will go toward increasing community services, is the real concern, he added.
“Is there going to be anything left over
to meet the needs of those currently in the community and those who will be
coming along?” he asked. “We just don’t know that yet.”
Jenkins and Pratt said they would like to
see more funding for people already on waiting lists and more services.
“Those willing to take on the responsibility
and take care of these people in the community,” Pratt said, “are saving the
state millions of dollars because they’re not forcing the state to put them in
an institution.”
Exactly how much of the $200 million will
be allocated to community service boards to bulk up programs is undetermined.
“I can assure you,” Pratt said, “it won’t
get us anywhere close to covering those already on the urgent list.”
Every community, Jenkins said, already has
waiting lists for people who need services.
Virginia Beach has 70 on its urgent list
for mental retardation waiver services, and Chesapeake has 25 waiting.
“That means they need the service in the
next 30 days,” said Chesapeake Community Services Board Director Candace Waller.
Waller said another 35 residents are on
the “nonurgent” list (for people in need of a slot but not within the next 30
days) and 65 on the “planning” waiting list (those who know they will need the
service in the future). Waller said 1,467 people are on urgent lists statewide,
awaiting waiver slot openings.
“So if you add all that together, you’re
talking about a pretty significant number of folks,” Waller said. “The numbers
change month to month.
“Other states have downsized facilities, but
they have zero waiting lists for waiver slots,” Waller added. “You’ve got to
have enough slots. My big concern is for the people in the community now, who
can’t get services they need.”
John Sulfaro, a Chesapeake resident whose
34-year-old daughter is mentally disabled, shares that concern. The Chesapeake
Community Services Board helped his daughter find placement in a work program.
“It’s a start,” said Sulfaro, who is
trying to start an advocacy group for the parents of mentally disabled children.
“I’m truthfully initially concerned with
what Chesapeake is going to do for citizens with mental retardation,” he added.
“Just looking from the outside in, how are they going to take care of the
people displaced?, what will be the level of support for them? and what’s going
to happen to the people already on the waiting list?”
Lee Price, director of the Virginia
Department of Mental Health, Mental Retardation and Substance Abuse Services,
said increasing waiver slots for community services is central to the success
of the governor’s proposal.
“In order to make any significant changes,
we need to concentrate on the community infrastructure,” said Price, who also served
on the task force that made recommendations to Warner regarding the proposed
initiative. “That is fundamental to any kind of systems changing.
“We looked at the entire system,” he
added, “and the entire system – the facilities, the community systems – was
underfunded, particularly the community system.”
Building up community programs,
Shrewsberry agreed, is critical.
“There are literally thousands of people
in the community system who are in need of services. We know that,” he said. “I
believe given no development of community programs as they exist today – if the
community infrastructure isn’t worked on and if that $200 million doesn’t go to
the community – you could put 50 more beds out here and tell the community
services board we have 50 more beds, and they would be filled up before a
weekend.”
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