Care for disabled is Virginia's shame

In March 1972, a 12-year-old girl was admitted to a state institution in Lynchburg for the intellectually and developmentally disabled. When federal investigators visited in August, she was still there, though her family and doctors agreed five years ago that she was ready to be discharged to a community-based home.

Status reports from 2008 and 2009 contain the same forlorn explanation: "Nothing is available at this time."

Now middle-aged, she is one of 1,100 Virginians living in five training centers across the state. For many, years of confinement have diminished family ties and social skills. They are told what to eat and when, what to watch on TV and what decorations they can put in their rooms. They have lost their autonomy, their privacy and their dignity.

While some require 24-hour medical care, others are capable of greater independence. But they're not allowed to live, work, worship and volunteer in their communities because "nothing is available at this time."

It's an excuse Virginia has used for six decades as study after study concluded that the state should replace its outdated institutions with community-based services.

It's an excuse that won't work any longer.

Last week, the U.S. Department of Justice notified Gov. Bob McDonnell that the state is in violation of the Americans with Disabilities Act because of "needless and prolonged institutionalization" of disabled people. Justice Department investigators also criticized the state for failing to respond to the needs of 6,400 families on waiting lists for services. Half of those are "urgent" cases in which disabled people risk being institutionalized because they are cared for by aging parents or because they are in danger of being abused.

Virginia is one of 10 states that have failed to close any of their large facilities for the intellectually disabled. A dozen states have eliminated all their institutions.

In Virginia, those facilities retain a strong base of support. Each employs hundreds of people represented by legislators who don't want to lose a large employer. Even families of residents often oppose closure because institutions are the only part of the system that receives a dependable stream of state aid.

Errors made during a first attempt to shutter an institution set the cause back for years.

Former Gov. Tim Kaine gave just six months notice of his intent to close the Southeastern Virginia Training Center in Chesapeake in 2009. There were few residential alternatives available, and terrified families rushed to Richmond to condemn the plan. The legislature responded by approving a new $24 million facility, while investing just $8.4 million in community alternatives.

Although the closure had been discussed for years, Kaine's haste was motivated by the need to cut billions of dollars from the state budget. The behavioral system has always been shaped more by short-term budget fluctuations than long-term planning.

The pattern continues. McDonnell proposed spending $30 million for behavioral health needs, including 275 new "waivers" that pay for services to families that choose not to put their children in an institution. But the governor also recommended cutting respite support for caregivers and reducing reimbursements to medical providers, which makes it difficult to create and staff new community programs.

Those budget games must end now, or Virginia will face a lawsuit by the federal government. McDonnell and legislators must fund between 400 and 1,000 new waivers annually for several years to eliminate the waiting list of desperate families. They must create new crisis care, group homes, and respite, vocational and nursing services in order to transfer most, if not all, training center residents back into their communities. They must reassign staff to group homes and other residential settings. And they must hire more inspectors to ensure the quality and safety of an expanded array of private providers.

It will take four or five years to manage the transition properly, but the state can provide more humane care to thousands of Virginians while saving taxpayers money. DOJ estimates that it costs the state $194,000 a year to house one person in an institution, but an average of just $76,400 to provide services in the community.

McDonnell has shown a desire to be that leader, but he must take much bolder action than his original budget plan reflected. Virginia should never again lock away its most vulnerable sons and daughters with the shameful words, "Nothing else is available at this time."