Bills aim to keep training centers open

More supporters of the Virginia training centers have stepped up efforts to convince the General Assembly to protect the facilities for the intellectually and developmentally disabled from closing.
Gov. Bob McDonnell proposed closing four of the state-run facilities, including the Southwestern Virginia Training Center in Carroll County, and reducing the fifth to 75 beds as part of an idea to shift more residents to community care situations.
He announced this plan after the state arrived at a settlement agreement with the federal Department of Justice in an investigation based on the Virginia training center system’s compliance with the American’s with Disabilities Act.
Supporters of the training centers — parents like Wanda Robinson of Carroll County, who has a daughter living in the local facility — stress that the governor still needs the General Assembly’s support to carry out this plan. The parent groups continue to drive their message home with state senators and delegates, and several of the state representatives have signed on with the cause, based on their legislation.
A bill introduced by Del. Anne B. Crockett-Stark (R-Wytheville) and cosponsored by delegates Israel O’Quinn (R-Abingdon) and Nick Rush (R-Christiansburg) applies to the Southwestern Virginia Training Center specifically.
“That, notwithstanding any plan for the closure of training centers developed by the Department of Behavioral Health and Developmental Services currently in place, the Southwestern Virginia Training Center shall not be subject to closure and shall remain open and continue to accept new admissions of individuals with intellectual disability for whom treatment in a training center is appropriate,” says House Bill 1669.
Peter Kinzler — a Northern Virginia Training Center parent, attorney and legislative liaison for parent groups — shared other General Assembly actions being introduced to protect these facilities and their residents.
He reports that Sen. Barbara Favola (D-Arlington), with co-patron Republican Sen. Dick Black, will propose a budget amendment that would require an independent survey of authorized representatives of training center residents to learn whether they want their loved ones to remain in their current training center.
“If more than 50 at any training center wish to remain, then [the Department of Behavioral Health and Developmental Services] could not close the training center,” Kinzler said. “If fewer than 50, then the DBHDS could close the training center, but not until all the residents were either moved to another training center or placed in community facilities with equal or better services and treatment.”
Del. David Bulova plans to introduce a similar budget amendment in the House of Delegates, Kinzler added.
Black has also written his own bill, calling for a moratorium on DBHDS changes until the legislators carry out their role of consulting on the development of a plan.
Kinzler, along with other training center supporters, have compiled reports on key issues like the cost of implementing the governor’s plan, the role the General Assembly plays in that plan and problems than an appointed independent reviewer found with community-based services.

Study reveals problems with transition
The independent reviewer, Donald Fletcher, was appointed to monitor the process of transitioning training center residents to community-based care under the settlement agreement.
Thus far, he has found that no training center residents with complex medical needs have yet been discharged from state facilities, according to the parent group’s summary. “Even community providers actively seeking referrals rejected them. Their staffing needs and maintenance are too expensive for current waiver rates.”
For those who have been moved out of training centers into community care in Virginia, Fletcher reported on a number of problematic transitions.
“Of the 59 training center residents [statewide] discharged under the settlement agreement, four have sustained serious injuries requiring ongoing medical attention,” states the parent group’s summary. “Since the submission of Fletcher’s report, he has confirmed one death due to the negligence of the deceased’s caregivers, occurring within months of discharge after decades of safe care at a training center.”
Surveys involving 32 of the individuals removed from the training centers discovered “significant deficits” in their case management and oversight, as well as upkeep of their medical and dental care.
Roughly a third of those individuals had not received any dental care arrangements, according to the summary.
A third of individuals had not received all items called for in their service plan.
More than half, 53 percent, did not receive their monthly meetings with case managers as promised by DBHDS, the summary said.
Parent groups also released a study by Dr. Robert Anthony, a Ph.D, titled “Preliminary analysis of the health and human resources budget for the settlement agreement.”
Anthony based his analysis on information from a Health and Human Resources brief to the Senate Finance Committee and the Department of Behavioral Health and Developmental Services. His analysis also gets into Medicare waivers meant to fund community based services.
“Leaving all five of Virginia’s training centers open would likely have a neutral effect or save Virginia’s General Fund more money than would closing four of them, as planned,” Anthony wrote. “The HHR budget assumes [intellectual disability] waiver rates that were recognized by all parties not to be adequate to support most current training center residents, many of whom came there after failing to find adequate placements in the community.”
The Health and Human Resources report leads Anthony to believe that growing waiver costs would add $1.9 billion to state budget requirements over a 10-year period.
This is on top of a baseline of $4.5 billion for those already receiving support for the intellectually and developmentally disabled, he wrote.
“Organizational integration and economies of scale at training centers offer options to contain costs for those few with the most intense professional services and behavioral management needs,” Anthony explained.
The report also states that moving residents from training centers to community care increases morality risks, due to staffing, he wrote.  
“Most community placements are too small to justify the cost of two staff on the overnight shift that provides emergency backup and inhibits abuses and neglect,” he said. “Access to nursing and professional services is either delayed or very expensive if on site. Characteristics such as these can cause an estimated 72 percent higher mortality for those transitioned to the community.”
Anthony also points out that more than 97 percent of residents’ authorized representatives want their people to remain in their training center.
Due to the fact that Health and Human Resources mentions lower per-person costs at intermediate care facilities in communities, this may point to the possibility of having smaller regional training centers.
If this year’s training center battle isn’t successful, those trying to keep the facilities open have promised to fight on. Crockett-Stark told The Gazette she would continue to introduce her legislation multiple times, if necessary, in the years before the 2018 closing date set for the Southwestern Virginia Training Center.