Virginia will close four of its five homes for the developmentally and intellectually disabled and instead provide services in local communities under a 10-year, $2 billion settlement Thursday with the U.S. Department of Justice.
The deal follows a three-year investigation that found Virginia violated federal law by needlessly warehousing disabled individuals in institutions instead of providing adequate community-based services. The settlement was filed with the U.S. District Court in Richmond after nearly a year of negotiations with the Justice Department.
The agreement is meant to provide better, more localized care for 5,000 Virginians with intellectual and development disabilities, including more than 1,000 who currently reside in five large facilities scattered across the state. It calls for Virginia to provide nearly 4,200 waivers to pay for localized care, enhanced crisis management services, housing assistance and greater employment opportunities for those receiving treatment.
Of the $2 billion it will take to implement the settlement agreement, $935 million would come from the federal government. Officials estimate the money saved by closing the facilities will bring the state's total cost down to about $340 million over the 10 years.
Virginia agreed to close the four institutions by 2020, leaving open 75 beds at Southeastern Virginia Training Center in Chesapeake.
“What we're trying to do is to give people the opportunity to get into the most integrated setting possible and have some safety net there for those very few who, for whatever reason, would be unable to make that transition,” State Health and Human Resources Secretary Bill Hazel told The Associated Press.
Virginia is among only five states that operate multiple state-run institutions for the intellectually and developmentally disabled, as most states began transitioning those services to the community decades ago. The settlement echoes those DOJ has reached in recent years with Delaware and Georgia.
“We can and indeed must do better as a nation, and this agreement will serve as a national model for our agreements moving forward,” Assistant Attorney General for the Civil Rights Division Thomas Perez told reporters.
In its far-reaching probe, the Justice Department found that most of those in state facilities were locked away with little or no interaction with those who are not disabled, denied freedoms like choosing what to eat or watch on television and often physically restrained. The report said the state rarely discharged residents, and when it did, the process was “slow and muddled.” It also determined that the lack of community-based treatment options put others at risk of being institutionalized.
About 6,000 people are on waiting lists for community-based treatment. The agreement calls for the state to add 4,170 waivers over 10 years to provide treatment in the community. Legislators could add more waivers, but are obligated to provide at least that many.
Hazel said the settlement is “just the beginning,” and that now the state must develop the systems to care for those leaving facilities. In addition to providing more services, the state will beef up its licensing system and management to track those who are leaving facilities and heading back into the community.
“That is a big job ahead of us,” he said.
Hazel said the department would work with the more than 3,000 employees at the four closing centers who are likely to lose their jobs. Many could go to work in the private sector, which is expected to expand to provide the required community services, Hazel said.
Negotiators tried to balance the wishes of families with loved ones in the facilities, many of which were opposed to their closure, and advocates who want them shut down more quickly and even more money put into localized services.
“People with disabilities in Virginia have long been denied the services they deserve,” said Colleen Miller, executive director of the Virginia Office for Protection and Advocacy. “This settlement agreement, while not perfect, goes a long way to correcting that historic wrong.”
Officials touted the cost savings involved with closing the bulky institutions, built decades ago to hold 6,000 residents. Enrollment is down to 1,018 residents, and is expected to dip below 600 by 2015. It costs $216,000 per person each year for those housed in training centers, compared to about $75,000 for treatment in the community.
Meanwhile, the state provides some community-based services, although the Justice Department found those lacking.
“We just simply cannot afford to run two systems simultaneously,” Hazel said. “We have to choose. We are choosing the one we believe individuals want.”
But state officials pushed during the negotiations for the changes to be spread out over 10 years to give them enough time to build up the community system of care and case management to make sure residents were protected, he said.
The first center to close will be Southside Virginia Training Center in Petersburg, which will shut down by June 30, 2014. It will be followed by Northern Virginia Training Center in Fairfax by June 30, 2015, Southwestern Virginia Training Center in Hillsville by June 30, 2018 and Central Virginia Training Center in Lynchburg -- the biggest with nearly 400 residents -- to close by June 30, 2020.
Southeastern Virginia Training Center in Chesapeake was chosen to remain open because it already was undergoing a renovation to convert its 150 beds into a campus of 15 homes that each house five people. Those renovations are expected to be finished by the spring.
It will be up to future lawmakers to approve the payouts. An independent reviewer will be appointed to oversee the agreement. If that person determines the state is not meeting its obligations, the Department of Justice can ask the courts to intervene.
By taking the settlement, the state avoided a costly and prolonged legal battle with the Justice Department that would have ended with the courts deciding what changes, if any, needed to be made and how quickly. As a technicality, the Justice Department had to file a complaint in federal court, followed by the settlement agreement.
Hazel said the settlement should bring Virginia in line with other states when it comes to taking care of people with intellectual and developmental disabilities.
“We've got some catching up to do,” he said. “But I would think that at 10 years we would be probably in the mainstream in terms of very good integrated care in the community, and I would hope that we would be very proud of what we've accomplished.”