SDC closure status raises more questions than answers
State Senator Mike McGuire asked state health administrators tough questions about the status of the ongoing plans to shutter the Sonoma Developmental Center (SDC) by 2018, but didn’t get any clear answers that would allay concerns about the seemingly hasty process forced on the state by Federal deinstitutionalization policies and associated funding cuts. A special hearing in Sacramento on Feb. 23 heard from the major participants in the ongoing drama of moving the most fragile and at-risk, developmentally disabled people out of the institutions where many have lived for most of their lives, and into an uncertain future in community homes with questionable levels of care.
The decision to close developmental centers was prompted by changes in federal guidelines. Federal Medicaid policy promulgated in 2013 was clearly aimed at achieving that end, allowing no funds for people being cared for in institutional settings like SDC.
The state’s three remaining developmental centers are Sonoma, Fairview and Porterville, with Sonoma slated to close first, and the other two by 2021. After years of declining admissions, the number of people statewide who will be moved was 770 as of Jan. 16, with 348 to be moved out of SDC. These numbers will drop over the next few years as clients are transferred or pass away.
Not enough time or money for transitionOn Feb. 23 state officials, community home vendors, patient advocates, Regional Center administrators, developmentally disabled people, and some of their parents and guardians who have to make critical decisions for them all testified to the Senate Budget and Fiscal Review Subcommittee No. 3 on Heath and Human Services, chaired by McGuire.
Most of those testifying expressed strong doubts about the timetable and funding for closing the three centers.
“My challenge is that we are expediting a plan in three years,” McGuire told John Doyle, deputy director of the Department of Developmental Disability, frustrated at Doyle’s inability to be more specific about numbers. “We have never done it in under five years. People [employees] are already leaving. Real estate is expensive in the Bay Area. This will be a challenge.”
Doyle could not provide a specific answer to McGuire’s repeated request to know how many, if any, new homes were ready to accept transfers, even though over $45 million was budgeted for new community homes last year, along with another $8.6 million this year.
The legislature is considering a tax that would substantially increase funds available for the developmentally disabled, but how much is still unclear.
Assemblyman Bill Dodd was equally adamant.
“The timeline is unrealistic to accomplish those goals,” Dodd said. “The state needs to invest in better reimbursement rates, medical support services, and leverage the expertise of existing staff.”
“I feel the 2018 deadline is ridiculous,” Dr. Anne French told the subcommittee. French is a physician serving SDC residents for the past nine years. She said many services available at SDC would be difficult to replicate in a community setting, including around-the-clock trained nurses and physicians, immediate access to primary care doctors or dentists, access to licensed psychiatric technicians, and the general continuity of care that patients currently enjoy.
Plans to move state employees of the SDC to the private sector are not viable. Pay scales between the developmental centers and the private, community sector are too wide to be bridged without extra funding. DC personnel are state employees, earning $25 an hour or more in many cases, and having retirement and health benefits that are completely lacking in the private sector. Most private sector community homes pay $12 an hour without benefits, and do not attract highly trained people to care for their residents.
Community care homes not readyFor years private community care homes have been failing due to financial pressure. McGuire initially thought that 421 community homes had closed since 2011, and was somewhat shocked to find that more than 520 homes have closed, as the state has slashed healthcare and developmental disability care by over $1 billion since 2008. Many patient programs have been cancelled as well.
Private home operators said that moving patients out of centers to homes can be long and complicated; homes have to be approved before being populated, and the process can take up to a year. Since they only get paid when people are in residence, home operators frequently have empty beds and no income to pay staff.
“Providers need to be kept financially healthy during startup,” Michael Kottke said. Kottke is executive director of Elwyn of California, which operates a number of community homes and programs for the developmentally disabled. “You need to fund the vacancies. We can’t wait for full placement.” He noted that a financial support program for an earlier developmental center closure was very helpful.
Kottke underscored the variables involved in filling vacant beds.
“It’s a very bureaucratic process with many entities involved,” he said. “A lot of wrenches can get thrown in the process.”
Special services needed for severely disabledCalifornia initially cared for its physically and intellectually challenged citizens through large institutions that developed around the state. Since 1969, however, legal and ethical challenges to that system have resulted in a major migration of people from the institutions to community care administered through 21 Regional Centers (RCs). After the remaining three institutions – developmental centers – are closed, the RCs will have responsibility for all California citizens who qualify for support, except the most difficult behaviorally and physically challenged populations, most of whom will remain in a special section of the Porterville Developmental Center and a few small crisis centers scattered around the state.
Secretary Diana S. Dooley of the California Health and Human Services Agency said that while there are problems, the department fully expects to meet the 2018 closure deadline. She left early, leaving Doyle to take the brunt of questioning by the subcommittee on the details.
Developing adequate medical and dental care for severely and profoundly disabled people will be a major hurdle to providing adequate care in community settings. Severely disabled clients often require very specialized treatments and treatment facilities. Many have to be anesthetized before any dental work can be done. It can take over a year to find these services in the private sector.
Resolving those issues puts Sonoma County squarely in the picture as it seeks health care alternatives that could continue the level of care now available at SDC.
“It’s clear that there’s support for some medical solutions to dental and medical issues out there,” Kathleen Miller said. Miller is president of the SDC Parent Hospital Association and has a son living there. “We have work to do to get the safety services remaining saved.”
County health official Rod Stroud said the county is looking at creating a special health center.
“The county supports a Health Disability Resource Center that would provide a continuation of three core services – a Federally Qualified Health Center (FQHC), an Equipment, Resource and Information Center, and an Acute Crisis Center.” The idea should be well developed in the next few months, but further development will require a better knowledge of future funding opportunities, Stroud noted.
“The FQHC will provide the full array of primary care, dental services, behavioral health services and preventative care,” Stroud said.
Sen. Holly Mitchell sharply questioned whether Sonoma County was intending to use existing SDC property. Stroud said the county was looking at several possible locations. He was clear that the center would be specifically looking to retain existing SDC personnel.
“Most importantly, it will act as an information hub that will allow for coordination of services across the full continuum of the client’s medical and behavioral services and supports.”
Miller was thankful that Senators McGuire and Mitchell are taking a proactive role in maintaining oversight over the closure process.
“We still have work to do figuring out whether we can put services on the [SDC] site, something families and the coalition are very interested in,” she said. “We feel that land is sacred and the best location for certain safety net services, such as a place of last resort.”