The Ohio Department of Developmental Disabilities is overseeing continued downsizing at Tiffin Developmental Center and nine other centers statewide.
Vicki Rich, chief public information officer for DODD, explained her department's biennial budget began in July 2011 and concludes at the end of June.
During the two-year period, TDC lost 54 positions, which included some part-time positions and individuals whose positions were abolished when they retired.
"We manage the removal of positions through attrition when possible," Rich said. "As part of our budget planning for the upcoming biennium, we are projecting 180 individuals leaving the institutions (from the 10 developmental centers). We plan for population and facility per budget cycle and do not have longer range plans than that."
Records show that 16 TDC residents moved in 2011 and four died. In 2012, 18 residents moved and five died. Some of those who left TDC were transferred to intermediate care facilities, while others were granted waivers for special services. Rich said downsizing at the developmental centers began more than four years ago.
"It's really about getting people who are able to thrive in community-based and more homelike settings ... to have the opportunity to do so and not have an institution as the only option." Rich said.
The Americans With Disabilities Act forbids discrimination against those with disabilities, including mental illnesses. In the late 1990s, the Olmstead Act decreed that people with mental disabilities could not be forced to live in institutions. Rich said 100 years ago, society as a whole thought it was best to segregate those with developmental disabilities in institutions. Since then, those attitudes have changed because parents and individuals have actively campaigned for integration into the community.
"Ohio is one of the states that was successful at creating good institutions and sheltered workshops ... so we ended up with a pretty big infrastructure of that kind of environment of caring for people," Rich said.
She added the DODD serves about 90,000 citizens in Ohio, but not all those individuals require full-time residential settings or intermediate care facility-levels of care. Some can live independently if they have transportation, non-medical care and other services. Home- and community-based waivers allow special services to follow individuals to wherever they live. If local levies are not available to fund services, people depend on Medicaid.
"We're operating, obviously, through Medicaid dollars, so the waivers have become the way that resources are serving more people. We have a new waiver for Ohio called the SELF waiver." Rich said.
During the first year of downsizing, the people who were moved out of institutions were the most eager and able to leave that setting. Those who remain are more complicated or special-needs cases.
For the coming biennium, the DODD issued a request for interest from private organizations and agencies to create 20 intermediate care facilities with six beds each. Rich said these could be new construction or rehabilitated structures within each region where the developmental centers are located. This month, the DODD is to review the proposals that have been submitted and decide which, if any, are acceptable. Rich said the state wants to form partnerships with private companies to house high-needs individuals.
"The goal is community integration when it's possible and appropriate for individuals. What has gone on so far is that people who were more ready and more easily prepared to live in a different setting are the people who have moved," she said. "Now, we have more individuals who can survive very well in a different setting. They just still require a special bundle of need services that not every provider is prepared for."
Rich said DODD has met with families and staff to determine what concerns they would have for individuals who might be moved. The DODD would likely manage admissions and discharges in the new six-bed centers to maintain the continuity of residents' care. As far as staff, Rich said agencies that operate residential facilities are required to meet the same standards as those in state-operated institutions.
"Providers of ICF services (licensed as ICF facilities and providing ICF level of care services) are all subject to the same training requirements and standards of care (whether the provider is public or private). There may be variances beyond that-as some providers might do additional training beyond or different than what other providers offer. There are well-qualified staff in both types of settings," Rich said. "There are thousands of private providers operating in Ohio where people are living very successfully."
There always will be a need for developmental centers to house individuals that could not survive in a community setting. Rich said the short-term admissions Bruce Amory mentioned (see accompanying story) have been developed so that clients can live in a developmental center temporarily for assessment, counseling and training to manage their behavior. The goal is for them to return to other places of residence.