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IL Blog: True & False, a Closer Look at Sunset

Dennis Borel
CTD

July 22, 2014

As CTD continues our discussion of independent living, we turn to one issue that has received a lot of attention this summer: the Sunset Commission's recommendation to close some State Supported Living Centers (SSLCs). What does this have to do with independent living? The Sunset Commission calculates a savings of over $236 million in the first five years and recommends transporting this money to cost-effective community services. For the 120,000 Texans on the community services interest list, it could mean a much shorter wait for services and supports in their own homes.

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In May 2014, the Sunset Advisory Commission released its staff report on the Department of Aging & Disability Services (DADS). In the report, Sunset recommended the closure of six of the 13 state supported living centers (SSLCs) over an eight-year time frame. SSLCs are state–operated segregated residential facilities for people with intellectual and developmental disabilities (IDD). The staff report was developed over several months of intensive study and cited “declining enrollment, skyrocketing costs and questionable quality of care” as reasons for the recommendation. Supporting details were provided.

On June 25th, the Sunset Commission held a public hearing on the report. Several legislative members of the Commission identified the key issue of balancing the concerns presented in the staff report while respecting people’s choice of where to live.

But as Director of the Sunset Commission Ken Levine pointed out in his opening comments at the hearing, there's a “lot of incorrect, misinformation going around." Let's examine several items that have people talking.

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Is this an effort to close all the SSLCs? No. No one—not the Sunset report, not community advocates, not legislators, not any other recent analysis—says to close all the SSLCs. What these groups do want is for DADS relocate all residents to the community (a) if those residents want to go and (b) when primary medical providers agree it is appropriate. Residents and their families who prefer an institutional level of care should be able to remain in an institutional setting.

Can community services absorb the relocations from SSLCs? Probably. People who live in or are eligible to live in an SSLC can also access community-based services with a Medicaid waiver (either Home and Community-Based Services (HCS) or Community Living Assistance and Support Services (CLASS)). Currently, more than 28,000 Texans are budgeted to receive HCS or CLASS (source: General Appropriations Act 2014-15). If roughly 50% of the SSLC population chooses community placement, it would mean an increase of less than 10% of current HCS and CLASS recipients (1,600 people over seven years).

The Sunset report recommends closing six of 13 facilities. That's almost half! Isn't that extreme? No. The resident population has declined 74% in the last 40 years, yet the number of institutions has only decreased from 15 to 13 (source: Sunset Report- DADS). The report recommends right-sizing the SSLC network.

Why do advocates for community services hate SSLCs? They don't. They do object to Texas' institutional bias, whereby a person in need of services and care can either enter an institution immediately or join a 13-year wait list for community services (source: DADS Interest List home).

With an annual per resident cost of over $250,000 (source: HHSC ICF/IID Payment Rate Information), SSLCs soak up a disproportionate amount of the State's budget, choking off funding for community. Meanwhile, the interest list for IDD community waivers exceeds 120,000 people (source: DADS Interest List home). CTD and many of our advocacy partners want Texans with disabilities to have real choices about where they live, whether in the community or in an institution.

Will closures create a hardship on families who visit? Maybe. The scope of this issue is unknown and difficult to measure. A significant number of SSLC residents are seldom visited. When appropriate, a family could support having their loved one relocated to a nearby group home. CTD recommends that DADS consider creating a travel stipends fund to assist families in visiting their relocated loved ones. The fund should be means-based and only for families not otherwise able to visit.

Doesn't the State need SSLC capacity for alleged offenders (those that have been charged but not convicted of a crime)? No. Only 230 (about 6%) of the current SSLC residents are alleged offenders (source: Sunset Report- DADS). Further, alleged offenders should be considered for placement into Outpatient Competency Restoration programs rather than SSLCs, similar to alleged offenders with mental health competency issues.

Some residents are so severely disabled that an institution is the only option. We disagree; everyone should have a choice of where they live. Consider two things. First, people with severe physical disabilities do live in the community. Second, those with behavioral disabilities with the highest level of need are often cited as the most difficult to serve in the community. Yet only 16 of the 143 Texans at this level actually live in SSLCs; the rest live in the community (source: Sunset Report- DADS). Regardless, according to Sunset's recommendations, no one who chooses an institutional setting would be forced to live in the community.

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Read the full Sunset Report.

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About Dennis

As CTD's Executive Directed since 2000, Dennis is frequently called upon for research, policy analysis, and recommendations to the Texas Legislature and state agencies on issues surrounding disabilities. Read his full bio.