When D writer Katherine Dinsdale took a critical look at what was going on at the Fort Worth State School for the mentally retarded last September, we learned that larger and larger cutbacks in state and federal funding for the institution seemed to be at the root of complaints lodged against the school: complaints that ranged from understaffing to client abuse and neglect. Dinsdale charged that the public was indifferent to the cries for more money. Professionals in the mental retardation field warned that woes at the Fort Worth State School were only symptoms of larger problems rampant throughout the state.

Due to a court-ordered effort to ease conditions at state institutions by reducing staff/client ratios, 73 mentally retarded persons must be returned this year to community-based programs like the Dallas County Mental Health and Mental Retardation Center, which operates nine homes. But the court order has turned into a nightmare for the center’s executive director, Dr. James E. Craft, because state inspections are now tougher. Failure to pass inspections can stop or at least slow receipt of badly needed Medicaid funds to community homes. Also, new eligibility guidelines are stricter for mentally disabled people seeking financial help from Medicaid, and the cost of moving institutionalized patients back into community-based facilities is higher than the state is willing to pay. “The role of the state school is changing, and that’s what the pain of it is right now,” Craft says. “I happen to be a believer in the state school. Its natural role is to care for the medically fragile, multiply impaired person. The community could care for these people, but the issue becomes at what cost.” Craft claims that community-based facilities around the state have been “traumatized” by the court order to reduce the number of patients in state institutions. Craft says parents or guardians of mentally retarded patients who were waiting to be admitted to the state school have flooded the waiting lists of community-based facilities. At the same time, Craft has to think about patients whose names were on his waiting list even before this new surge, as well as current patients who may no longer be eligible for his program. “This puts us in the ridiculous position of having to decide whether we’re going to help the state resolve its problems or abandon all the people we’re also supposed to be serving.”

Craft says his problem is magnified by the fact that the state is only willing to reimburse the Dallas County center about $55 a day per patient for the services it contracts out to the DCMHMRC. His cost averages $60 to $70 a day per patient, and that includes the special programs he is required to maintain in order to keep receiving Medicaid money. Craft and other mental health professionals must come up with the extra money, or see services to the mentally retarded decline in quality. “It’s not that the state is holding a gun to our head, but we are inundated with lists of clients who are allegedly ready to be returned to the community. We’ve got a budget request pending before the Dallas County Commissioners Court for over $2 million right now. It doesn’t even include requests for additional MR programs. And the commissioners haven’t jumped right out there with a bunch of money because, frankly, they don’t see mental health and mental retardation as a traditional county function.”

Craft’s dilemma would be bad enough as is, but now the federal government is cutting back on Medicaid money, which pays for 90 percent of the Dallas County center’s operating costs. Those cuts have forced the center to adopt tougher patient admission guidelines. The center also faces more frequent facility inspections and harsher penalties for sometimes minor violations. “We are by no means perfect,” admits Craft. But he is confused by inspectors who appear to consider holes in blankets or serving green beans four times a week to be as serious a violation as failing to give a patient proper medication. Until the problems are corrected, Medicaid payments to centers like the DCMHMRC can be stopped. The harshest punishment calls for suspension of a center’s license.

To Craft, the situation looks hopeless. “Every two or three months I think we’ve finally reached rock bottom and then it looks a little farther away.”

One ray of hope in the abysmally complicated situation is Advocacy Inc., an organization empowered by the federal government to look out for the rights of mentally retarded individuals around the nation. David Sloane, who represents Advocacy Inc. in Austin, says the organization intends to go to court, possibly representing a client at the DCMHMRC, to show that the state is violating the rights of the mentally retarded in several ways. Among Sloane’s grievances:

● Due to new, more strict requirements, many retarded persons who are currently in the community system find themselves ineligible for disability payments.

● The state’s reimbursementfee for community-based facilities it has service contracts with is questionable. “Children’s programs require more intensive and more expensive programs,” Sloane says. “But the state’s reimbursement fee is the same for everyone.”

● Sloane has serious questions about the fairness of the appeal process involving the inspection, licensing, certification and decertification of community facilities.

● The state currently has no plan for dealing with patients in facilities it orders closed.

Despite these problems, Craft says a big obstacle faced by community homes was removed by the passage of Senate Bill 940 this past session. The bill prevents cities from passing zoning ordinances to keep group homes for the mentally retarded out of residential areas. “You know, it’s two steps forward and three steps backward,” Craft says. “Society pays for it anyway. It’s just a matter of which pocket you want to put the money in. Right now, our society seems quite content to put their money into the police and sheriffs’ departments and into the jails. It would be cheaper to go ahead and treat them in our system.”


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