V
irginia
C
apitol
C
onnections
, S
ummer
2014
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an empty office, since the Governor had emptied his office, to delay the
“official” receipt of the budget, and give himself more time to decide
about a veto).
In the end, McAuliffe satisfied himself with a few line-item vetoes,
including a veto of the Stanley amendment that tied his hands on
Medicaid. That vetowas overriddenwithout a vote, whenHouse Speaker
WilliamHowell ruled it out of order, on the grounds that line-item vetoes
can only be applied to spending items, and not to policy directives.
Assembly Republicans, for their part, restated their willingness to
convene a special session for the sole purpose of discussing the future of
Medicaid. That session will take place in September.
In the debate over the future of Virginia’s training centers, some
have maintained that the state cannot afford to continue to operate “two
systems of care” for the intellectually disabled, one for training centers
and one for the community. Therefore, they argue we must close training
centers because community care is cheaper. This argument is based on
false assumptions and is pure political spin by those who would impose
community care on individuals who do not desire it, despite the Supreme
Court’s admonition against such imposition. A number of academic
studies have found no significant difference in costs for serving similarly
disabled people in either setting. The prevailing evidence shows that
the minor cost difference between institutional and community care
for such individuals is primarily a matter of staff salaries and benefits,
an inequity that will be reduced by the U. S. Department of Labor’s
recently established requirement for overtime pay for private direct care
workers. Furthermore, Virginia’s own plan calls for keeping one center
open and federal and state law require it to provide additional training
center placements for the hundreds who prefer to remain in the centers.
Virginia does not operate two systems of care but one continuum
of service options designed to accommodate a diversely impaired
population. Most people are served in the community under several
programs including Home and Community Based Service (HCBS)
waivers, but hundreds of the most severely impaired and their families
have chosen the most intensive service option offered only at training
centers, to which they are entitled under federal regulations. The
severity of intellectual, medical and behavioral disability and personal
choice determine the level of care an individual may receive and in
what setting, but in order to receive community services an individual
must first “waive” his or her federal entitlement to more intensive and
more thoroughly regulated services offered at the training centers. The
Americans with Disabilities Act (ADA) and Medicaid law support the
continuation of such care since individuals must decline an institutional
placement in order to accept a waiver. Furthermore, the Supreme
Court’s
Olmstead
decision, much misrepresented by community-only
advocates, recognizes that community discharge requires both consent
and the recommendation of treatment professionals, and that for some
individuals, “the most integrated setting …may be in an institution.”
Furthermore, the Supreme Court said that “the ADA is not reasonably
read to impel States to phase out institutions, placing patients in need of
close care at risk.”
The remaining training center population includes a significant
percentage who need intensive medical support, including many who
receive daily medical care (like those at Central Virginia Training
Center’s [CVTC’s] specialized skilled and long term nursing facility
and many other training center residents statewide.) Such individuals
are
more
expensive to serve in the community than in institutions,
according to a 2006 waiver study done by the University of Minnesota.
Thus, closing training centers would likely
increase
costs for medically
fragile training center residents. One Lynchburg surgeon with a CVTC
contract, for example, has said that many of CVTC’s residents would
have to live in hospitals if discharged to the community.
For those with challenging behavioral difficulties, often the
consequence of co-occurring intellectual disabilities with mental illness
or autism, a comparable community infrastructure to support their
complex and intensive needs is not yet in place and will be costly to
build. The training centers still receive such individuals when they
are failed by the community, usually after repeated inappropriate
community placements, police encounters and psychiatric hospital
admissions which cause weeks or even months of needless trauma and
decline, sometimes irreversible. According to the Minnesota study,
these people will cost nearly the same wherever they reside.
With a shortage of appropriate providers, facilities and services,
closing more training centers means the state would have to replicate
specialized training center services in scattered small facilities. This
would likely result in no net savings and even increased expense due to
the loss of the training center economies of scale.
Senator Newman’s bill, SB 627, now state law, requires written
certification by the State to training center families that its proposed
community placements offer medical, health, behavioral and
developmental care and safety that is
comparable
to that offered at
the resident’s training center, unless the authorized representative
waives such certification. Without “reinventing the wheel” the State
will be hard-pressed to provide comparable care for the remaining
training center residents and, if it does, it is likely to be more costly
than current training center care. With hundreds of families choosing
continued training center placements, to which they are legally
entitled, it’s time to abandon ideological agendas and face facts.
Under the new leadership of Governor McAuliffe and Commissioner
Ferguson, the State has an opportunity to alter its course to one that is
more reasoned and responsible.
Jane Powell is President, CVTC Family & Friends.
Caring for individuals with intellectual disability:
one system to meet all needs
By Jane Powell
Thus, a timely and (almost) totally unexpected resignation saved
Virginia from a repeat of the partial federal government shutdown. But
while avoiding the worst manifestation of Washington-style gridlock,
Virginia political leaders seem to have adopted the brinkmanship, bitter
rhetoric and party-line voting that have marked the Bush and Obama
eras in Washington. With a Democratic governor thwarted (so far) in
his most cherished legislative goal, and a General Assembly likely to
remain in Republican hands, it is certain that the ghost of the 2014
budget standoff will haunt the corridors of government buildings in
Richmond for some time to come.
Ed Lynch is Professor of Political Science at Hollins University.
A Political Upheaval
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Taylor, Central Virginia Training Center.
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