It’s long been a cliché that no positive change occurs in Texas without a major public scandal or a federal lawsuit. This session, reforming Texas’ violent and troubled institutions for mental retardation required both.
The state operates 13 large facilities for mentally disabled Texans. After neglecting and underfunding them for years, the Legislature finally took steps this session to make residents safer, lighten the workload on the overburdened staff and raise the level of care. All it took to prod lawmakers to implement these reforms was three years of damning media reports (including several in this magazine), an embarrassing abuse scandal and the threat of litigation from the U.S. Department of Justice.
The abuse and neglect inside Texas’ institutions for the mentally disabled first made headlines in December 2005, when a Justice Department report detailed poor conditions at the Lubbock State School. The facilities are known as state schools, though that’s a misnomer—they are actually sprawling institutions for Texans with mental disabilities who need 24-hour care. They house a diverse population, from elderly residents who have been institutionalized for decades to teenagers who stay just a year. (In an attempt to clear up the confusion, the Legislature, in its most superficial reform of the system, changed the names of the facilities. The state schools will now be called “state-supported living centers.”) The residents are among the most vulnerable Texans. Some can’t feed or clothe themselves; others can’t rise from a gurney.
In the past three years, media reports have documented gruesome stories of abuse (one caretaker at an East Texas center repeatedly smashed a resident’s head into a metal door), and numerous systemic flaws, including direct care workers who earn about $8 an hour. The turnover among the low-paid, overworked staff is astronomical: Among direct care workers at Austin State School in 2007, the turnover rate was 70 percent (see “Systemic Neglect,” May 2, 2008).
The Justice Department investigated all 13 facilities and released a scathing report late last year that said the care violated residents’ constitutional rights. Investigators documented more than 50 recent preventable deaths in the facilities. The Justice Department indicated it would sue to force reforms.
With a federal lawsuit looming, Gov. Rick Perry and state leaders suddenly deemed state schools an “emergency issue” when the session opened in January. In February, just as the Legislature began to debate reforms, the system became a national embarrassment. Police in Corpus Christi obtained video that showed workers at the Corpus Christi State School staging fights between residents. The “fight club” video was shown on CNN and quickly became the symbol of a system in crisis.
The debate over how to reform state schools was emotional and fierce. Some advocates for the mentally disabled want all the facilities closed permanently and residents moved to small, three- and four-person group homes in community settings where, they say, residents live more independently. “It’s just that large institutions are fraught with this ability to get skewed into a guard-and-prison mentality, even if it’s not a jail,” Susan Murphree with Advocacy Inc., a nonprofit that advocates for the mentally disabled and wants state schools closed, told the Observer. “It’s really hard to get someone to have control over their own life in a large facility. … [It's] not the same as living in a typical neighborhood, going to community events much more often, deciding where and when you want to eat, helping prepare your food, and deciding just general things you want to be interested in.”
On the other side, many parents and relatives of state school residents argue just as fervently that state schools should remain open and be reformed. Nancy Ward helps run the Parent Association for the Retarded of Texas, which advocates for state schools. Ward’s 47-year-old daughter is profoundly mentally disabled and has lived in state schools for nearly four decades. Ward says some higher-functioning residents might benefit from the added independence of a small group home, but not her daughter, who can’t dress herself and needs constant care. Like many parents, Ward knows the state school staff and trusts them to keep her daughter safe. She is deeply suspicious of the conditions in privately run group homes.
Early in the session, the Legislature appeared divided on whether to close any of the state schools. Eventually, lawmakers fell back on their tried-and-true response to such contentious issues: They punted. They never seriously debated any bills dealing with closure and funded all 13 state schools for the next two years.
Instead, lawmakers enacted a modest bill by Sen. Jane Nelson, a Republican from the Dallas suburb of Flower Mound, and Democratic Rep. Patrick Rose of Dripping Springs, that requires security cameras in all public spaces in state schools. It also creates an ombudsman’s office to review the facilities and stipulates that abuse investigations be handled by an independent agency.
While those well-intentioned reforms certainly couldn’t hurt, security cameras and ombudsmen weren’t going to fix troubled facilities that lawmakers have chronically underfunded. As the legislative session lumbered into its final months, it appeared the state schools would not receive the funding boost they needed.
That changed in May, when state officials reached a settlement with the Department of Justice. Federal officials agreed to put off their lawsuit as long as Texas improves conditions in the state schools. As part of the agreement, the state promised to spend significantly more money on the facilities, hire more staff and raise the level of care. The Legislature later approved the settlement—and added funding.
State schools will receive an added $279 million in state and federal funds during the next five years, including $112 million in state money. That’s roughly a 12-percent increase. The money will help hire 1,160 more state school workers to give the overworked staff some help. Facilities will add doctors, dentists, nurses and direct care workers.
Those changes pleased state school advocates. But advocates for the disabled at the ARC of Texas and Advocacy Inc., who have pushed for at least some state schools to be closed, were less pleased because closure was never addressed. They did support the $200 million increase in funding that budget writers approved for community services for mentally disabled Texans who are not in state schools. The money will pay for nearly 8,000 more mentally disabled Texans to receive needed services in their neighborhoods, including housing and medical care, from a list of approved providers. That’s a 40-percent increase in funding for these community services—a move that Dawn Choate with the ARC of Texas called “monumental.”
But one big problem with state schools wasn’t addressed: the low pay. Direct care workers in the facilities earn fast-food wages. They are, on average, the lowest-paid state employees in Texas, and that contributes to the high turnover. Neither the Justice Department settlement nor the state budget mandates a pay raise. State health officials had asked the Legislature for a 10-percent pay increase for state school workers, but lawmakers didn’t put it in the budget. As a result, state officials may have a hard time filling all the new jobs.
Without a pay raise, it’s unclear whether the reforms passed this session will solve the major problems with state schools—or satisfy the Justice Department. The settlement requires the state to improve conditions, and independent monitors will inspect every state school at least twice a year to ensure that care inside the facilities is improving. If not, the Justice Department could still go ahead and sue the state.
For the moment, the political fight over state schools (or state-supported living centers) is over. But the hard work of bettering these sprawling institutions—whatever you call them—has only just begun.