| Perspectives on Texas

For years, parents, advocates, and legislators have wrestled with the appropriate fate for the 13 State Supported Living Centers. Emotions run high, disinformation abounds and every side walks away frustrated — to the detriment of the people still living in these outdated institutions.

Nearly ten years ago, law enforcement discovered Corpus Christi SSLC staff were forcing residents to fight one another. The U.S. Department of Justice began an investigation into all 13 centers, and found the conditions were so poor they violated the residents’ civil rights. Texas entered into a 10-year settlement agreement in 2009, agreeing to bring the system into compliance or face closure. Eight years later, the reports issued by DOJ show less than minimal progress. Our efforts are not working.

Recently the Tribune ran an article on Senate Bill 602, a moderate proposal that would establish a restructuring commission to take a look at the system and determine how — and if — it should be restructured. If a center is recommended for closure, the bill would require proceeds from the sale of land be reinvested in services for people with intellectual and developmental disabilities. Some might fear that all 13 SSLCs are going to be immediately shuttered. This is not the case. SB 602 is about choice, not closure. We have an opportunity to finally put out a fire that has been raging for decades.

I am a former associate psychologist at the Austin State Supported Living Center with almost ten years’ experience working with people with intellectual disabilities and co-occurring mental health diagnoses. I have seen most aspects of our state’s health and human services system, but it is the SSLC system that sticks with me the most.

My caseload fluctuated anywhere between 16 and 48 clients, but generally consisted of about 36 because the state could not fill the psychologist positions. A “normal” caseload is around 24 people. The primary challenge for many of my clients were serious psychiatric disorders like schizophrenia and bipolar disorder; their intellectual disabilities were secondary — and sometimes even debatable.

I worked with the high-needs people often assumed to be too aggressive or too disabled to live in the community. Many of them have moved to the community, and are now thriving. One person I worked with had lived at Austin since the age of three, and used a gait belt and wheelchair. That client now walks without help, is working, and likes to spend free time at the mall — none of which was possible at Austin SSLC.

It took me a long time to figure out how best to describe what I witnessed at Austin SSLC. We were resident rich and resource poor.

I heard stories from other coworkers of reviewing recordings of restraints and seeing residents cornered and targeted by staff like they were animals. I would talk with people who had been restrained and genuinely could not understand why, and were visibly shaken by the experience.

I had clients we feared had been sexually abused by staff at another home, but had no way of knowing for sure because we couldn’t get the assistive technology they needed in order to communicate (it was “too expensive” and the state apparently had contracts that mandated the use of other, older devices). Instead, they remained in their shared bedroom and we tried desperately to treat their depression.

Some truly outstanding people work in the living centers. They make herculean efforts to improve the quality of life for residents. However, they’re fighting against a rip tide that can drown the most determined caregiver. Direct care is one of the most difficult jobs: turnover is outrageously high, and as a state we provide few incentives to keep doing it—let alone to do it well. If we figure out what size the system needs to be, we can create the right environment to replicate these outstanding employees instead of stretching them over 13 half-empty living centers.

The waiting list for community services has 132,000 people on it, a number that is only going to grow if the Legislature remains uninterested in funding more slots. And yet we continue to throw money into an oversized, outdated institutional system that has proven to be completely unable to meet the basic standards of care. Restructuring the system will better serve both people who choose to use SSLCs, and those who wish to live in the community.