The Arc of Massachusetts, Massachusetts Families Organizing for Change, and Massachusetts Advocates Standing Strong (a self-advocate organization) all weigh in vigorously on closing the DMR facilities by the start of 2006. It can be done, and we propose a top-level plan on closing them and moving people to the community with compassion and caring. DMR has closed multiple facilities in the past twenty years, and the DMR managers know how to do it.

What are the advantages of full closure?

• Individuals with disabilities and families are scared that they could be forced into open facility beds. Available facility beds are always a potential placement for someone in the community. Given their cost, the only reasonable assumption is that those beds will be filled. The use of this existing resource will always come before the development of additional community support services.
  
  Self-advocates, including members of Mass Advocates Standing Strong, feel very strongly that this risk of institutionalization is unacceptable. The most famous occurrence of misplacement is that of L.C. and E.W., the two Georgia women whose case led to the Olmstead ruling by the United States Supreme Court in 1999.

• In the post-Olmstead era, facilities are seen as outdated service models and are no longer appropriate placements, given their restrictive institutional settings. Since the 1970s, a large number of service models for community and home supports have evolved, offering a far wider range of choices. DMR, families, and individuals working together have developed pilot programs and collected data that have resulted in proven service models. The result, in our opinion, is that institutional settings like the facilities have become programmatically marginalized, except for the dollars they consume.
  
  Further, the national data shows a strong national trend away from facility settings. Massachusetts is the last New England state with multiple facility campuses, and may soon be the only New England state with any facilities.

• Equal or better services to the medically fragile, behaviorally challenged, and forensically involved are proven to work in settings other than the present six facilities (Fernald, Glavin, Hogan, Monson, Templeton and Wrentham). For medically fragile and behaviorally challenging individuals, the strong medical and academic resources that are available in Massachusetts’ community settings make those community settings the preferred choice for these individuals. We are fortunate to live in a state rich in medical skills and services that are offered and consumed here by people in-state, nationally, and internationally. In fact, medical services (and related services for behaviorally challenging people) are a leading export, as Massachusetts is seen as a center of excellence for these skills and services.
  
  In an environment rich in medical and behavioral services competence, it is not appropriate public policy for DMR to perpetuate an in-house system geared only to individuals with mental retardation. Experience in many service industries shows that in-house services will invariably fall behind vibrant services in the community that must daily prove their worth and effectiveness. In summary, we see no future role for the facilities for medical or behavioral services, and recommend that the facilities be closed for this purpose. We do see a need for consultation and support services so that more community physicians and specialists are trained to work with individuals with significant cognitive limitations. In addition, medical safeguarding projects to review the care of individuals with complex medical needs is an important priority. Such projects already exist in Massachusetts and need to be expanded to all communities.
  
  For the forensically involved, a strong multi-disciplinary team located near an academic medical facility is a clear preference for high-intensity services. The multi-disciplinary team is not a luxury, but an essential element in identifying causes and establishing treatments for people that often have significant undiscovered medical issues. No existing facility is appropriate for a high-intensity program, and none is well-positioned near an academic medical facility.

• The operating cost analysis shows that closing all facilities is the clear preference for operating cost reasons. Given DMR’s role as fiduciary for public funds, we see that operating costs are an important issue. Further, we believe that cost savings from facility closure should be directed to strengthening the community service system for the approximately 30,000 people receiving those services.

• Closing the facilities will avoid nearly all capital expenditures otherwise needed if the facilities remain open. The last major investment in the facilities was in the early 1980s. For the facilities to remain open, the 2002 DMR Strategic Plan Working Group report says that capital expenditures in the range of $25 million to $93 million (in February 2006 dollars) are required.
  
  We disagree.  Our view is that these numbers are low, and that the capital investment needed could range up to $210 million (February 2006 dollars)*
  
  To reach this estimate, we assumed that eliminating the deferred maintenance plus normal capital expenditures requires pro-active spending equal to three times the rate that the deferred maintenance accrued, or $10.5 million per year. Given that nearly all facility buildings are at least 35 years old (there has been no new construction since the 1970s), the changing requirements of building standards, the ADA, and the unforeseen (and inevitable) surprises in capital maintenance and construction, we believe that the spending rate of $10.5 million should continue for a minimum of 20 years. Our estimate, therefore, is $210 million ($10.5 million times 20 years).
  
  From a facility planning working group perspective, we recommend a capital expenditure estimate that is realistic, allows for surprises, and includes some new buildings in the estimate. Keep in mind that facility buildings will be a minimum of 45 years old in FY2011, and at the end of life for commercial buildings. With that perspective, even the $210 million estimate may be low.
  
  The high cost and uncertainty on capital expenditures can be avoided by DMR if the facilities are closed by the beginning of FY2006.

Summary 

With the closure of the six facilities, there would be benefits for the people now at those facilities. They would have a wider horizon of opportunities for participation in the community. That’s where the families are, the jobs, the recreation and learning opportunities. That is where we all live our lives. It is a privilege for all to be there. Let’s open the doors, meet the post-Olmstead world with a strong proactive plan to minimize institutionalization, and think about our fiduciary responsibility to provide appropriate services to a fully integrated community system.

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