AUSTIN – Texas' state schools for the mentally retarded have already come under fire for reports of horrific abuse and vile living conditions.
Now, a Dallas Morning News investigation has found the smaller group homes regulated by the same agency – facilities often believed to be safer by virtue of their size – suffer from similar problems.
A review of the 50 "intermediate care" group homes in Dallas County, the small, state-monitored facilities providing the same degree of care as the state schools, shows everything from medical neglect to debilitating financial troubles. Homes were allowed to stay open after repeated reprimands.
These reports don't appear to be as grave or as common as those found in the state schools, and the bulk of the problems seem to be concentrated among the dozen worst-offending facilities. But callous indifference is common, with residents with limited abilities often treated as though they have none at all.
The intermediate care homes "continue to be mini institutions – it's what would happen if you put a state school through a meat grinder," said Jeff Garrison-Tate of Advocacy Inc., which lobbies for home and community-based care instead. "It's such a controlled environment, and those controlled environments continue to breed cultures of violence."
Among the troubles found in two years' worth of inspection and investigation reports:
•Serious medical mistreatment, where staffers did not notice fractured bones and illness for weeks, gave residents too much medication, or forgot to give prescription drugs at all, resulting in hospitalization
•Unsanitary living conditions, including buildings infested with roaches and black mold, trash cans overflowing with dirty diapers, and frequent outbreaks of scabies, pin worms and staph infections
•Financial crises that forced facilities to have their water and phone services disconnected, allowed vehicle inspections and insurance to lapse, and dug into residents' trust funds to pay for gas and prevent checks from bouncing
•Employees who abused or embarrassed residents, either by hitting and slapping them, forcing them to wear clothes backward, or fitting them with diapers the residents didn't need.
These conditions weren't found at all of the homes; nearly a quarter of the Dallas County facilities reviewed by The News have consistently clean inspection reports. But there are more than 860 facilities statewide, and despite some threats of closure, just one has had its license revoked in the last five years.
Officials with the Department of Aging and Disability Services, the agency that regulates the facilities, say they take abuse and neglect allegations incredibly seriously, regardless of whether they're at a state school or a smaller group home.
The agency's regulatory division completes an up-front survey of every new care provider, followed by unannounced annual inspections, spokeswoman Cecilia Fedorov said. That division also conducts investigations of complaints and all incidents self-reported by the facility.
The problems reviewed by The News were discovered through a combination of annual inspections and complaint investigations.
"Even a single allegation of abuse or neglect is cause for concern," Ms. Fedorov said.
The small group homes, which generally have fewer than eight beds, house 6,600 people in Texas, compared with 5,000 in the 15 larger state schools and centers.
In July, a Dallas Morning News review of the state schools found widespread reports of abuse and neglect. The news followed a critical U.S. Justice Department report in December on the Lubbock State School that found conditions there violated residents' civil rights.
The story prompted several lawmakers to call for better legislation to monitor the state schools. The news reports also raised questions about whether the problems extended beyond the large state schools to the small group homes, the overwhelming majority of which are privately run.
The News' research shows 13 Dallas County homes have at one time been denied recertification or threatened with license cancellation over the last two years – some of them several times. State regulators generally recommend pulling a facility's license if problems identified aren't fixed within a 90-day time period – and they give a shorter window to homes where residents' safety is in danger.
Currently, the agency gives eight of the 13 high marks. Only three of the Dallas County facilities – Apple Tree Court House and Anna House in Irving, and the Ridge Oak Way House in Farmers Branch, which are all operated by the same company – are listed as having scores under 70, based on a 100-point rating scale.
Ratings are compiled for the public based on performance in the home's most recent inspection and their worst investigation finding in the past six months, but don't directly affect whether the facility is closed.
At one of these facilities – the six-bed Apple Tree Court House – inspections conducted as recently as February showed employees used bleach-laden industrial wipes to clean the mouths and hands of residents, some of whom suffered from painful skin boils and rashes. (Staffers said they couldn't tell the difference "between disinfectant wipes for skin and Clorox wipes.")
In a 2005 incident, a staff member at that facility left five residents unaccompanied and rolled a sixth down the street in a wheelchair, entering a neighbor's home and dropping the resident off in the neighbor's bed. The staffer claimed the resident, who is profoundly mentally disabled and cannot speak, had indicated relatives lived in the house.
The problems also extend beyond the homes with low scores. At the Embers Trail House, a six-bed facility in Grand Prairie, employees failed to act for six weeks late last year when a severely disabled woman stopped eating and sleeping, started having severe tremors and became unable to walk.
By the time she was admitted to the emergency room, she had dropped 30 pounds, was experiencing kidney failure and was suffering near fatal dehydration and malnutrition. Doctors determined she had four times the normal level of lithium – a mood stabilizer – in her bloodstream.
Investigators couldn't determine who ordered the increase in medication, and found several pages of notes had been removed from the woman's record. Despite this – and two years of inspection reports documenting medical errors, sexual activity among residents and concerning red whip welts on a resident – the facility never lost its license. As recently as July, inspectors gave Embers a clean bill of health.
Nicole Haenszel, state director of developmental services for Volunteers of America Texas Inc., which operates Apple Tree and Embers, wouldn't discuss specific cases at the facilities they operate, citing client confidentiality. But she said the management company, which has 11 intermediate care group homes in North Texas, has "excellent quality"
"This is not a trend you're seeing," she said.
She attributed many of the problems at private North Texas group homes to financial struggles.
"A lot of providers have issues ... because we have been so incredibly under-funded" by Medicaid, the state-federal program for the poor, Ms. Haenszel said. "A lot of facilities are actually shutting down because they just can't afford to operate."
The problems don't appear to be limited to Dallas County.
In June, a resident at the Cimarron Living Center in Denton County, a private facility with 116 beds, was admitted to the hospital after employees found 30 maggots living in a wound on his head. Family members said they had been extremely pleased with their relative's care until that point, and an allegation of neglect was never substantiated.
In April 2006, police were called out to the same facility following a report that a female employee had taken an 18-year-old male resident home with her over the weekend and sodomized him. Over the course of the investigation, officials determined that the employee was a male transvestite who identified as a woman – news to the privately-owned facility – and who frequently took the resident home on "weekend pass" and abused him.
Following the investigation and the employee's termination, management sent out a memo prohibiting staff from taking residents out on overnight stays.
Cimarron's facility director said she could not comment and referred all calls on investigations or allegations to the state. Phone messages left with Diamondback Management Services, the company that manages Cimarron, were not returned.
Lawmakers and watchdogs say the root of the problem is the same at the worst state schools and group homes: a combination of underpaid, underqualified employees and insufficient state oversight.
"A lot of it goes back to funding; these jobs are very low-paying, and we have very low-skilled people in positions of great responsibility," said Rep. Lon Burnam, a Fort Worth Democrat who attempted to organize an interim committee on the state schools this fall, but stopped when he couldn't get the support. "We need a system in place that strengthens monitoring."
And although some parents call these intermediate care facilities a godsend, others say they wouldn't have spent years on a waiting list – the timeline for some private facilities – if they had known how their children would be treated once they got in.
One father, who spoke only on condition of anonymity for fear of retribution, said his child has been hospitalized twice since entering a North Texas intermediate care home – both times for serious ailments that festered because staff members ignored them.
He said in his experience, staffers would rather try to handle illnesses and abuse cases in-house than risk bringing in state investigators.
"They'd rather roll the dice than take them to the hospital when they need it," he said. "The times it doesn't work out, people have lost their lives.
To Rep. Jerry Madden, R-Plano, problems in the homes are strikingly similar to those in the Texas Youth Commission's private contract facilities, which have come under fire for cutting corners in their treatment of youth inmates.
"I'm not prepared yet to say there's a fundamental problem" in the state's facilities for the disabled, said Mr. Madden. "But the state has a responsibility to make a judgment about what's working and what's not."
A look at the scope of "intermediate care" facilities for the mentally retarded in Texas:
STATE-OPERATED SCHOOLS OR CENTERS
Number: 15
Description: Facilities with hundreds of beds, where abuse and neglect allegations are investigated by the Department of Family Protective Services.
Total population: Nearly 5,000 residents
COMMUNITY FACILITIES
Number: 120
Description: Smaller, publicly operated group homes, where abuse and neglect allegations are investigated by the Department of Family Protective Services.
Total estimated population: About 1,000
PRIVATE FACILITIES
Number: 742
Description: Smaller, privately run group homes where abuse and neglect allegations are self-reported and self-investigated. The Department of Aging and Disability Services oversees the investigation process.
Total estimated population: About 5,600
SOURCES: Department of Aging and Disability Services; Department of Family and Protective Services
Some recent cases of neglect or mistreatment at Dallas County group homes for the mentally retarded, according to inspection and investigation reports:
March 2005, Evergreen Pyramid Community Home in Garland: A staff member didn't cut up a resident's food small enough. When the resident choked, the staffer denied the resident anything else to eat.
March 2005, Eastbrook House in Mesquite: Medications were kept in unlocked containers, black mold was found growing on windows and spider webs and dead bugs were found throughout the home.
September 2006, the Embers Trail House in Grand Prairie: Employees failed to act for six weeks when a severely disabled woman stopped eating, lost 30 pounds, started having tremors and became unable to walk. When she was finally hospitalized with kidney failure and near-fatal malnutrition, doctors determined she had perilously high levels of lithium — a mood stabilizer — in her bloodstream.
January 2007, the Dallas County DADS Lehavre Home: Staff withheld pneumonia medication from a sick resident, causing him to be re-hospitalized. Later this year, residents were found ingesting topical medications.
February 2007, Anna House in Irving: Staff members prepared meals by putting leftover Frito pie in a blender with water and bread. Residents were found with head bruises, split earlobes and other medical problems.
February 2007, Apple Tree Court House in Irving: Employees used bleach-laden industrial wipes to clean the mouths and hands of residents, many of whom suffered painful skin boils and rashes. Staffers said they couldn't tell the difference between disinfectant wipes for skin and Clorox wipes.
May 2007, Dallas County Mental Health/Mental Retardation Center in Irving: A staff member witnessed a client eating out of a garbage can and threatened him with a stick, saying, “You don't want me to hit you.”
SOURCE: Dallas Morning News research
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