The fairest solution for SDC

On Christmas day last year, there were 463 patients living at the Sonoma Developmental Center. A year earlier there were 516, a year before that there were 558, and a year before that, 602. You don’t have to look hard to spot a trend.

Back up another 15 years and SDC had a resident population of 1,164. And with, perhaps, 1,500 employees, it was virtually a town.

Now, like a melting glacier, the trend is both obvious and apparently inexorable. And like a melting glacier, it seems at times to be guided by forces outside human control, or at least, local human control.

There are multiple reasons for the glacial diminution of SDC, but the most important one for this discussion is the moratorium on new admissions imposed on all California developmental centers in 2012. Since then, no new admissions have been allowed, except for law enforcement cases and last resort crises. And with an average resident age north of 50, attrition keeps reducing the population while increasing the cost of keeping and caring for each resident. It is now approaching $400,000 per person.

Even without the so-called “deflection” policy, admissions had been dropping long enough and fast enough to suggest an end time was approaching. The Lanterman Act, a landmark law passed in 1969 that codified civil rights for the developmentally disabled and dictated at least semi-independent placement in the community whenever possible, spawned an exodus from the centralized centers into community homes that has topped 10,000 people.

It was an enlightened policy and helped end the practice of warehousing disabled people just for the sake of convenience. But some advocates for the developmentally disabled now argue that, on the one hand, the populations remaining have been sifted to such an extent that only the most severely disabled are left, and that, on the other hand, burgeoning populations of patients with autism spectrum disorders are in need of precisely the kind of care and housing that SDC provides so well, but isn’t allowed to offer.

Last Saturday, a parade of parents and guardians, with relatives and wards still living among the shrinking population at SDC, painted a bleak picture of the future awaiting their brothers and sisters, sons and daughters, should the center be completely closed.

Gathered at a meeting of the Parent Hospital Association on the bucolic SDC campus, a parade of speakers testified to the unique quality of the care and treatment their loved ones receive there, and to a man and woman they questioned whether moving them out into small group homes, without daily medical care and appropriately-trained staff, would be feasible, safe or humane.

One woman spoke of a severely-disabled brother who has been at SDC for 35 years, needs around-the-clock care and a crane to lift him out of bed and into a chair. “My brother would not survive if he were taken out and put in any other home,” she said.

Another woman who works as an advocate for disabled clients said she had discovered that, “Many outside doctors have no idea how to treat (developmentally disabled) patients. Many SDC patients see a doctor every day. No group home has daily access to a doctor.”

The mother of a patient she described as “autistic and intelligent,” explained that her son has repeatedly failed to successfully transition to small group homes, has challenging behavior issues and is in renal failure requiring regular dialysis with the support of two care givers for each session.

“Are you saying, “OK, we’ll close it (SDC), we’ll send him to his death?” she asked.

Despite promises to the contrary, there appears to be a predisposition among Sacramento policy makers to ignore such “anecdotal” accounts. They don’t fit the budgetary mandate to drastically trim per-patient costs, and they contradict the prescribed solution, transfer to small group homes, often run by for-profit corporations with minimally-trained and poorly-paid staff.

It is a familiar scenario because it mimics the once-enlightened strategy of shutting down California’s large, gray mental hospitals in favor of community mental health clinics and group homes. Because, as the large hospitals were closed, the state failed to adequately invest in community-based mental health facilities, resulting in what appears to be a permanently expanded population of homeless people, an estimated 25 percent of whom are mentally ill.

There is an infrastructure of 21 private, nonprofit regional centers scattered around the state, designed to address the needs of the developmentally disabled, and many of them do great work. But they have also been the targets of criticism inspired by a lack of transparency, accountability and, in some cases, competency. And they, too, depend on for-profit, bottom-line operators to house and care for many of their clients.

Given all this, we believe that no decision can be fairly made to close SDC until equal care, lodging and quality of life can be provided somewhere else nearby. And the best solution, we think, would be a down-sized SDC, with an expanded client base, and the conversion of much of the property to park land.