Closing Institutions

Many of our supportive communities are being destroyed.  People are being evicted from their homes and dispersed to isolated housing in the name of “inclusion.”  The reason this is happening is because people and agencies are being misguided with inaccurate information, both with regards to costs and with respect to the 1999 US Supreme Court Decision Olmstead.

It is for this reason that I am providing this information in my attempts to clarify what the costs are and what choice means to those of us who care for our loved ones who have  limited abilities to make their own safe choices.

When looking at costs, direct care costs are the most logical cost to compare since this is a cost that is needed in all types of supportive residential settings.  This is the basic cost and the one that is most often reported for the cost of care in community residential settings.  The costs reported for supportive communities (Intermediate Care Facilitates/Intellectual Disabilities (ICF/ID), Nursing Facility/Intellectual Disability (NF/ID) and Residential Habilitation Centers (RHC) ) are generally very comprehensive costs and by the very definition will be more expensive than the direct care costs reported for community settings.  Below are the lists of services that are included in the comprehensive costs for the supportive communities.

Looking at only direct care costs across many residential settings and support needs – there are two very clear facts that can be seen:

1.  The cost of care increases as the support needs for the person increases – those needing more support have a higher cost for direct care.

2.  The Economies of Scale come into play – in supportive communities, even when the support needs are high, the cost of direct care is lower per person, on average, than in isolated homes.

In Washington State, this became especially evident with the closing of Frances Haddon Morgan Center, one of our state’s RHCs.  In addition to looking at the Economies of Scale in action with the downsizing and closure of one of our RHCS, we were also able to obtain the average daily cost of care for community residents with the highest support needs. The chart below illustrates that as the size of community decreases, the average cost per resident for care increases.

economies of scale

2010 direct care costs

2011 direct care costs

2012 direct care costs

The cost difference between 49 residents and 9 residents for Frances Haddon Morgan Center is astounding.  Moving these residents from their homes proved disastrous for several of these residents, death to one, hospitalizations and crisis to others – all for what was assumed to be a cost saving measure.  This experiment failed on many levels.  It’s time to actually look at the real data, understand what the data represents and move forward.

cost centers 1 cost cetners 2

National Council on Disability – Toolkit for Disaster

The message below was forwarded by an advocate for a continuum of care.  These are the contacts for those in Washington State –  People from every state should write their representatives to ensure that our most vulnerable are treated fairly and with human dignity – not negligence.

PLEASE ACT NOW!  Please use this email to send a letter to the National Council on Disability

National Council on Disability (NCD) is a federally funded organization advising the Administration on Disability Issues.  NCD has   launched an all – out attack on facility care (institutions).  They propose the closure of all facilities over 3 beds.  They have even created a Toolkit for community advocates to follow in order to affect closures. They refer to deinstitutionalization as “unfinished business”. To the best of my knowledge, we have never had a representative of this organization visit any of our RHCs.  These are the people advising President Obama and Congress regarding the supports & services needed for the most vulnerable. If this group cannot represent both sides of the care question (institutions and community) they should not receive federal funding.

With the above in mind, please write, fax, telephone or e-mail the NCD regarding their position on congregate care.  Tell them our loved ones, living at the RHCs, are unable to receive the supports & services they need other than in our facilities.  The quality assurance within the community must be brought up to the same standards required by Centers for Medicare & Medicaid.  All of this takes planning, time and money.  All are in short supply at this time.

NCD, the President and Congress must be told not all individuals can successfully live in the community.  Many have tried and failed OR the community has failed them. VOR has contacted NCD and the White House with its concerns and objections.  Now it is our turn.

The contact information for the NCD is: National Council for Disability, 1331 F Street NW, Suite 850, Washington, DC 20004; Telephone: 202-272-2022; Fax: 202-272-2004; E-mail: website –  At website you can click on their e-mail contact on the lower left hand side.

The President & Congress are best contacted through e-mail, fax or telephone. The White House contacts are: or 202-456-1111.  The mailing address for the White House is 1600 Pennsylvania Avenue NW, Washington, DC 20500.  Our Congressional Delegation can be reached as follows:

Sen Patty Murray                                 202-224-2621/F-202-224-0238

Sen Maria Cantwell                              202-224-3441/F-202-228-0514

Rep Suzan DelBene -1st                      202-225-6311/F-202-226-1606

Rep Rick Larsen-2nd                           202-225-2605/F-202-225-4420

Rep Jaime Herrera Buetler-3rd         202-225-3536/F-202-225-3478

Rep Cathy McMorris Rodgers-4th    202-225-2006/F-202-225-3392

Rep Doc Hastings -5th                         202-225-5816/F-202-225-3251

Rep Derek Kilmer-6th                         202-225-3251

Rep Jim McDermott-7th                     202-225-3106/F-202-225-6197

Rep Dave Reichert-8th                       202-225-7761/F-202-225-4282

Rep Adam Smith-9th                           202-225-8901/F-202-225-5893

Rep Denny Heck-10th                         202-225-9740/F-202-225-0129

Website addresses are also a link for contact.  Senators (last; Representatives (

Please send them your thoughts about the need for facility care as part of the continuum of care – the Safety Net – for our most vulnerable.