State still falls short when caring for people with disabilities

Years of federal oversight of Georgia’s mental health system has not brought requested changes
A 2010 agreement called for the state to move all patients with developmental disabilities out of state psychiatric hospitals, such as Central State in Milledgeville, shown here. ALAN JUDD/

A 2010 agreement called for the state to move all patients with developmental disabilities out of state psychiatric hospitals, such as Central State in Milledgeville, shown here. ALAN JUDD/

Despite 12 years of supervision by a federal court, Georgia’s system for caring for people with mental illness and intellectual disabilities remains a dangerous place, according to a new report.

State officials have failed to meet numerous requirements under a 2010 agreement resulting from an investigation by the Department of Justice, according to a report issued in mid-June by court-appointed reviewer Elizabeth Jones.

Among the issues Jones cited were a failure to protect former patients at state psychiatric hospitals who have been transferred to group homes and other community-based facilities, inadequate efforts to recruit community service providers, and the lack of sufficient beds for people in crisis.

A lack of staff and other issues have rendered one-fourth of the state’s crisis beds unavailable. As of last month, patients had occupied all but five beds — which are supposed to be reserved for short-term stays — for longer than 30 days. One patient had been in a temporary crisis unit since January 2018.

“The reasons for these lengthy placements in crisis homes and hospitals have not changed over the years,” Jones wrote. “There have been and continue to be serious gaps in the community system.”

Because of the bed shortage, the report said, one woman referred to a crisis unit had to remain in jail, where she developed sepsis. She died in a hospital.

Jones’ assessment of the state’s compliance with the settlement agreement is key to determining whether the court’s supervision continues. The agreement has required the state to vastly increase its spending on care for people with mental illness and intellectual disabilities. The federal investigation was a response to articles in The Atlanta Journal-Constitution in 2007 that found more than 100 patients had died in state psychiatric hospitals because of neglect, abuse and substandard medical care during the previous five years.

Jones wrote that staffing shortages have “seriously impeded” the implementation of the settlement, as wages for staff have failed to keep pace with other fields like the fast-food industry or retailers. The lack of staff has forced at least 11 group homes to close, prompting about 30 patients with intellectual disabilities to relocate.

“Unless remedial action is implemented immediately, the situation may worsen,” Jones warned.

When asked for a response to the report’s findings, a spokesperson for the Department of Behavioral Health and Developmental Disabilities defended the state’s “tremendous” progress over the last decade in supporting people with mental illness and developmental disabilities. But the department noted Georgia is facing the same workforce shortages during the pandemic as other private healthcare entities and public safety net providers across the nation.

“These workforce shortages have made the coordination of care for individuals with complex health needs even more challenging than before — in Georgia and across the country,” the spokesperson wrote.

Devon Orland, litigation director with the Georgia Advocacy Office, said this latest report is further proof that the state is still failing to create a system of support for people with developmental disabilities.

“While we can blame the pandemic or staffing shortages, the reality is the state has done little to remedy or get in front of those problems,” said Orland, whose organization looks out for people with disabilities. “When McDonald’s can do a better job with the state and recruitment and retention, that’s when we know that there’s a real problem.”

Jones’ latest report focused on community placements for people with intellectual disabilities. State officials, she wrote, had failed to provide critical oversight in numerous cases, with harmful results.

The report recounted “multiple system failures” that caused substantial harm to a man identified only by the initials MS. Because the state failed to plan for his community placement, he ended up in a medical hospital for several months, where he developed bed sores and a bowel obstruction. Because of the bowel obstruction, the man underwent a surgical procedure known as an ileostomy, which moves waste out of the body.

Another man, identified in the report as ML, was transferred to a new home with only four or five of the more than 20 medications he required. The new home was not notified that he had diabetes, so he did not receive a special diet. His blood glucose level was so high he had to be hospitalized.

But the department argued that the state is making systemic changes to help people with disabilities. They pointed to how the governor and lawmakers have continued to expand community based services and invest in housing vouchers for people with mental illness. The state is also funding an expansion of a waiver program for people with disabilities to pay for care in their homes and to help others transition out of institutions. Starting July 1, there will be 513 new waivers available. Earlier this year, advocates pegged the waitlist at 7,000 people who have already qualified for services.

The department also said in its statement that the state has prioritized the use of federal pandemic relief funds and state appropriations to support a temporary increase in pay for care providers for those with intellectual and developmental disabilities. The relief money will also be used to conduct an independent study to determine whether more funding is needed for home- and community-based services.

“We strongly believe these strategic investments and efforts to bolster the provider community will ultimately be successful in rebuilding our provider workforce, which is at the heart of a robust support system for individuals living with disabilities and mental illness in Georgia,” the department said.

But Orland, the litigation director with the Georgia Advocacy Office, said the state needs to act swiftly to recruit providers.

“There’s been lots of conversations about raising rates and about doing things to recruit and retain quality providers but nothing’s been launched,” Orland said. “It’s because the state doesn’t move with deliberate speed.”

Jones, for her part, asked the state to create a detailed plan with “specific measurable objectives” as to how it will recruit providers. This endeavor is all the more urgent, given that increase in spending for services for people with disabilities.

“It will be extremely challenging to use those valuable resources without reducing staff shortages and expanding provider capacity,” Jones warned.