Mr. Bailey's testimony

Testimony from William Bailey

My name is William Bailey, and I am the Chief Steward for the Service Employees International Union, Local 668, F-4 Shop at the Polk Center. I represent the professional support employees at Polk State Center. We are the social workers, speech-language and hearing specialists, occupational therapists, psychological services specialists. We are the residential, therapeutic, vocational and recreational workers. Many of our positions require advanced degrees, licensure, and professional certifications. Interestingly, we civil servants make considerably less in comparison to the national average of salaries for professionals in our fields of expertise. I'm am not asking for a pay raise, Senators; rather, I am pointing out that every one of us chooses to work at a State Intermediate Care Facility not for the money, but for the opportunity to work with some of the most amazing individuals in the Commonwealth.  We choose to work at State Centers because we love the jobs we do, and we love the people we work with.

With that being said, I would like to discuss two realities within the community of people with intellectual disabilities that need attention drawn to them in relation to the announced closure of the Polk and White Haven facilities. The first reality is the fact that the population of Pennsylvanians, in general, and therefore the population within the community of people with intellectual disabilities, is aging. It is important to realize that I am not just referring to to the individuals with a diagnosis of intellectual disability, but also their family caregivers. Many individuals waiting for additional supports and services at this point still live with their families. According to the Pennsylvania Waiting List campaign report from 2016, 84% of individuals on the PA waiting list still live with their families. Additionally, there are currently 2,499 individuals identified on the emergency and critical needs lists who have caregivers over 60 years old. These individuals and their family members are not getting any younger. According to the World Health Organization, there are numerous concerns regarding meeting the needs of older individuals with intellectual disabilities. There is a general lack of organized public and private sector systems designed to address their needs. There is a greater need for supportive services, health surveillance and provision, and family assistance.

Finally, many health care providers fail to recognize the special problems experienced by individuals with intellectual disabilities as they age. Housing is often inadequate and health provision neglected. Older adults with intellectual disabilities are often marginalized and not provided with the support necessary to be productive members of their societies.  Rehabilitative services, vocational opportunities, and quality old-age services are not provided. Mental health provision schemes are often inadequate and do not recognize the special needs of adults with intellectual disabilities as they age.  Health care provision may be sketchy at best, and specialty services for people with intellectual disabilities are not available, further compromising their health and potential longevity.

When I think of the place I work, I realize these issues are currently being addressed with thehighest quality of care. The individuals living in our State Centers do not need to worry about these issues because they're addressed every single day. We have round-the-clock medical teams which ensure there is no need to rely on urgent care or emergency room services, except for the direst needs. Numerous individuals at Polk State Center require ongoing assistance from medical technologies, and luckily, Polk Center has been outfitted to ensure that even in the event of a power failure, there is no interruption in services. How many community homes have hardwired back-up generators?

We have physicians employed full-time with considerable knowledge of the medical needs of eachindividual. Most of our physicians and contracted specialty physicians have worked with the individuals at Polk Center for years and know them personally. If an individual needs to be seen by a psychiatrist or a neurologist, they are typically seen within the week. Often in community or group homes, an appointment for these services may not be scheduled for months, thus requiring emergency placement. The specialists on the interdisciplinary teams at Polk work full-time shifts,allowing for immediate access to professionals who know our residents as a person and are intimately familiar with their history of support services. As the individuals age, new issues are more easily identified because of the level of familiarity, and supports can be more quickly modified or added to ensure stability in the resident's quality oflife. These realities contribute to "differential mortality," the concept that healthy people tend to live longer. One need look no further than a State Intermediate Care Facility to see the reality of this, as many of the residents currently at StateCenters not only live longer but better lives because they are receiving the necessary health care and social supports to ensure their life span is of utmost importance.

This brings me to the next population of interest: the younger people who have been admitted through the courts. For the past many years, most of the residents recently admitted to the State Centers were admitted through a 406 commitment process. With this process, the State has 30 days to arrange forthe transition of the individual into a State Intermediate Care Facility. What many people don't realize is there is also a 405 commitment process, which requires an immediate placement into a state facility. The fact is, our State Centers have been getting new intakes, and they all have similar backgrounds. They are younger, and prior to coming to a State Center, most were receiving services from community-based providers. These types of residents are now are court committed to a State Center because the community based providers were unable to provide the necessary level ofsupport to assist them in the community successfully. This is not being stated to imply that community-based providers are lacking or unprofessional in any manner. It's simply admitting the fact that there is a population within the intellectual disability community that has extreme behavioral issues that are compounded by their intellectual disability and often other comorbid medical concerns. All community-based providers have the professional expectation to admit when they can no longer support someone in the community, and this has been happening. The problem many of these young people face is that, by the time they are court committed to a State Center, they have had many failed community placements, which makes them "less appealing" for future community placement. The staff members of our State Facilities do not have the option of saying that we cannot provide the necessary support that these residents desperately need. Time and time again, we have taken in someone through the court commitment process and seen the individual stabilize in their behaviors and begin to lead a more fulfilling life.

Though the current argument is that court commitment is a rare occurrence, more and more people with intellectual disabilities are reaching what isknown as the Service Cliff, where they age-out of the existing early intervention services which they have relied on for years. I believe that we are seeing only the tip of the iceberg, and as time goes by, the potential for an exponential increase in the individuals coming before the court system will dramatically rise. To combat that coming rise in court commitment, we should be talking about reinvestment in the State Centers, not closing them. Multiple professionals at the Polk Center have proposed the creation of a specialized intake, stabilization, and transition unit specifically to accommodate the needs of younger people, but these proposals have fallen on deaf ears or have been drowned out by the clamor to shut down all of Pennsylvania's State Centers. The numbers don't lie. In a report published in November of 2015 concerning the prioritization of urgency for need for care (or PUNS report), there were 4,463 individuals in Pennsylvania on the Emergency Waiting List alone. Keep in mind the waiting list is divided into emergency, critical, and planning lists. Fast forward to May of 2017, and there were 4,905 people on the emergency waiting list. This is an increase of 442 individuals in less than two years. This is not a secret, as I was able to obtain these numbers from the Primer Newsletter put out by Representative Joe Markosek, Democratic Chair of the House Appropriations Committee.

In closing Polk Center and White Haven, it's clear that the intent is to shift an additional 305 individuals (who arecurrently receiving the highest quality of service) into that same arena of emergency need. Many proponents of the closure of State Centers cite the Olmstead Litigation as a source to justify their desires. There are three primary components of the Olmstead decision. First, the State is responsible for providing community-based services when the State's treatment professionals determine that community placement is appropriate. Each year the individuals living at State Centers participate in a review of their individualized service plan, and their eligibility to receive services at a State Intermediate Care Facility must be reconfirmed. The second aspect of the Olmstead Litigation clearly states that the person being considered for community placement can not be opposed to this change in placement. It is my understanding there were numerous individuals at both State Centers who are verbal and expressed very clearly that they did not want to move into the community but instead were choosing to stay in the place they have called home for the majority of their lives. Third, the State has the available resources to provide community placement. As I stated earlier, the number of people on the current waiting list requiring immediate services has increased and continues to do so. These individuals represent the very people who currently receive services at our State IntermediateCare Facilities, in that many are elderly, lack family members to care for them, and have a constellation of needs in addition to their intellectual disability. They represent the very people the state cannot provide community-based services for now.

Often, the fact the State Centers are operating at less than maximum capacity is cited as just cause forconsideration of closure. In fact, it was stated that in 2014 that only 991 beds were being utilized between all of the remaining State Centers, which left them operating at less than half their capacity. The sad truth is that even if we reopened admissions to the State Centers and utilized every available certified bed, the State would still not be able to accommodate even half of the individuals currently on the emergency waiting list. The rapid-fire announcement of the closure of not one, but two State Intermediate Care Facilities in no way reflects the ruling requirements of the Olmstead Decision. Instead, it exposes the overwhelming difficulty the Commonwealth has had in meeting those basic requirements.

In closing, I share with you that at the community hearing for the Polk Center, a Chief Executive Officerfor a community-based provider ~poke. He discussed the overwhelming shortages in direct service professionals currently facing the Commonwealth. In the end, he provided an analogy of the support system for people with intellectual disabilities in Pennsylvania was like a house completely engulfed in flames, and the decision of the Office of Developmental programs to close two State Centers was akin to trying to build an addition on that already burning house. The Commonwealth should recognize that it has a system already in place, staffed by highly trained and experienced treatment professionals, and we should be looking for new ways to renew and revitalize a long-standing tradition of the highest quality of care for the citizens of Pennsylvania who are our most vulnerable and are most likely to fall through the cracks. At Polk Center, we can't decide we don't have what it takes to provide the necessary support. As essential employees, we work all day, every day to ensure that the residents under our care can move forward with their lives while providing the highest quality of care.