September 8, 2009
Governor Pat Quinn has decided that the State of Illinois will shut down its troubled Howe Developmental Center in Tinley Park and move residents to other quarters by April 2010.
The decision, announced on August 28, 2009, came four months after the General Assembly’s Commission on Government Forecasting and Accountability on April 28 backed a recommendation by the Illinois Department of Human Services that Howe be closed. The decision also came after a consultant hired by the Governor supported the closure and the Governor himself paid a visit to the facility.
Officials of the American Federation of State, County and Municipal Employees (AFSCME), which represents workers at Howe, were sharply critical of Governor Quinn’s decision. Some families of residents were also upset that their relatives would have to find other places to stay. Howe currently has 251 residents and about 699 active staff members.
As previously discussed in this blog, Howe, a state-run facility for the developmentally disabled, was decertified by federal authorities in 2007 after reports of substandard care and safety violations, including deaths of residents in unexplained circumstances. Because of the decertification, the State has lost more than $40 million in federal Medicaid funding. Howe is also under investigation by the U.S. Department of Justice for alleged violations of the rights of institutionalized persons.
Anne Shannon, the consultant commissioned by Governor Quinn to review Howe, raised new questions about the facility in her report, which was delivered to the Governor on June 30, 2009 but not released to the public until the announcement of Howe’s closure. Ms. Shannon formerly headed Aspire, a nonprofit group that provides community-based programs and other services for the developmentally disabled.
Ms. Shannon reported that Howe has a total of 760 staff members, but 61 are inactive, meaning that they are on a leave of absence or suspended pending an investigation. After accounting for residents who require additional staff services, Howe has 684 employees for the 250 residents not needing extra care. The report concluded that this staffing ratio of 2.7 to 1 is high compared with the average of 1.84 to 1 at other state-operated developmental centers. Since October 2006, staff levels dropped 2% while the number of residents dropped 40%, according to the report. Ms. Shannon concluded that overtime work and the number of employees on family medical leave are “much higher than average” at state facilities.
The report found that medical charts of 11 residents, including private information such as medications and medical history, were missing. “Management staff is aware of the issue, agree that a policy exists for signing in/out the charts, and that the policy is rarely followed,” the report stated. Ms. Shannon recommended that a review be done immediately to determine how many other charts might be missing.
Since July 1, 2008, there were 51 cases of abuse and/or neglect, according to the report. Of those cases, 13 remain open and 3 have been substantiated.
The report found that some parents and guardians of residents believe that Howe is a permanent residence. Over half of the residents have been at Howe for more than 20 years. However, Howe is actually supposed to function as an intermediate care facility that prepares residents “for a transition to a less restrictive environment,” the report said. Some families of residents are worried that trauma relating to being transferred elsewhere would result in the death of loved ones. Ms. Shannon found that there have been five potential cases of death from this kind of trauma since 2007, out of 85 residents transferred, but she could not say why the residents died or if the death rate was out of line compared with other state institutions.
The report makes general recommendations about the State’s handling of the developmentally disabled that go beyond the fate of Howe. Ms. Shannon recommended that any staff member at a state institution found to be at fault for abuse or neglect “face appropriate consequences.” She urged that state officials provide financial incentives and formal planning to help residents at other institutions move to community care settings. A recent report on the State’s Medicaid program by the Civic Federation’s Institute for Illinois’ Fiscal Sustainability also raised the issue of excessive institutionalization of the disabled in Illinois.