Background: The state operates five residential habilitation centers (RHC) established in statute to provide services and housing for persons with developmental disabilities: Rainier School in Buckley, Lakeland Village in Medical Lake, Fircrest School in Shoreline, Frances Haddon Morgan Children's Center in Bremerton, and Yakima Valley School in Selah. Today approximately 900 individuals reside in RHCs, as permanent residents, for short term or respite stays. There are 36 individuals under age 21.

Over the years there have been repeated efforts to reduce the number of people in RHCs as trends for providing services to persons with developmental disabilities have increasingly focused on doing so in community settings. Today, the Department of Social and Health Services (department) provides community-based services through a number of programs to approximately 20,000 clients. These are designed as alternatives to institutions for eligible individuals with developmental disabilities who either live with family members, in rented housing, or in contracted or licensed residential housing in the community. Besides the individuals who receive some services either through RHC or in the community, an estimated 14,000 eligible clients do not receive any paid services due to lack of available funding.

Currently the department is implementing plans to close two of the five RHCs: Frances Haddon Morgan, by June 30, 2011, and Yakima Valley School by December 31, 2012. The closure of these facilities is included in the Governor's proposed budget for the 2011-2013 biennium. All of the 50 residents of Frances Haddon Morgan will be relocated to either a community residential placement, such as a state operated living arrangement (SOLA) or to one of three remaining RHCs.

The department plans to set up three new SOLAs, and is currently working with Fircrest, Lakeland, and Rainier to accommodate residents leaving Frances Haddon Morgan who do not want a community placement.

It is planned that the first ten residents leaving Yakima Valley School will do so by the end of 2011. The department is planning to establish crisis stabilization programs for children and adults using, where possible, institutional staff who will no longer be employed at the closed facilities.

Summary of Bill (Recommended Second Substitute): Section 4. It is clarified that RHCs should serve adults and requires that RHCs no longer accept children under age 21 as of July 1, 2012. Individuals between age 16-21 are allowed to receive short-term respite services in the RHCs.

Section 5. The permanent establishment of RHCs is removed; DSHS may provide services at Fircrest, Medical Lake, Yakima, and Rainier. References to Frances Haddon Morgan Center are removed.

Section 6.

DSHS is directed to close Frances Haddon Morgan Center by December 31, 2011.
New admissions are prohibited to Yakima Valley. Current residents are allowed to remain in the facility and short-term respite or crisis stabilization services are permitted. Eight crisis stabilization and eight respite beds at Yakima are established.
Within available funds, DSHS is required to allow nonprofit entities to purchase one or more cottages at Frances Haddon Morgan Center and convert them to use as SOLA's, within certain conditions.
It is clarified that DSHS must not execute additional downsizing.

Section 7.

Within 60 days of admission to an RHC, DSHS may modify the individual habilitation plan (IHP) to add a discharge plan. The discharge plan should be person-centered and specify the services needed if they move to the community.
DSHS must limit the ability of SOLAs to reject clients.

Section 8. A Legislative Task Force is created to consider the future uses of the remaining RHCs (Fircrest, Lakeland, Yakima, and Rainier) and report to the Legislature by December 12, 2012. The task force is to include legislators and representatives from stakeholder groups.

Section 11. Beginning November 1, 2012, and annually thereafter, DSHS must report on its progress toward meeting the requirements of this act, including client and guardian satisfaction; stability of placement and provider turnover; and safety and health outcomes.

EFFECT OF CHANGES MADE BY WAYS & MEANS COMMITTEE (Recommended Second Substitute):

Section 4 – Clarifies that RHCs should serve adults and requires that RHCs no longer accept children under age 21 as of July 1, 2012. Allows individuals between age 16-21 to receive short-term respite services in the RHCs.
Section 5 – Removes the permanent establishment of RHCs, but states that DSHS may provide services at Fircrest, Medical Lake, Yakima, and Rainier. Removes references to Frances Haddon Morgan Center.
Section 6:
- Directs DSHS to close Frances Haddon Morgan Center by December 31, 2011.
- Prohibits new admissions to Yakima Valley. Allows current residents to remain in the facility and permits short-term respite or crisis stabilization services. Establishes eight crisis stabilization and eight respite beds at Yakima.
- Requires, within available funds, DSHS to allow nonprofit entities to purchase one or more cottages at Frances Haddon Morgan Center and convert them to use as SOLA's, within certain conditions.
- Clarifies that DSHS must not execute additional downsizing.
Section 8 – Creates a Legislative Task Force to consider the future uses of the remaining RHCs (Fircrest, Lakeland, Yakima, and Rainier) and report to the Legislature by December 12, 2012. The task force is to include legislators and representatives from stakeholder groups.

EFFECT OF CHANGES MADE BY HEALTH & LONG-TERM CARE COMMITTEE (Recommended First Substitute): The names of all five RHCs are restored to the statute. All references about closing RHCs are removed. All references related to RHCs only serving persons 21 and older are removed. Any savings achieved through consolidating or closing RHCs will be deposited into the Community Residential Investment Account created in the state treasury. The savings will be used to extend services to people with developmental disabilities receiving limited or no services or to enhance rates paid to community residential service businesses.

Staff Summary of Public Testimony on Original Bill (Health & Long-Term Care): PRO: Children should not be in institutions where the average age is 45. This bill does not propose ground breaking ideas. Most of what is in it happens today, but the trend continues to be moving people into the community and we need to state explicitly in law the process for doing that. It is important that plans for moving people out of institutions are carefully designed and administered, and that families and guardians are involved.

Segregating children is bad for them. They should not grow up in an institution. There are many, many people in the community who have higher acuity levels than people in institutions. We can build a community system but we can't do it if we keep supporting huge institutions that are not full.

CON: This would eliminate choice and that is against the law. If children are forced to leave institutions, they will be shipped out of state. My daughter has done so much better in an RHC. Her terrible behaviors have been dramatically reduced. There were no services for her in the community. Keep these institutions open as regional centers for the developmentally disabled. There is expertise in RHCs that can't be found anywhere else. If my developmentally disabled son loses his job at Yakima Valley School I don't know what we'll do. We need a better safety net for the most vulnerable people in our communities. This is not the way to achieve that.

Persons Testifying (Health & Long-Term Care): PRO: Senator Kline, prime sponsor; Scott Livengood, Chad Hogman, Community Residential Services Association; Lance Morehouse, ARC of King County; Sue Elliott, ARC of Washington; Diane Stadden, parent; Ed Holen, Developmental Disabilities Council.

CON: Julianne Moore, Sue Henricksen, Washington Federation of State Employees; Teresa Davis, Lynn French, Toni Penuel, SEIU; Maria Walsh, Terri Anderson, Friends of Firecrest; Cheryl Felar, Because We Care; Saskia Davis, Action DD.

Staff Summary of Public Testimony on Recommended First Substitute (Ways & Means): PRO: This bill is needed; there are too many RHCs and too much capacity. The community care is safe.

CON: This bill hasn't been fully developed with stakeholder input. The bill came up today with very little notice. Moving too quickly on this issue could significantly impact the state's most vulnerable individuals. The level of care in the community isn't sufficient. DSHS doesn't really allow families to access care in the RHCs, many more families would like to have their loved ones cared for in an RHC.