Developmental Disabilities Administration.
The Developmental Disabilities Administration (DDA) is a division of the Department of Social and Health Services (DSHS) that assists individuals with intellectual and developmental disabilities and their families with obtaining services and supports based on individual preferences, capabilities, and needs. Clients of the DDA may live in the community or in an institutional setting such as a residential habilitation center (RHC).
Residential Habilitation Centers.
The DDA operates four RHCs that provide clients with residential, habilitative support in an institutional setting. The RHCs generally only serve clients age 21 and older, though clients 16 and older may be served on a short-term basis for respite or crisis stabilization services when no appropriate service options are available in the community. The RHCs are federally certified by the Centers for Medicare and Medicaid Services (CMS) as either an intermediate care facility (ICF) that provides individualized habilitative services, a nursing facility that is capable of caring for clients with unique medical needs, or both.
The four RHCs are:
Rainer School.
Rainier School provides 24-hour residential care and teaching in the areas of work or vocational training, leisure activities, social relationships, and everyday life tasks. Between 2019 and 2023, two of Rainier School's three program areas were closed following CMS findings of noncompliance with federal requirements, and residents were relocated. The one remaining program area is CMS certified and is currently serving 58 long-term clients and 15 short-term clients. The Rainier School also operates Klamath Cottage, which was opened in 2020 at the direction of the Governor to move medically stable clients out of acute hospital beds to ensure hospital capacity was available during the pandemic surge, and which provides transitional services while long-term community-based options are pending. Klamath Cottage operates as a non-ICF program with state funds, and currently supports eight individuals. Funding for Klamath Cottage expires in June, 2025.
Yakima Valley School.
Yakima Valley School provides direct care and support to clients with 24-hour nursing care, clinical and therapeutic programs, and recreation and activities. The facility also offers planned respite services and crisis stabilization services. Since 2017, new admissions, other than short-term admissions for respite or crisis stabilization services, have not been permitted at Yakima Valley School, and the facility is scheduled to close when the number of permanent residents reaches eight people. Yakima Valley School is currently serving 36 long-term clients and has 13 additional clients receiving respite and crisis services.
When the Yakima Valley School closes as an RHC, it must operate crisis stabilization beds and as many respite beds as the needs of the DSHS-identified catchment area or as emergency placement needs require, subject to the availability of appropriated funds. The DSHS must provide state operated living alternatives (SOLAs) within funds specifically provided in the budget for RHC residents transitioning to the community who prefer a SOLA setting.
Supported Living Services.
Supported living services support clients living in their own home in the community with support services provided by a DDA contracted agency. Individuals typically live with up to three roommates and receive staffed support based on needs, ranging from a few hours per month to 24 hours per day. Clients pay for their own rent, food, and other personal expenses. State operated living alternatives are equivalent to supported living but are staffed by state employees rather than contracted providers.
By June 30, 2027, the Department of Social and Health Services (DSHS) must close Rainier School and Yakima Valley School residential habilitation centers (RHCs) and relocate current residents. The DSHS may not permit any new admissions to either RHC unless admission is limited to the provision of short-term respite or crisis stabilization services. The requirement remains that when Yakima Valley School closes as an RHC, it must operate crisis stabilization beds and as many respite beds as the needs of the DSHS-identified catchment area or as emergency placement needs require, subject to the availability of appropriated funds.
Within available funds, the DSHS must provide state-operated living alternatives (SOLAs) to residents transitioning to the community as a result of the closures who prefer a state-operated community residential service, and may use existing supported living program capacity in the community for former residents who prefer and choose a supported living program. The DSHS must provide space at other RHCs to those who prefer an RHC setting.
The DSHS, within available funds, must offer RHC employees opportunities to work in SOLAs and other state facilities and programs.
Current law provisions related to the closure of Yakima Valley School when it reaches a census of eight residents are repealed.
The substitute bill retains the provisions of the underlying bill and reinstates the current law requirement to operate crisis stabilization beds and respite service beds as needed at the Yakima Valley School facility following its closure as a residential habilitation center, subject to the availability of appropriated funding.
(In support) The cost of institutional placement is much more expensive than community settings are. As facilities downsize, their cost increases. In this economic slowdown, it is time to close institutions and focus on community services. To do so is a good idea financially, and it is good for people to have a meaningful life. Institutional care is an outdated model, and community capacity will not be built until closures occur. Transferring the workforce to the community is welcome and needed. People are able to receive a wide range of services in the community including catheter care, behavioral supports, feeding tubes, and other medical and dental care. Staff supports can also assist with medication, appointments, and social activities. People with disabilities and parents of children with disabilities have been thankful that recommendations for institutionalization have not been pursued. These children have gone on to have successful childhoods and lives, participating in activities, college, and job opportunities. It would be better if institutional care was not even offered. It is time to move past this. Everyone deserves quality of life and to live in the community. There is plenty of capacity in the remaining residential habilitation centers for those who want to live in one.
Rainier School is a uniquely dangerous place, and all but one of its facilities have been shut down due to repeated regulatory deficiencies, inadequate staffing, unsafe conditions, and severe abuse and neglect. Inadequate supervision has led to resident deaths and sexual assaults. Rainier School is like a prison camp where residents are told where to go and what to do and are given many chores to perform if late. Former residents know what has happened there, including people being choked with towels. Persons residing at Yakima Valley School have been abused, exposed to feces and urine at cafeteria tables, and beaten and raped by staff. All of these people were put there by their parents, and they had no choice. Institutionalization affects a person for life. Please listen to those who have lived in these environments and prioritize lived experience. There is a lot of trauma and fear over being sent to these facilities, which leave lifelong scars. Shut them down.
(Opposed) Community placement is not a viable option for all people, and residential habilitation centers provide a safety net for people with complex needs and those necessitating a level of care that cannot be matched in the community. Closing these facilities would be devastating, and it will result in people ending up in hospitals, jails, and homeless shelters, as the infrastructure for community placements does not exist. Some people have been in the Yakima Valley School crisis beds for seven years because every time they leave they come right back. It will take a decade to build necessary community placements. This population deserves better. A 2019 Ruckelshaus report found that the continuum of care needs to include residential habilitation. It is not true that these closures will save money, as people will end up in more expensive facilities and emergency rooms. Fixing the deficit should not come at the cost of people's livelihoods.
Living in the community is distressing and dangerous for some people. Many people cycle through every other type of placement without success and end up doing well at residential habilitation centers. Moving these people again is not a good idea. Caregivers often cannot control the negative behavior of the person in their care, and fear for their own safety. Police have been called multiple times. As the underlying issue is not a mental health issue, they cannot be involuntarily committed and the only option is arrest for crimes; however, they are also not competent for criminal liability. Some people are subjected to abuse and chemical restraints in community settings. Other former residents have been moved to community placements when stable, only to be put in dangerous situations when community placement staff, who are not trained the same way, are unable to control their behavior. As parts of Rainier School have closed, people have gone into crisis and have died. People with disabilities should not be warehoused in hospitals, subjected to involuntary holds, or sent out of state. This is a failure of care that will expose the state to liability.
Residential habilitation centers are modern, highly regulated places. People with firsthand experience have observed staff caring for residents like family. Residents are offered choices constantly about their preferences and what they want to participate in, and they have opportunities to partake in community activities. Residents are celebrated in reaching goals, getting jobs, and continuing their education, and they take pride in things like working on the facility grounds. Residential habilitation centers are also able to offer onsite medical, dental, and psychiatric care, which are necessary for the safety and wellbeing of the people living there. There are not a fraction of the services available in the community, and some people have had to wait five years for dental care. Additionally, it is easy to shift roommates, caregivers understand the population, and people enjoy more freedom than they would in another placement. These placements allow families great peace of mind to know that their loved one is being cared for by trained professionals. Relationships are what make people succeed. Some people want to stay in these placements, and their decisions should be honored. There are people who have left and begged to come back. There should be more beds at residential habilitation centers where vulnerable people can thrive.
(In support) Stacy Dym, The Arc of Washington State; Shawn Latham, Self Advocates In Leadership; Chloe Merino, Disability Rights Washington; Krista Milhofer, People First of Washington; Julie Clark, Washington State Developmental Disabilities Council; Elizabeth Johnston; Laura Ivanova Smith; Robert Wardell; Mike Raymond, People First of Mason County; and Russell Allphin.
More than 20 persons signed in. Please contact the House Public Records Office at https://leg.wa.gov/public-records-requests/ or call (360) 786-0926.
The Appropriations Committee recommended requiring the Department of Social and Health Services to implement individualized transition plans for residents of closing residential habilitation centers by prioritizing transition factors, coordinating with agencies and stakeholders, providing supports, and enforcing robust oversight and accountability measures.
(In support) Transitioning individuals from institutional settings to community-based care is a fiscally responsible, best practice strategy that aligns with the long-term goals of deinstitutionalization. Evidence from successful models in other states demonstrates that, when supported by comprehensive planning, sufficient funding, and robust crisis and respite services, community-based care can deliver equivalent care at lower costs while offering transformative benefits. This approach promotes greater autonomy, personalized support, and improves quality of life compared to traditional institutional models. This allows for better integration and long-term outcomes for individuals.
(Opposed) Closing residential habilitation centers (RHCs) without a fully resourced and comprehensive transition plan puts vulnerable adults at risk. The planned shift to community-based care lacks the necessary infrastructure, specialized staffing, and proven support systems required for effective implementation, and previous transition failures underscore the danger of repeating past mistakes. Underestimated costs could lead to higher overall expenditures and disrupt existing care continuity. The loss of long-standing relationships with RHC caregivers who are essential for understanding each resident's unique needs, particularly for those with communication challenges would further compromise care quality.
(In support) Cathy Murahashi, The Arc of Washington; Shawn Latham, Self-Advocates in Leadership; and Krista Milhofer, Program Administrator People First of Washington.