De-Institutionalizing Louisiana, Part Two: Demand vs. Expansion

Apr 16, 2013

In Boyce, La., St. Mary’s Residential Training School offers both residential care and educational services for individuals with developmental disabilities.

This concludes our two-part series on the state’s goal to wind down the number of individuals living in places like St. Mary’s.

The chapel at St. Mary's Residential Training School in Boyce, La.
Credit St. Mary's Residential Training School

St. Mary’s Residential Training School is a 30-acre facility that provides around-the-clock care to almost 200 adult and child residents, all with some form of developmental disability. The state is trying to move people out of places like this to allow more independent living.

Megan Vetts, St. Mary’s public relations and executive assistant, said their goal is to help individuals learn the skills they need to live in their own homes. But that it's not possible for everyone.

"For most of our residents their disabilities range in the severe to profound range and so realistically that may not be possible but it’s definitely what we’re working towards," said Vetts.

The St. Mary’s campus has three dorms - two for males and one for females - where residents typically live four-per-room. There are also ten group homes for the more independent residents and a plethora of amenities including a 24-hour clinic and a learning center.

The cafeteria looks just like a regular school lunchroom. There’s a food line for those familiar trays and a place to wash off plates and utensils. But Vetts points out there’s something different hanging on the wall -  a book of every resident’s individual dietary needs.

A book detailing every residents' individual dietary needs hangs on the wall in the cafeteria at St. Mary's Residential Training School.
Credit WRKF

"For instance, this child has a low-lactose diet. Pureed meat. Pureed bread. And because they’re lactose, they receive juice or punch," explained Vetts.

To keep track of all these details, Vetts said the staff-to-client ratio is generally one-to-four. But St. Mary’s finances have seen better days, and while they’ve only let budget cuts impact things like employee benefits, rather than services, that could be changing.

Administrative and Health Services Director Christi Guillot said the majority of their revenue comes from Medicaid, an amount allotted at the state’s discretion. She said their overall Medicaid funding has actually seen a 10 percent increase since 2005, when the state began to shut down its institutions, but patient care costs have increased over 28 percent over the same period.

In response to an on-going moratorium on any new beds, some residential facilities have switched the way their care is funded - from an all-inclusive per diem to waivers. The state says waivers, which are used to pay for at-home services, are the cheaper option.

But Rosalind Auzanne, Regional Director of Housing and Disability with the Volunteers of America, said waivers only pay for services and nothing else like rent or food. She said putting people who need 24-hour care on waivers may not be fiscally sustainable.

"So it can be pretty intense and pretty costly."

"They may need a pretty intense, what we call interdisciplinary team, which can consist of everybody from a doctor, to a psychologist to a psychiatrist to a behavioral specialist," said Auzanne. "So it can be pretty intense and pretty costly."

Auzanne said that’s why residential facilities are still needed.

But Sandee Winchell disagrees. She’s the executive director of the Developmental Disabilities Council, a state-affiliated group.

"We believe 100 percent that we need to continue to try and support everyone in their own home," said Winchell.

Winchell said while waivers have increased since 2005, the majority of savings realized from downsizing state-run institutions have gone to balance Louisiana’s budget. 

"The closures of the developmental centers have actually saved our community services from being cut," Winchell said. "But we were not able to get any expansion with those savings."

And now there are not enough waivers to meet demand.

Winchell said although anyone moved out of an institution automatically gets a waiver, the waiting list for others with developmental disabilities has grown to over 9,600 people with a wait of over eight years.

The first part of this series is available HERE.