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North Dakota's institution takes steps to reduce admissions

Bismarck Tribune - 1/6/2019

Jan. 06--The state-run institution for people with disabilities has devised a new plan to keep individuals in their homes and return institution residents -- some who have been there for several years -- to their communities.

Administrators at the Life Skills and Transition Center in Grafton have included additional funding in the center's proposed 2019-21 budget to create a statewide team that would work with community providers to help keep people with developmental disabilities in their homes.

Population at the Life Skills and Transition Center

Adults: 51

Youth: 15

Source: North Dakota Department of Human Services

The request to expand the team -- called the Clinical Assistance, Resources and Evaluation, or CARES -- totals about $970,000 and would include 7.5 full-time positions. Gov. Doug Burgum included funding for the CARES team expansion, as well as additional funding for the institution, in his budget proposal.

Disability advocates, including representatives of The Arc of North Dakota and North Dakota Protection and Advocacy, are welcoming the proposal in hopes that it will prevent future admissions to the Life Skills and Transition Center.

"I definitely think anytime we can put resources into communities to help with crisis intervention, it's a positive thing," said Pam Mack, director of program services for P&A.

Sue Foerster, superintendent of the Life Skills and Transition Center, said the request to expand the CARES team will move available resources from the institution to communities.

An attempt to expand the CARES program during the 2015-17 biennium failed due to high costs, according to Foerster.

For the next two-year budget cycle, the LSTC had to eliminate 20.5 full-time positions, Foerster said. But, the institution would get back 7.5 full-time employees, if state lawmakers approve the request to expand the CARES program, she said.

Tom Eide, director of field services for the state Department of Human Services, which oversees the LSTC, said the state agency and the institutions it manages all had to find efficiencies for the next biennium, including the State Hospital in Jamestown, which he said is planning to reduce its number of beds from 100 to 80.

"With the LSTC, we're trying to continue to reduce that permanent population of people that are on site, but really continuing to expand our function as a safety net for (community) providers across the state," Eide said.

The 7.5 full-time positions would likely be placed at the eight regional human service centers across the state, Eide said. The CARES program has existed since 1995, and currently there are 10 full-time employees on the CARES team.

Mack said, when people with disabilities are in crisis, they are limited in the amount of support available to them in their communities in the state. This also is the case for people with behavioral or mental health needs.

"As a result of that, we were seeing people having to utilize psychiatric units or the Life Skills and Transition Center in Grafton as a service gap if they were in crisis," she said, adding that she's hopeful the CARES team will bring resources to individuals.

Last legislative session, Sen. Nicole Poolman, R-Bismarck, introduced a bill that would study replacing the LSTC, but it failed in the Senate. Instead, language was added to an overarching bill studying behavioral health and developmental disabilities needs in the state, which included the role of the LSTC.

Poolman was a member of the interim Health Services Committee that undertook the study. No bills specific to the LSTC resulted from the study, though lawmakers toured the institution in 2017.

"I certainly hoped that the study showed that we needed to do better in terms of making sure that level of care is available not just in Grafton, but across the state," she said.

Poolman said she was frustrated by the lack of information available to lawmakers about youth entering the institution, a population that has grown in recent years.

"As a legislator, it's difficult to make suggestions in terms of where we should be targeting our resources to improve the quality of life for people across the state when we aren't able to know where these folks are coming from," she said.

Poolman said she doesn't plan to introduce any legislation specific to the LSTC this session, but, as a member of the Senate Appropriations Committee, she intends to "push" the Department of Human Services for a plan to improve crisis level care across the state.

In addition to supporting the CARES program expansion, Poolman said she also would like the LSTC to reduce the amount of time people spend there, including residents who spend, on average, about two years on a list the institution uses to deem them community-ready.

"We need to provide community-based crisis care for people with disabilities so they can live near their families and live in their hometowns," she said.

LSTC's budget also includes $2.1 million in renovation projects at the institution. Foerster said the funding would be used to renovate two newer buildings and move staff and residents elsewhere on campus into these two buildings. This would result in a "smaller footprint" at LSTC, according to Eide and Foerster.

Also, the LSTC has requested $916,000 to demolish two unused buildings that were included in the institution's 2015-17 budget, but were eliminated due to state budget cuts. Foerster said the buildings, which are more than 20 years old, "need a lot" of renovation work, and it would be wiser to demolish them.

"At this point, they're almost hazards because of the condition they're in," Eide said. "And the cost of the renovation far exceeds any value we could possibly get out of the facility at this point."

Efforts to reduce the population at the Life Skills and Transition Center were ramped up in 2005, when legislation was passed to transfer more residents out of the LSTC and into their communities. Also, DHS convened the Transition to Community Task Force, which previously set target population goals for the LSTC.

The task force set new goals this year for the LSTC, which includes reducing the number of beds and developing "community transition plans" for each resident.

Though there is no specific target population goals right now, Foerster said the CARES program and the community transition plans will "naturally decrease" the population at the LSTC.

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(Reach Blair Emerson at 701-250-8251 or Blair.Emerson@bismarcktribune.com)


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