Senator Eliot Shapleigh - El Paso, Texas

Cassie Shackleford, 20, who is profoundly disabled, waited years for a group home then was abused there, a relative said. ELIZABETH M. CLAFFEY/DMN

AUSTIN – Kathy Cato's family was ecstatic when her number finally came up. The 43-year-old, who has cerebral palsy and is deaf, had been waiting for nine years to move out of a Lewisville institution and into the state's Home and Community-based Services program – where she was assured she'd get extensive physical therapy, help finding a job, and an interpreter.
Cassie Shackleford, 20, who is profoundly disabled, waited years for a group home then was abused there, a relative said.

The reality was far different. There was no physical therapy, no job, no one who knew sign language in the four-bed group home in Garland where Ms. Cato moved. Bathing was rare. Medical conditions went untreated.

"This has been a six-month battle," said Ms. Cato's sister D'Anna Webber, who has been unable to find another care provider. "First you have a waiting list to get in the community, and then you have a waiting list if your first placement doesn't work out."

Ms. Cato and her family aren't alone. More than 30,000 people with disabilities are waiting for Home and Community-based Services, or HCS – a program that currently serves 12,000 Texans in their homes, a foster home or a small group home. But the services they get once they receive these sought-after community slots often aren't as good as they hoped, the result of underpaid employees, some profit-driven group homes, and state reimbursements that care providers say are simply too low.

While reports of abuse and neglect are less common in these settings than in the state's institutions for people with disabilities, a Dallas Morning News review of Dallas County inspection records shows that the quality of these independent living services varies widely – from decent to deplorable.

In The News' review of three years of state inspection reports, 12 of the 68 HCS providers operating in Dallas County had violations so severe that their state reimbursements were put on hold – the last step before having their contracts canceled. Three Dallas County providers lost their HCS contracts in that timeframe.

And only half of the providers, which range from statewide and national health care firms to small mom-and-pop operations, ever received an inspection that didn't require corrective action.

Complicated issue

The findings complicate the battle cry of those lobbying to shut the state institutions for the disabled: that the services provided in the community are far safer and far stronger than those provided in institutions. These same advocates will testify today before a House select committee on care for Texans with disabilities.

"What the research tells us is that having smaller settings, where people are more visible, decreases the amount of abuse and neglect," said Amy Mizcles, director of governmental affairs for The Arc of Texas. "But one of the biggest concerns I have with people who are so confrontational about closing the state schools and moving people out is, are we sure there are enough quality services back in the community?"

The worst community-based conditions seem to parallel those found in institutional settings.

One Allen provider was repeatedly cited in 2006 and 2007 after inspectors learned that staff members at a group home were tying doors shut with shoestrings, administering expired and discontinued drugs to residents, and transporting clients in a van with shattered glass from broken windows. Employees also used a camping tent as a restraining mechanism, zipping one resident inside for hours at a time.

In another 2007 incident, a McKinney HCS provider failed to take extra precautions after a client threatened to kill himself. Two days later, the client was admitted to the emergency room after overdosing on pills.

That summer, inspectors found that a Dallas HCS provider had allowed residents to live with a roach infestation and a broken air conditioner. The only food in the house was a bag of dried beans and rice, and a pack of bologna.

Two Garland care providers were cited in 2006 for similar conditions. In one house, inspectors found rusty appliances, rotted counters and doors, and a layer of mold and grease covering windows and sinks. In the other, there was no working bathroom, and piles of trash blocked halls and doorways.

Advocates for people with disabilities acknowledge that these stories are horrific. But they say they probably affect only a small number of people. The large majority of people receiving HCS services live in their family homes or in foster care, not in group homes. In Dallas County, where 830 people receive HCS services, the group homes – not the home health-care providers – appear to have the worst conditions.

And they say the numbers do seem to confirm their belief that these placements are safer. State complaint records obtained by The News show one confirmed abuse or neglect case a year for every 27 people in home and community-based care, compared with one for every 17 people in institutions.

State's actions

State officials caution against comparing those records. Investigations are overseen by two separate agencies, depending on whether the alleged victim is in an institution or in the community.

And they stand behind the group homes they regulate, saying they won't hesitate to cancel the contract of a care provider with an unacceptable track record. The Department of Aging and Disability Services has done it 25 times since 2005.

Said Cecilia Fedorov, spokeswoman for the agency: "Every time there's a citation, no matter how minuscule, there's a plan for correction."

Dusty Nixon sees no way to correct what happened to her granddaughter Cassie. After waiting a decade for a home and community-based slot, the autistic and profoundly disabled teenager got one. She was then beaten so hard over the head with a serving spoon at an Arlington group home that she now suffers frequent seizures, her grandmother said.

The HCS slot was supposed to make their lives easier, said Ms. Nixon, who has raised Cassie, now 20, since she was a baby. Instead, she found herself filing police reports and visiting neurologists, and moving Cassie back into her Benbrook home.

"She is spastic now. I'm scared to put her anywhere," said Ms. Nixon, who now receives limited services for Cassie in her home. "It's just sad now, because I've got another set of problems, and so does she."