COFAR blog

We are supporting the efforts of a number of unions and other advocates for the disabled to save the Pappas Rehabilitation Hospital from closure.

We are also pushing, at the same time, to add the state’s two remaining Intermediate Care Facilities for persons with intellectual and developmental disabilities (ICF/IDDs) — the Wrentham Developmental Center and the Hogan Regional Center — to the list of endangered facilities that must be preserved in Massachusetts.

There appear to be a number of parallels between the Healey administration’s reported policy of restricting admissions to the Pappas Hospital, and its policy of denying most requests for placement at Wrentham and Hogan.

The administration has placed “overly restrictive admissions criteria” at Pappas, according to nurses there. It is a policy that is likely to lead to Pappas’s closure.

As we have long reported, the administration is similarly allowing the Wrentham and Hogan Centers to die by attrition by denying admissions to all but a handful of applicants in recent years.

The 60-bed Pappas Rehabilitation Hospital in Canton offers medical, rehabilitative, educational and recreational services for persons with developmental disabilities up to the age of 22. In January 2025, Governor Maura Healey did announce that she planned to close the facility in order to save money and move the hospital’s programs to the state-run Western Massachusetts Hospital in Westfield.

COFAR joined state employee unions in opposing the governor’s closure of Pappas. That opposition prodded the administration to reverse its public stance. Healey is now saying she has no plans to close the facility, but the nurses there contend the governor’s statements don’t match the administration’s actual policy.

Last month, staffers at Pappas cast a vote of no confidence in Public Health Commissioner Robbie Goldstein in light of the Public Health Department’s alleged efforts to restrict admissions there, the Boston Herald reported.

Denials of admissions at both Pappas and the ICFs

The administration maintains the allegations of restricted admissions at Pappas are “inaccurate and (an) unhelpful escalation.” But the Herald reported that a mother’s request for admission to Pappas of a 12-year-old boy with severe disabilities had been denied. The boy is nonverbal, blind, and has other medical complications.

The Department of Developmental Services (DDS) has similarly routinely denied requests by family members to gain admission of their loved ones to Wrentham and Hogan. One of those cases involved Kristen Robinson, who is profoundly intellectually disabled, legally blind and quadriplegic, and has a seizure disorder and severe dysphagia, a medical condition that causes an inability to swallow.

DDS initially denied multiple requests by Kristen’s sisters, Kim Meehan and Karen Brady, to get Kristen admitted to the Wrentham Center. It was only through exhaustive efforts that included contacting the media, that Kim and Karen were able to get Kristen into Hogan, where she is now thriving. DDS has continued to deny Kim’s and Karen’s requests to place Kristen at Wrentham, which is much closer to where they live.

It also appears that the legal and internal appeals divisions at DDS have a bias against families and guardians seeking admission of their loved ones to Wrentham and Hogan. In at least two cases, a DDS hearing officer denied appeals by families to transfer intellectually disabled persons from corporate, provider-run group homes to Wrentham.

In both cases, the same DDS hearing officer denied the appeals in rulings that used much of the same language, and discounted concerns raised by the families about a lack of adequate care and meaningful activities in “community-based” group homes and day programs.

In both cases, the hearing officer stated that the individuals did not have a right under federal law to placement in an ICF. Also, in each appeal, DDS stated that it was restricting admissions to ICFs to cases “where there is a health or safety risk to the individual or others, and generally, when all other community-based options have been exhausted.”

COFAR is, as a result, urging state lawmakers to adopt language in the state budget, asserting the right to ICF care for all persons who have been found to be eligible for that level of care.

Rhetoric not matching policy

In the case of Pappas, the administration is insisting that there are no admissions restrictions.  The Herald quoted a spokesperson for the governor last month as saying:

Pappas continues to operate as usual, with new patients being admitted and patients being appropriately discharged when they finish their treatment. In fact, the Commissioner has been actively notifying providers of space available for new patients to be admitted at Pappas, and will continue to do so.

At a recent call-in show on Boston Public Radio, Governor Healey made a similarly reassuring statement to a COFAR advocate who asked whether the governor planned to keep the Wrentham and Hogan Centers open. Healey responded, saying, “Rest assured, there are no plans to close any facilities in Massachusetts.”

But the advocate wasn’t given the opportunity on the call-in show to ask any follow-up questions, such as why DDS routinely denies admission to the Wrentham and Hogan centers, and why there has been a steadily declining number of residents, or census, in facilities as a result.

The census at Wrentham dropped from 323 in Fiscal 2012, to 143 in Fiscal 2025 – a 56% drop. The census at Hogan dropped from 155 in Fiscal 2012, to 84 in Fiscal 2025 – a 46% drop.

We are urging all of the advocates for the preservation of Pappas to join us as well in fighting to preserve Wrentham and Hogan. Email or call your House member and urge them to support the upcoming budget amendment establishing a right to care in Wrentham and Hogan. You can find your legislator here.

Saving Pappas and saving Wrentham and Hogan are all a part of the same battle. It is a battle to stop the runaway privatization of state-run care and the race to the bottom in standards that will result from the closure of those state-run facilities.

There is a strange dichotomy in a new book by writer and anti-congregate care activist Alex Green about the professional life of Walter E. Fernald, the first superintendent of what was later to become the Fernald Developmental Center.

On the one hand, “A Perfect Turmoil: Walter E. Fernald and the Struggle to Care for America’s Disabled,” offers a largely positive and sympathetic account of Walter Fernald, who took the reins in 1887 of what was then called the Massachusetts School for the Feeble Minded.

Green portrays Fernald as a complex figure—capable of compassion, self-reflection, and change—as he engaged with the flawed scientific ideas of his time.

In contrast, the book paints the Waltham-based Fernald Center itself in a uniformly negative and what we consider to be unfair light, branding it at the outset of the book as “a nightmare” and “a place of shame.” That stark characterization is not supported by a similarly balanced examination of the history of the facility, which functioned until its closure in 2014.

There is no question that institutions like Fernald experienced serious problems, particularly in the early and mid-20th century. But the book gives virtually no attention to the landmark federal litigation in Massachusetts — Ricci v. Okin — which brought about significant improvements, starting in the 1970s, in the care and conditions at Fernald and other developmental centers in the state.

That omission is not a minor one. The Fernald Center remains a potent symbol in the ongoing debate over the future of care for people with intellectual and developmental disabilities (I/DD), including the role of the two remaining congregate care facilities in Massachusetts — the Wrentham Developmental Center and the Hogan Regional Center. By focusing almost exclusively on the Fernald Center’s darkest chapters, the book reinforces a one-sided narrative that continues to shape policy discussions today.

Green has long promoted uniformly negative views about Fernald, the institution. For a number of years, he organized protests and petitions related to the Fernald site, and wrote a commentary in November 2020 that advocated for deinstitutionalization. He was also instrumental in the creation of a state commission in Massachusetts, which made several uniformly negative statements about institutional care in its final report.

Green’s advocacy on these issues is also relevant in light of the book’s selection last month as the winner of the National Book Critics Circle Award in the biography category.

Book lauds Walter Fernald, but disparages the Fernald Center

Here is Green’s description of Walter Fernald, the man, in the introduction to his book:

When (Walter) Fernald died (in 1924)…(h)e was remembered for his compassion and kindness; for having seen a group of people who were otherwise unseen, as individual human beings deserving of our attention, love, and fellowship.

Green also states, later in the book, that:

No figure in American history did more to develop a link between the expert professions that continue to work with the cognitively and developmentally disabled today… Because of his influence on the world around him, (Walter) Fernald’s story is of immense historical significance, but its greatest importance lies in his capacity for self-reflection, self-criticism, and change.

Green does criticize Walter Fernald for his view that intellectual disabilities are inherited, and for being “a master propagandist (and) a moralist prude.” But that criticism pales in comparison to the assessments he makes about Fernald, the institution.

Here is the opening paragraph of the introduction to Green’s book:

The Walter E. Fernald State School is the most important historic site of its kind in the United States. The nation’s foremost institution for intellectually and developmentally disabled people, the school had a life span that stretched across an expanse of time from before the Civil War into the early twenty-first century. But for those who know its name, it does not stir thoughts of dates, places, or events. It is a threat, a nightmare, a deep-seated fear. It is a feeling. A place of shame.  Its name is a provocation. It should be.

Here is the first sentence of the second paragraph of the introduction:

Sprawling across 196 acres near Boston, the Fernald School is synonymous with the scandal of human experimentation in the 1950s, of gut-wrenching exposes of abuse and neglect, of the futility of institutionalization and society’s widespread failure to confront that fact.

When it comes to Walter Fernald, Green can clearly be quite complimentary. But when it comes to the facility that Walter Fernald ran, he is relentlessly negative. The question is why. Why not treat Fernald, the institution, with the same open-mindedness and fairness that he treats Walter Fernald?

Fernald, the facility, lasted 90 years after Walter Fernald’s death. It was closed over the objections of the families of its 14 then remaining residents, who filed administrative and court appeals to keep it open. The appeals were ultimately unsuccessful.

Why leave out the positive aspects of Fernald’s history after the 1980s, long after Walter Fernald’s death?

The late U.S. District Court Judge Joseph Tauro noted in his 1993 disengagement order from the Ricci V. Okin case that both the major capital and staffing improvements to the facilities and a program of community placements  had “taken people with mental retardation from the snake pit, human warehouse environment of two decades ago, to the point where Massachusetts now has a system of care and habilitation that is probably second to none anywhere in the world.”

Green doesn’t mention that. In fact, he dispenses with Tauro and the Ricci case with one sentence, simply saying that:

In Massachusetts, a series of suits on behalf of inmates, first launched by University of Massachusetts Professor Ben Ricci at the Belchertown State School, were consolidated by Judge Joseph Tauro in federal court, and when Michael Dukakis became governor in 1975, he committed to settling the combined suit by pumping significant sums of money into institutional reform.

Green does not acknowledge Tauro’s conclusion that the reform resulted in a world-class system of both institutional and community-based care. To do so would contradict the narrative that the Fernald Center was never anything other than a nightmare and a place of shame.

Governor asked about Wrentham and Hogan

At a March 27 appearance on Boston Public Radio’s Ask the Governor segment, co-host Jim Braude lauded Green’s book as Governor Maura Healey stood by. Later in the show, Healey took a question from Elaine Strug, a COFAR member and a member of our partner organization, The Saving Wrentham and Hogan Alliance.

Elaine asked whether Healey planned to keep the Wrentham and Hogan Centers open, noting that her son would benefit from the 24/7 specialized medical and clinical care available in either of those facilities. Elaine pointed out that Hogan and Wrentham, which are now known as Intermediate Care Facilities (ICFs), are federally regulated and Medicaid certified.

Healey responded to Elaine, saying, “Rest assured, there are no plans to close any facilities in Massachusetts.” But Elaine was not able to ask a follow-up question as to why individuals like her son are generally denied admission to the centers, and why the administration appears to be letting the centers die by attrition.

Little actual discussion of the Fernald Center

It is also somewhat strange that while Green’s book condemns the Fernald Center, it devotes relatively few of its 368 pages to actually discussing the Center’s sins and shortcomings.

The book instead dwells at length on Walter Fernald’s complex relationship with the eugenics movement in the U.S. and around the world in the early 20^th century. Green also extensively discusses Fernald’s shifting views on the nascent intelligence testing movement during that same period. He notes that while Fernald understood the necessity of such testing, he questioned the methodology that was being developed at the time and whether it was accurate in measuring the capacity of persons with I/DD.

Green further discusses Fernald’s skepticism of the push in the early 20^th century, in line with the eugenics movement, to sterilize people with I/DD. He quotes Fernald as saying that intellectual disability, which was then called feeble-mindedness “is infinitely a more complicated problem than the believers in the potency of sterilization would have us believe.”

Green’s discussion of those topics is the strongest and most interesting part of his book. There is actually remarkably little discussion in the book of conditions in the Fernald institution itself, even prior to the 1980s.

Green does acknowledge that by the time Fernald closed in 2014, the community-system itself wasn’t living up to the promise that had been envisioned for it. He states that, “group homes became isolating and isolated mini-institutions in and of themselves.”

Green also recognizes that by 2014, the parents of the remaining residents were resisting Fernald’s closure, noting that, “They had fought for improvements to the institution and were getting them. Why should they send people into a world (community system) of cruelty and abuse?”

But then Green dismisses the parents’ concerns:

They were unwittingly in the same position as Walter Fernald in the 1890s, making the argument that had failed him because it deprived disabled people of their fundamental rights as a result of something they were not responsible for – the cruelty of the nondisabled.

Green’s is the standard argument in favor of community-based care: Even if the community system is an isolating system consisting of isolated mini-institutions, disabled people have a right to be subjected to those conditions. Even their families need to understand that this is what is best for them.

And Green flatly states that “the institutions were capable of only so much reform. Rampant abuse was impossible to stamp out,” although he acknowledges abuse is “as likely to occur inside or outside of an institution.” So, why does he condemn only institutional care at the outset of the book?

A book that gets institutional care right

The best history of institutional care I’ve read is Ingrid Grenon’s book, “From One Century to the Next: A history of Wrentham State School and the Institutional Model in Massachusetts.”

As I noted in my review of Grenon’s book, her account of the Wrentham Center makes a powerful case that institutions, in themselves, are neither good nor bad. It is how they are run that counts, just as is the case in any care setting. Grenon recounts that the 1920s was a period when the then Wrentham State School, under the direction of its first superintendent, George Wallace, had a caring staff and administration, and offered a multitude of services and activities for the residents.

As Grenon points out, the Wrentham Center, like Fernald and other similar institutions that sprang up in this state and around the country, entered a long decline, starting in the 1930s as they became more and more overcrowded and understaffed. The state schools in Massachusetts were finally brought back to excellence as a result of the Ricci v. Okin class action litigation.

Unlike Green, Grenon, in our view, draws the correct lesson from history of the role of institutional care in Massachusetts and elsewhere around the country.