Three men and their home at Templeton
On a freezing cold morning last month, the fields of snow shone in the sunlight as Tony Shepherd drove through the Templeton Developmental Center campus in Baldwinville in central Massachusetts, pointing out the sights.
“It’s God’s country,” he said, of the 1,400-acre campus that stretched around us in all directions. Directly ahead of us loomed the peak of Mount Monadnock in New Hampshire.
At the top of the much smaller hill on which we were driving, a group of cottages, farm houses, and small brick buildings was scattered. Those buildings are home to the 106 residents of the Templeton Center, which has been targeted by the Patrick administration for closure by Fiscal Year 2013.
If you talk to Tony Shepherd and other guardians of the Templeton residents, you’ll often hear the word “miracle” used to describe this facility for persons with intellectual disabilities, with its working farm and dairy operation. I talked to three of those guardians, and each described how Templeton turned out to be the solution to problems that, in some cases, had brought them or other members of their family to the brink of despair.
Here is a brief account of the stories of three of Templeton’s residents. An expanded version of these three stories will be included in the upcoming March issue of our newsletter, The COFAR Voice.
Jimmy Holdsworth
Jimmy Holdsworth, 59, is autistic and nonverbal, and has been at Templeton for more than 20 years.
When he was young, Jimmy’s parents tried to keep him at home, but his behavior was so volatile and unpredictable that they had to be with him constantly, says Judith Holdsworth, his sister and guardian.
Jimmy’s mother and father couldn’t go anywhere without him, and yet they couldn’t leave him at home either. They had almost no social life and no relief. When his parents were finally able to get him into Templeton, they were already in their 60s. “That was the first positive time I remember for my brother and my parents,” Holdsworth said.
At Templeton, Jimmy gets 24-hour supervision and learned for the first time how to control his impulsive behavior. The staff developed a plan for dealing with his behavioral issues and for other related problems, including his need to lose weight.
Jimmy has participated in a wide range of activities at Templeton, from horseback riding to woodworking. Both of those activities have been discontinued in recent years due to budget cuts. Jimmy’s current job at the center is keeping the soda machines stocked.
Jimmy Holdsworth (seated in front) with family members on Cape Cod. Jimmy’s sister and guardian, Judith Holdsworth, is in center.
Tony Welcome
Before he was admitted as a resident at Templeton in 1989, Tony Welcome had been in various group homes and programs, including a homeless shelter. Nothing worked for him, says his mother, Bonnie Valade.
Tony, who has a mild intellectual disability, was constantly in trouble. He particularly liked to steal cars and was once coaxed into lighting a fire in an apartment building. Another time, someone persuaded him to stick a piece of burning paper in the gas tank of a vehicle, which luckily didn’t blow up.
Tony Welcome
“It’s hard to understand how vulnerable he was, that he would do anything anyone wanted him to do,” Bonnie Valade says. ”It was his way of fitting in with the so-called normal people.”
In 1987, Tony spent three months in the Worcester County Jail, where he was beaten badly by another inmate, and had to be placed in solitary confinement for his own protection.
Templeton accepted him two years later, and Tony, now 46, has been there ever since. Since his admission to Templeton, he has not had one instance of troublesome behavior, his mother says. She attributes the turnaround to the tight supervision at Templeton combined with the center’s relatively remote location, which eliminates many of Tony’s previous sources of temptation.
The doors are unlocked in the residence on the Templeton grounds in which Tony lives. Yet, he’s never attempted to run away, Bonnie Valade says.
Valade notes that her son has impulse disorder and psychotic tendencies. “In the community system (of care), he would see a psychologist less than once a week,” she said. ”He needs that on a daily basis. Here (at Templeton) he meets with two different psychologists two to three times a week.”
Valade said that the staff at Templeton has gotten Tony to understand the necessity of behaving appropriately. ”When he starts to slip, they’re on it before it gets out of hand. A lot of people don’t understand,” Valade continued, ”that there are a lot of Tonys out there in the community. They don’t realize that these people have other issues in addition to their intellectual disability.”
At Templeton, Tony works in the dairy barn, where he cleans up, feeds the cows, and helps in the pasteurization process.
Bobby Shepherd
Bobby Shepherd is 66 and first came to Templeton when he was 15.
Bobby has always been a wanderer, his brother, Tony, says. When he was seven or eight years old, he climbed into a fenced-in area in the neighboring farmer’s yard and was found petting his bull, normally a very dangerous thing to do.
Bobby Shepherd (right) with Tony, his brother and guardian, in front of the dairy barn at Templeton
Bobby is verbal and has a moderate intellectual disability. He can’t read or write and doesn’t understand the rules of adult social interaction. As he grew older, he would try to make friends with people he’d see on the street, sometimes putting his arm around women he’d never met. As might be imagined, his attentions often got him into trouble.
He’s been at Templeton for more than 50 years and has lived at the Waite Lodge, a two-story farmhouse on the campus, for the past eight to 10 years. There he shares a room on the second floor with a roommate. On the wall by his bed are photos of horses and one of John Wayne, along with framed sketches of him and one of his brothers, done by their mother when they were young.
Food is prepared and Bobby’s special dietary needs are monitored by the staff at the Lodge, Tony says. Bobby’s medications are administered by a nurse on site.
Tony maintains that at Templeton, Bobby can wander around wherever he likes, in safety. “Everyone knows him here,” he says.
The Waite Lodge at Templeton
At the dairy barn, Bobby puts his arm around Lori Aldrich, his advocate at Templeton. Lori takes him to see movies and takes him horseback riding in the town of Orange, at least 10 miles away, on her own time. ”You’re my honey,” he says to her.
Bobby is also involved with a number of other residents in a can and bottle recycling program at Templeton, and sorely misses it whenever any of his friends are not available to particpate.
Tony Shepherd is concerned about Bobby’s health. He has been experiencing shortness of breath lately and sometimes needs oxygen. If Templeton closes, Tony said, the only place he would consider placing Bobby is in the Marquardt Skilled Nursing facility, which is slated to remain open at the Fernald Developmental Center in Waltham.
One day last fall, Tony said he went to visit Bobby, who seemed out of sorts at lunch in the cafetaria at Templeton. Tony said he asked if the nurse was available, and she was there within two minutes. She checked Bobby’s color and vital signs and returned with a wheelchair and took him to the nurses’ station. There, more examination showed Bobby had low oxygen and stomach pain. He was treated and kept overnight for observation at the nurses’ unit.
Tony Shepherd says he is sure that kind of immediate medical attention is not readily available in the community system, and will no longer be available to his brother when the high level of care provided at Templeton is eliminated.
It’s also unclear what will become of Templeton’s extensive farm operation, in which many of the center’s residents participate. Shepherd notes that during the summer, feed corn is grown on 1,000 acres of the campus. The milk produced by the cows is processed and packaged in the dairy barn and provided to the center’s residents, with the surplus going to local dairy companies. Templeton residents also raise vegetables for the center’s dietary department.
As Bonnie Valade sums it up: “I always thought they would keep this place open, that no one could ever be cruel enough to close it. I still can’t even believe it.”
We need an independent cost analysis in closing developmental centers
It has become apparent to us that the state Legislature needs to commission an independent analysis of the costs and benefits of closing developmental centers for persons with intellectual disabilities in Massachusetts.
We have just reviewed a purported cost-benefit analysis that was submitted to the Legislature last July by the Executive Office of Administration and Finance regarding the planned closures of the Monson, Templeton, and Glavin Centers.
For one overriding reason, which I will explain below, we consider this analysis to be meaningless. Yet, the Legislature is relying on it in making the decision to approve the closures of these critically important state facilities. (The Legislature has already given its okay to the closure of the Fernald Center without even requiring the administration to submit any cost numbers whatsoever.)
First, a bit of background about the EOAF cost analysis. The submission of the report to the House and Senate Ways and Means Committees and the Joint Committee on Children, Families, and Persons with Disabilities was required by language in the Fiscal Year 2010 state budget. While the Legislature was considering that budget, the administration was lobbying heavily against including Fernald in the cost analysis, and ultimately got its way. But it’s a puzzle as to why Department of Developmental Services Commissioner Elin Howe, in particular, fought so hard to exclude Fernald, because the cost analysis produced by the administration for closing the three other facilities is so self-serving.
Here’s the key flaw in the analysis: The EOAF analysis compares what it terms “fully loaded” costs of operating the Monson, Templeton, and Glavin Centers with community-based costs (plus alternative facility costs reflecting “anticipated placement decisions.”) “Fully loaded” simply means the costs include health benefits and other indirect personnel costs paid for by agencies other than the DDS.
The EOAF report concludes that the community-based and alternative facility costs are lower, and, thus, closing the Monson, Templeton, and Glavin Centers will save $20.3 million a year, based on FY09 rates. But the comparison is meaningless because the populations being compared are different.
The Monson, Templeton, and Glavin costs were calculated by dividing their total FY09 budgets by the number of residents in each facility. The community-based costs were calculated by dividing community-based line items in the FY09 budget by the number of residents in the community system.
The problem is that the Monson, Templeton, and Glavin residents are, on average, older, more intellectually disabled, and more medically involved than are residents on average in the community system. (One of the charts in the EOAF report lists the average age as 62.3 at Monson, 59.2 at Templeton, and 51.1 at Glavin.)
For that reason, the developmental center residents require more care on average than do community-based residents, which means that more staffing is needed per developmental center resident, which means the cost is higher. But that does not mean that there will be a savings if the Monson, Templeton, and Glavin Centers are closed. The reason is that when those residents are transferred from the developmental centers to community-based residences, their higher staffing needs will remain. If, as the administration promises, former developmental center residents will receive equal or better care in the community system, the staffing needed to serve them will need to be higher than what is needed for the average community-based resident.
For that reason, we contend that a more valid approach to the analysis required by the Legislature would involve taking a statistically valid sample of residents in the community system who have the same average age and level of intellectual disability and medical issues as the residents at the Monson, Glavin, and Templeton Centers, and only then comparing the services, staffing levels, and cost of care in the two settings.
In fact, an analysis of 250 cost studies in the journal Mental Retardation concluded that when equivalent populations were compared, cost savings were relatively minor when institutional settings were closed; and, if there were any savings at all, they were likely due to staffing costs when comparing state and private caregivers. (Kevin K. Walsh, Theodore A. Kastner, and Regina Gentlesk Green, Mental Retardation, Volume 41, Number 2: 103-122, April 2003.)
There are numerous other flaws and misstatements in the EOAF analysis. Here are just a few:
- The EOAF report lists projected capital expenditures that it contends would be necessary if the Monson, Templeton, and Glavin Centers were to remain open. However, the report fails to list corresponding capital expenditures that will be needed to develop new community-based residences for the Monson, Templeton, and Glavin residents. The EOAF report projects that a total of 213 residents of those facilities will be transferred to new and existing community and state-operated group homes.
- The EOAF report states that there is “virtually no new demand for facility beds” due to expanded community-based options for individuals created through legislation. This claim ignores the vast majority of the residents of the Fernald Center who have chosen facility beds rather than to be transferred to community-based housing, and it ignores the 59 residents of the Monson, Templeton, and Glavin Centers, who are projected in the EOAF report itself to chose beds in other developmental centers. The report also fails to mention that the developmental centers have been essentially closed to new admissions since the 1980s and that people waiting for DDS supports and services have been largely prevented from choosing the centers as residential options.
- The EOAF report implies that community-based options are sufficient for everyone who wants or needs them. The administration has never explained how it can promise comparable or equal or better services in a community system in which strict Medicaid requirements that apply to the developmental centers have been waived, and which is admittedly under-funded. The report also neglects to mention that the people waiting for community services in Massachusetts may number in the thousands.
- The EOAF report claims that the DDS’s Quality Management and Improvement System (QMIS) has been “effective in creating safe and healthy environments” in the community system. What the report doesn’t say about the QMIS licensure system is that it fails to cover the entire group home system in a comprehensive or systematic way. The House Post Audit and Oversight Committee has reported that only 20 percent of community-based group homes are surveyed for licensing each year.
In short, the Legislature asked the administration for a comprehensive analysis of the costs and benefits in closing the Monson, Templeton, and Glavin Centers and for information about the quality of care in the developmental centers and the community, among other issues. What the administration provided was a public relations document, which attempts to justify the administration’s ideology that all institutional care is bad and should ultimately be supplanted by privatized care in community-based settings.
In our view, it is imperative that an independent auditing agency conduct an unbiased and comprehensive analysis of costs and benefits subject to legislative approval prior to closing any developmental center in Massachusetts.
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