The proposal, broached at a legislative task force meeting on Medicaid, drew audible gasps from those in the audience, but received no immediate response from lawmakers. The Developmental Center in American Fork has survived previous attacks by backers of a decades-long movement to move the disabled out of institutions.
But advocates believe "times have changed," and they're hoping to capitalize on Utah's push to contain soaring Medicaid costs.
If slowing Medicaid spending is a goal, "look no further than the state Developmental Center," Fraser Nelson, director of the Disability Law Center, told task force members. Nelson asked the task force to explore selling the center and putting the profits in a trust to pay for less expensive care options, such as group homes and supervised apartments.
When the center - formerly the "Training School" - opened its doors in the 1930s, American Fork was an isolated farm town. Now it sits on some of the most valuable land on the eastern bench overlooking Utah County, said Nelson.
And although the center serves only about 6 percent - 235 patients - of the 4,000 Utahns receiving services through the state Division of Services for People with Disabilities, it consumes 25 percent of the division's budget.
That's $37.6 million a year, or $400 per person per day, which compares with $75 per person daily for services delivered in people's homes or homelike settings, said Nelson. "There is no reason these services can't be offered in smaller settings in the community."
What's more, said Nelson, institutionalized care is "outmoded."
Though it began as a short-term training school, the Developmental Center has evolved into a place where some people spend the majority of their lives, said Nelson. "While the physical conditions may be less horrific than in years past, it is still an institution. The residents do not choose how to spend their day, what to eat or when to go to bed."
State Human Services officials disagree and contend the Developmental Center fills a unique niche.
It serves the most severely disabled: medically fragile people with multiple diagnoses, some of whom are violent and pose a danger to the community, said the center's superintendent, Karen Clarke.
Clarke said most of her clients are referred by other providers with lower staff ratios and less training. She added that, contrary to the belief that the institutionalized remain institutionalized forever, the average length of stay at the Developmental Center is between three months and one year.
The record of 65 years is held by a man who still inhabits the center, acknowledged Clarke. But she said he is among a group of patients who chose to stay following the state's 1993 settlement of the "Lisa P. lawsuit," which alleged people were languishing and deteriorating in institutional settings.
Historically, parents and advocates have been bitterly divided on how to best care for the cognitively disabled. This, the Developmental Center's place in history and its status as a major employer, complicate any talk of its demise.
The institution supports yet another Utah County institution, providing decent-paying jobs with full health benefits to students at LDS Church-owned Brigham Young University in Provo.
Clarke said the health benefits come as part of the package offered to all state employees. Though wages may outpace those at competing nonprofits, she said, they fall below those at hospitals with which she competes for quality workers.
For now, lawmakers are withholding judgment. But asked whether he would consider phasing out the Developmental Center, Rep. Jeff Alexander, R-Provo, said, "It didn't strike me as a crazy idea."
Nationwide, policymakers looking to control Medicaid growth are examining the long-term care industry. Senior citizens and people with disabilities make up only 25 percent of Utah Medicaid enrollees, but consume 70 percent of the resources.
kstewart@sltrib.com
