SORC AND NORCE: AN OKDHS PERSPECTIVE

Mark Beutler: The Southern Oklahoma Resource Center in Pauls Valley, commonly referred to as SORC and NORCE, which is the acronym for the Northern Oklahoma Resource Center in Enid are state owned facilities that care for developmentally disabled citizens many of whom have been there for decades. 

The buildings at both centers have been maintained as best as possible but time, over a century for some buildings, will take a toll on any structure. There are massive repairs required to bring the buildings up to a minimum standard. Repairs that add up to millions of dollars that have not been funded for quite some time. 

You may remember the Oklahoma Human Services Commission had researched and discussed the future of the two remaining long-term care facilities. 
The vote was to have taken place at the July Commission meeting. Providing input were family members of the residents, representatives from Pauls Valley city government, and a representative from the Oklahoma Public Employees Association. 

Needless to say there are many different perspectives on this issue and they are all valid and very emotional. In the balance of this decision are jobs, city revenue, state tax dollars, the residents' and their families' sense of security and, of course, the quality of life for the residents. 

As with many decisions on the Commission agenda, this one has far reaching consequences. Jim Nicholson, the Director of the Developmental Disabilities Services Division, also addressed the Commission to present the perspective of OKDHS. 

We thought it would be a good idea to sit down with Jim and have him explain to us the situation. He told us how Oklahoma wound up with this facility-based model of service delivery in the first place.

No Audio: Jim Nicholson, Director Developmental Disabilities Services Division
 
Director Jim Nicholson: Well, the practice that existed in states from the early 1900s was to put people in big facilities in rural parts of the state. Over time you had these huge state facilities in operation and particularly in the eastern part of the country, but we had a pretty significant number in Oklahoma as well, that were very large in terms of the resident population, were very understaffed, were very underfunded and what was really required was that the higher-functioning residents who lived in the facility took care of lower-functioning residents who lived there and to carry on a lot of the businesses that the facilities had. 

A lot of them had institutional farms and other kinds of things that the residents really did on an unpaid basis. They were really kind of uncompensated, some would say "slave labor" that were in these facilities and it was barely custodial care, if that. 

Mark Beutler: This model was the nation's standard until President John F. Kennedy began to address the issue, in large part due to having a sister with developmental disabilities. 

No Audio: Photo of Rosemary Kennedy

Director Nicholson: The awareness was created after the Kennedy administration and, finally in 1971, Congress adopted the ICFMR program which was the Institutional Long-Term Care part of Medicaid. It wasn't because the facilities were best practice or had been or were operating as the result of any conscious decision that this was the way that people needed to be treated. It was simply the existing practice that the Federal Government tried to correct. 

Mark Beutler: As time went by, in state after state, residents filed class action lawsuits in favor of more community-based services to be offered to this population. Oklahoma went through this legal challenge in the mid-1980s. 

The trend, bolstered by the lawsuits and backed up with research, was to begin phasing out facilities and placing residents in group and private homes by taking services to the clients. It was now known that the same level of care could be provided while eliminating the cost of upkeep on large, old buildings. 

Director Nicholson: I think one of the problems, or one of the challenges that any state faces with public facilities is they're dependent on the state budget and they're dependent on having available revenue to maintain facilities. And they become, really, hostage to the budget process. In Oklahoma there has simply not been funding provided for capital improvements, 

Mark Beutler: This is partly because the Federal Government is reinforcing the community-based model through funding requirements. 

Director Nicholson: One of the things that I told the Commission was that 
I think that in the future we can look at the Federal Government saying at some point, "We're not going to support these large institutions anymore." You know, in order to get federal support you're going to have to have a smaller facility, maybe 16-bed or less, or there's going to have to be some criteria that qualifies for federal funding. 

I think that we're really at the point where we've got to decide, "What do we do?" Are we going to summon the will to close the facilities and move people to a more integrated, more community-involved setting or are we going to invest a lot of money to maintain this current service model? 

One of the arguments that's frequently used to maintain the existence of facilities services is that you have a unique population who live there who could only be served there and they can't be served in a community-based setting or some less restrictive environment. 
We have a 20-year history of deinstitutionalization in Oklahoma that clearly provides evidence that that simply is not true. People can have their needs met in a regular family home or in a group home or in a shared living arrangement. 

Mark Beutler: Throughout this process it's been clear that everyone involved has made an effort to understand other points of view. But it's an emotional issue for everyone. There's a lot on the line for all parties. But Jim Nicholson reminds us of the philosophy that has been the driving force in his long career working to provide the best care possible for people with developmental disabilities. 

Director Nicholson: A lot of the discussion that has surrounded the future of the facilities has been fear-based and emotion-based and it's fear of what's going to happen if somebody moves and you have people who believe that everyone's going to die or their whole health condition is going to deteriorate. 

But the reality is this discussion is not about fear and it's not about death, it's about life. It's about a meaningful life and that we have an obligation as a state agency that funds services for people with developmental disabilities to ensure that the life that they have is the highest quality that we can manage with the services we have available. 

Mark Beutler: If you would like to know more about the history of the Developmental Disabilities Services Division, visit www.wagons2waiversok.com. Here you will find a beautifully constructed documentary that traces Oklahoma's care of these vulnerable citizens.