Elizabeth is one of 70 patients being moved out of James B. Craig Nursing Center in Milledgeville, about half of whom are bound for the Gracewood campus of East Central Regional Hospital. The Georgia Department of Behavioral Health and Developmental Disabilities is closing Craig by Aug. 31, as it has other state hospitals as part of a settlement with the U.S. Department of Justice over poor conditions.
But at least 82 patients died last year after being moved into community settings and the state halted placements of developmentally disabled patients as it worked to find better and safer placements. In a court ruling in July, the state acknowledged that Independent Reviewer Elizabeth Jones, appointed by the court to review how the state was implementing the settlement and the placements, has never found that the state was meeting its obligations to those patients in the community in terms of services and support. After giving the state time to correct that, Jones found in a recent filing that it still failed.
“The systemic problems and weaknesses are known,” Jones wrote. “The Department’s leadership has acknowledged them, without excuses, and, as of this date, has begun to implement some key corrective actions. While meritorious, these corrective actions are not fully realized and have not yet had a significant impact on the services and supports available to individuals placed from the State Hospitals.”
In a spot survey of 19 patients in community settings, when the nurse reviewer was asked if the patient’s “serious physical health care needs” were being addressed, the reviewers answered no for 16 of the patients. When asked if “professional standards of care” were met, the reviewers answered no for 17 of the 19 and said only one patient was getting nursing care that met professional standards, in the reviewer’s opinion.
The state said it will work with experts to come up with a plan by June 30 to bring services into compliance.
While there is not a moratorium on community placements, the state is now doing them on a case-by-case basis, said Chris Bailey, director of communications for the Department of Behavioral Health and Developmental Disabilities.
“The transition process has basically just slowed to a crawl until we find the folks that can handle these (patients),” he said. “We’ve moved a lot of folks out and the folks that we have left have really specific and oftentimes delicate medical conditions that require levels of care that have not been possible in community settings before. We’ve had a really rough time in these last few transitions just trying to find the exact right placement so we’ve really slowed that process to make sure we can find these folks a placement where they need to go.”
Elizabeth Cox was at one time considered for a community placement despite the fact that she cannot talk or move on her own and basically “functions about on the level of a three-month-old baby,” Ann Cox said. When the idea of a community placement was brought up, her mother was “totally 100 percent against it,” she said. “I don’t feel like it’s safe, not for somebody with her disability. Somebody in her condition, they can’t tell you, ‘They’re not feeding me. They’re hitting me. They’re not taking care of me.’^”
Elizabeth was originally on the list headed to Georgia Regional Hospital in Atlanta but Ann Cox lobbied to get her sent to Gracewood, which has a long history of working with developmentally disabled and medically fragile patients, like her daughter. But that means now having to leave behind from her home in Macon, where she moved a couple of years ago so she could be close enough to visit her daughter twice a week.
“I’m going to have to move,” Ann Cox said. “That’s what I plan on doing is putting my house up for sale in the next week. It’s awful. I have a new job that I was supposed to start at Georgia Academy of the Blind in August. I’m going to have to find a job in Augusta.”
As hard as it will be on the families, it will be even more so on the patients, she said. Elizabeth, 29, has been at Craig for 24 years and many others have been there just as long or longer, Ann Cox said.
“Everybody has been there a very long time and it is going to be very hard on them,” she said. “It’s going to be a big switch. Can you imagine? And to be in such fragile health.”