BEATRICE: Heineman Can't Hide - Has No One Else To Blame

This is just horrible (0.00 / 0)

This shows off Heineman's true colors, as far as I'm concerned.

What century is this?

phat

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by: phat @ Thu Mar 20, 2008 at 16:37:23 PM CDT

That is what has come to be expected from "compassionate conservatives." N/T (0.00 / 0)

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by: BTOz @ Thu Mar 20, 2008 at 21:33:30 PM CDT

Beatrice is beyond reform (0.00 / 0)

With some real effort and leadership, Beatrice will one day be a facility with safe and sanitary conditions for all of its residents.  But it will never be what the residents really need: a safe harbor for their growth as individuals, a place that provides necessary assistance while also allowing for all possible freedom and opportunity to make mistakes and learn.  

Beatrice has been scrubbed clean before, had new buildings erected and new safeguards installed, only to have institutional inertia slow and stop and bring us right back around to the start.  In the meantime, BSDC has never invested sufficiently in programs for individual development and by its very nature is incapable of helping clients feel more a part of their community, a critical first step towards encouraging individual growth and teaching social norms.  

We should use this opportunity to close Beatrice and relocate its residents into community services or smaller, local and less specialized facilities as their needs demand.  At the same time we should bolster and revamp our standards for community providers, with a greater emphasis on training for new staff and independent advocacy on the clients' behalf.  From my own experiences (admittedly limited to the various programs offered in the Omaha metro area), all of these providers do a great job of caring for basic needs and do a good job of providing necessary developmental support.  All of their efforts could be greatly improved in the latter area, and this would be a wonderful time to show that leadership and get the job done.

I say we should use this opportunity because historically one of the biggest roadblocks to closing BSDC has been the parents of Beatrice residents themselves.  They're (understandably) concerned primarily with the safety of their children and uncertain about the dangers that accompany the opportunities offered by community services.  Well, the dangers inherent in institutional services are apparent now as well.  Perhaps this opportunity can spur a new burst of courage and creativity from parents and providers the likes of the movement that first formed the community service model in Omaha in the early 1970s.  We need to reform and rethink, but that really should begin with abandoning the "warehouse" mentality of the late 19th century.

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by: Ryan Anderson @ Fri Mar 21, 2008 at 11:35:04 AM CDT

Community providers are not a cure-all (0.00 / 0)

In many instances, we've put far too much trust in community-based care - to the benefit of no one.  Of course, there are patients who are best served by the Community-based model, and I'm fully in support of getting them into the less restrictive environment where they are most likely to prosper.  But, for many patients, there does remain a need for the centralized care provided by institutions such as the Beatrice State Developmental Center.  We just have to make sure they are properly funded, have well-trained staff, and have adequate safeguards to prevents the failures and abuses we're seeing in this very sad and preventable situation in Beatrice.

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by: Kyle Michaelis @ Fri Mar 21, 2008 at 12:43:59 PM CDT

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Agreed (0.00 / 0)

Community providers are not a cure all.  That is why I pushed  smaller, more local and less specialized facilities (like specific wards of community hospitals) as an alternative for those not suited for community care.  But the big picture is that large scale institutions like Beatrice will never be able to serve clients the way that they must.  That is, so long as they are staffed by human beings.

One of my former clients spent more than thirty years in Beatrice, during a period when it was both "up" and "down" in the minds of the public as well as auditory agents.  She is confined to a wheelchair and had a room on the third floor of a building with no elevators.  She spent year after year after year without ever going outside.  That's not just the product of technology or training.  There are ways to move her around that don't require elevators, and there was certainly some way that rooms could be arranged to give her ground floor access and at least an occassional outing.  The failure to correct this problem for decades (again, decades where auditory agents came in with complaints and came out largely satisfied) is a failure of anyone, no matter what their training, to work day in and day out in a place where hundreds of residents are warehoused and categorized and filed away and still think of each of these residents as individual people.  That's that institutional inertia that wears on everyone, no matter what your training and no matter how passionate you are about your work.  

In some ways, emphasizing basic needs makes this worse, which is something I've noticed from my experience with community services.  The emphasis becomes on risk aversion: make sure every chore is completed, all the paperwork is filed... you come to feel that you've completed your job even if your residents have spent the whole weekend lying around and watching TV.  I don't think it's enough to have clients bathed and fed and monitored.  But in the best case scenario that is all you're ever going to get at a facility like Beatrice.

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by: Ryan Anderson @ Fri Mar 21, 2008 at 13:06:03 PM CDT

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Beatrice (0.00 / 0)

"The parents of Beatrice residents themselves...[are] understandably concerned primarily with the safety of their children and uncertain about the dangers that accompany the opportunities offered by community services."

Actually, the biggest issue in rural Nebraska communities is jobs, and BSDC is still the largest employer in Beatrice.  As we know, the primary cause of rural depopulation is the scarcity or unavailability of employment opportunities for the young.  The economic impact of closure or partial closure of BSDC is much more important than concerns about crimes from group homes.  The actual rate of crime in Beatrice is a huge concern to residents, like it is as an inchoate dread everywhere.  But anybody who has lived in a big city would consider random criminality almost non-existant by national or urban standards.  Beatrice is a safe place to live, and women can walk the streets at all times of the day or night alone.  But there is a chronic shortage of jobs that provide a living wage.

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by: tomdorsch @ Fri Mar 21, 2008 at 13:17:32 PM CDT

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I'm not talking about crime (0.00 / 0)

The concern I reference is about the safety of their children (the residents), not of people in the community.  They're concerned that less centralized care is more dangerous for the residents.  In many ways, they are right.

Employment is a concern, but it should not be determinitive.  The only issue should be whether or not BSDC is the best facility for serving its clients.  If it is not, we should not keep it open.  

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by: Ryan Anderson @ Fri Mar 21, 2008 at 13:22:20 PM CDT

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Sorry (0.00 / 0)

I reread my quote and understand why it confused you.  When I said Beatrice residents, I meant residents of the BSDC, not the city itself.

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by: Ryan Anderson @ Fri Mar 21, 2008 at 13:28:13 PM CDT

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Beatrice (0.00 / 0)

OK, impact on the residents is the most important consideration.  But it is unrealistic to think that a political decision with such economic impact on the community would not be extremely important.  The tax base in rural Nebraska is far more precarious than conditions in Lincoln and Omaha, and viable jobs for residnets is crucial.  

Why is there any reason to believe that deinstitutionalization would worsen conditions?  If it is done right, it should improve, not degrade, individual care.

BTW, there are few "children" at BSDC.  Most of the residents are older adults.  The individual that I vist regularly has been there almost five decaides.

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by: tomdorsch @ Fri Mar 21, 2008 at 13:39:01 PM CDT

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Indeed (0.00 / 0)

It's an important question, just one I'm not equipped to answer.  

And for the record, I'm advocating deinstitutionalization.  Just noting the reality that when you introduce clients into a less guarded community environment, you also introduce new elements of danger and risk.  That's reality.  But that's a trade off we've all decided is valuable in our own lives,  and one that is worthy for many residents of the BSDC as well.

Children, in this case, is a relative term, since I am discussing the advocacy of their parents.  

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by: Ryan Anderson @ Fri Mar 21, 2008 at 13:43:50 PM CDT

[ Parent ]

Beatrice (0.00 / 0)

"Just noting the reality that when you introduce clients into a less guarded community environment, you also introduce new elements of danger and risk.  That's reality."

Without belaboring the point, I'm not sure this is reality.  In a group home, there is close control by at least a better-trained group leader.  In the institutional setting, residents spend one or two shifts under supervision by very junior staff, with far less training and experience than the average group home leader.  The abuses chronicled in the reports, and that form the basis for adverse action by the Feds, would have been less likely to happen in a group home than on a ward where there is a small number of undertrained staff completely in charge of the residents.

There is no intrinsic reason -- other than economic ones -- why a group home setting would not provide more experienced and individualized care than a large institutional setting.

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by: tomdorsch @ Fri Mar 21, 2008 at 14:14:47 PM CDT

[ Parent ]

Well (0.00 / 0)

We may be defining risk two different ways, and I'll admit that you have a point.  Actually, this is one reason why I have hope that this represents an opportunity to sever the notion that institutions are a true cocoon of security for their residents.  As you note, that is obviously not the case.

But there are also special dangers that come from attempting to integrate the developmentally disabled within a larger community.  There's a greater risk that a resident will run away, for instance (close supervision is easier said than done when you're one staff looking after two clients in a large crowd), or that they will get in trouble with the law.  There are also social risks, of course... emotional risks that are less likely if you keep a personal bottled up in a closed and sterile social environment.  These are the concerns I think many parents have, and I think it's important to admit that they are honest risks, albeit ones worth taking in order to have a real life.

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by: Ryan Anderson @ Fri Mar 21, 2008 at 16:10:35 PM CDT

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