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"I can say he's alive today because of the quality of care at the state school," Miller says.
The push to move residents from state schools to community services motivated Miller to get information on abuse or neglect in the private homes, thinking his son might eventually end up in one. Even though the same agency — the Department of Aging and Disability Services — monitors state schools and private homes, the disparity between standards was shocking to Miller.
For instance, a division of DADS creates specific rules on how to care for patients, according to Fedorov. A separate agency, the Department of Family Protective Services, investigates reports of violations of those rules at the state schools and has a zero-tolerance policy for any confirmed cases of abuse.
"Every single instance of abuse or neglect, no matter how small or unlikely, has to be reported," Fedorov says.
A different division of DADS oversees the private homes. Providers are required to report any injury to the agency, Fedorov says, but if a complaint is made, even if it involves abuse, investigators can only check if the homes are complying with state and federal regulations. For instance, if an allegation is made that a staff member hit a resident, state investigators can check to see if a background check was done, if the employee is licensed and if the group home has written policies to investigate complaints. The state can't question the residents or the home's employees or initiate criminal proceedings.
"Investigators will be sent out, for example, to make sure there are bars on the walls for residents to hold onto, or that the hallways are wide enough, or things of that nature," Fedorov says.
Even Choate, the Arc of Texas spokeswoman, acknowledges the lack of oversight in community services is a problem.
"They're not being properly monitored, so we definitely want to take that regulation into consideration," Choate says, but, she adds, "The biggest problem with community services is that there aren't enough."
The minimal regulation at private homes is appalling to state school supporters like Miller, but the more stringent reporting standards and zero-tolerance policies at the schools haven't stopped the horrific cases of abuse there, as evidenced by the Justice Department report.
Miller thinks the state simply needs "more boots on the ground," but, he says, the mechanisms are in place for state school residents to report abuse, and if advocacy groups and legislators continue to push for residents and funding to go from state schools to community homes, those standards should move, too.
"We've been taking a bath with all the stories from the state schools," Miller says. "But nobody seems to see the importance of looking as closely at these places in the community."
The Department of Aging and Disability Services doesn't release details of investigations at private homes, so it's tough to gauge the extent of the abuse in those facilities, if it exists.
But during the summer of 2008, a mentally challenged man living in a community home was found overheated in a van and later died, according to a press release from the Houston Police Department.
Carlos Jackson was a resident at Belltech Enterprises, Inc., which runs a dayhab, or day rehabilitation center, near Richmond Avenue and Highway 6. Jackson, along with other clients, was riding from a dayhab to his home when the van broke down at a gas station. Another vehicle picked up the stranded clients, but by the time they got him to the hospital, it was too late for Jackson and he died later that day.
The police department says it is investigating the death, which was ruled accidental. Fedorov didn't have any information on a DADS investigation.
Even if the agency did investigate, the state doesn't categorize deaths in private homes, so there is no way to tell if Jackson's death was caused by abuse or neglect or simply by natural causes.
On a rainy morning in April, Linda Falk stood with two other women in the offices of the Four J's Community Living Center, Inc., which runs a day rehabilitation center in a business park not far from Sharpstown Mall.
The other women, Ilene Robinson and Sandra Reeves, also have relatives — a sister and a son — in Richmond State School, and with the push to move residents out of the institution, the ladies wanted to see the alternatives.
Waiting in the lobby of Four J's, Falk felt a chill. Every experience she had had with Trevor in a private group was bad, and the cold offices at Four J's didn't ease her fear.
After a ten-minute wait, a caseworker appeared from behind a locked glass door to show the women the dayhab rooms. They walked through a neatly landscaped courtyard through another locked door to see the high-functioning group, patients with some level of independence. It was lunch time and about 20 residents were sitting at white plastic tables eating prepackaged sandwiches from Sysco.
Across the hall, on the low-functioning side, the scene was a bit more chaotic.
Several caregivers served patients mashed potatoes on paper plates, and in one small room, about ten people in wheelchairs were crammed along one wall. A man sprawled on a hospital bed with no sheets, and another girl rested her body across the armrest of a recliner.