Nevada lags in disability funding

Saturday, Nov. 25, 2000 | 3:04 a.m.

Nevada has been worst in the nation since 1977 when it comes to funding services for individuals with mental retardation and developmental disabilities, according to a university study.

That and other negative statistics contained in a federally funded study by the University of Illinois at Chicago depicted Nevada as a state far behind the rest of the country in serving those needy citizens.

The report titled "The State of the States in Developmental Disabilities," based on 1998 statistics, was the sixth national report the university has produced on the subject since 1984. Nevada has come out the worst each time.

Jack Finn, spokesman for Gov. Kenny Guinn, had not seen the study but criticized it nonetheless.

"This is another one of those reports done in another part of the country that does not understand the situation in Nevada," Finn said. "In the amount of dollars we are spending per person we are not last. Our budget for services for people with mental retardation has been increasing by 9 to 12 percent a year."

Nevada advocates for the developmentally disabled were not blaming Guinn since he did not take office until January 1999, a year after the period covered in the report. Instead, they directed their ire toward Guinn's predecessor, Bob Miller, for severely reducing the state's mental health budget in the early 1990s.

Miller said at the time that he was left with little choice because he was confronted with a state budget revenue shortfall caused by a recession. Although funding has steadily increased since then, advocates such as Opportunity Village Executive Director Ed Guthrie said the budget has failed to keep up with demand for mental health services.

"We underestimated the number of people who would be moving here," Guthrie said of state population projections. "We now have at least 160 people on waiting lists for services in Southern Nevada alone. There are a number of other people who know there aren't enough services so they don't even apply."

Among the study's findings:

Agencies from all 50 states, including Nevada's Mental Health and Developmental Services Division, contributed statistics to the study. But David Luke, the division's associate administrator for developmental services, said one reason Nevada ranked low was that it did not have as many people seeking services compared to most other states.

"Nevada is not New York," Luke said. "If we see only a third of the people as the national average, we will fund only one-third as many people."

Luke later conceded that his division's clientele has grown from 1,700 to 2,700 over the past three years, indicating that the state is beginning to address increasing demand for services.

"The state has to continue to address its waiting lists," he said.

But Luke said that because the state has begun serving more people some of the study's negative findings related to Nevada have already become outdated.

The study theorized that states such as Nevada that ranked poorly in spending and staffing were in that predicament because they were weak in the area of civil rights and because they lacked advocacy on behalf of the developmentally disabled. Conversely, many states that ranked high were forced through lawsuits to increase their funding and staffing levels.

Advocates such as former state mental health division director Brian Lahren, director of the Washoe Association for Retarded Citizens in Reno, blamed state officials for lacking foresight.

"It's not so much a lack of advocacy as it is a lack of advocacy backed by a hammer," Lahren said. "The advocacy has failed to take the ultimate step, which is to sue the state."

There are an estimated 130,000 Nevadans who are considered disabled under the federal Americans With Disabilities Act, said Vince Triggs, executive director of the Nevada Association for the Handicapped. If all those people formed one organization, it would be almost as large as the 150,000-member Nevada AFL-CIO, one of the state's most politically potent forces.

On their own

But disabled individuals tend to fight only on behalf of their own particular ailments, thereby causing factions that Nevada advocates have only begun to fuse over the past five years, Triggs said. The effort to give the disabled community a greater voice in state politics was one reason his association helped sponsor a voter registration drive this year.

"Our mission is to change that dead last funding status," Triggs said. "But without real input into the legislative process whereby parents and family members of people with disabilities go to the money committees, it is easy to brush this issue under the rug."

Case in point has been the relative lack of state assistance for community-based organizations such as Opportunity Village in Las Vegas, which provides vocational training and recreation for about 1,000 clients annually.

The Nevada Legislature last year increased state matching funds for Medicaid waivers such as for vocational training. But Guthrie said there has been a cost of living adjustment of only 8 percent since 1993 in the rates the state pays community service providers. He said that has caused his agency to lose more than 15 percent of its purchasing power because rate increases have failed to keep pace with costs.

Consequently, he said he cannot pay his employees enough to retain them and has suffered a 65-percent annual turnover in personnel, three times the national average for similar agencies. The result is an inexperienced staff.

"The impact on us is that I have to turn down new programs," Guthrie said. "I can't grow because I can't handle what I've got now. Some services you cannot provide because you need trained employees to provide those services."

Lahren termed "idiotic" Nevada's relative lack of support for Medicaid waivers, in which the federal government matches state contributions dollar for dollar.

'We're tightwads'

"Nevada has had a very poor record getting people out of segregated work environments into the community because we don't pay for that support," he said. "We're tightwads. We could have people out in the community earning more and costing us less. But we are unwilling to do something for the long-term benefits because of the short-term costs. It is a lack of vision."

But Luke argued that the state has been placing more emphasis on community-based services for mentally retarded and developmentally disabled individuals during the Legislature's past two sessions.

Advocates hold out hope that Guinn will push the Legislature for increased funding for community-based programs because philosophically he has said he stands for decentralized government. His administration, in fact, has made reorganization and consolidation of state services a top priority.

But Finn said the governor has not yet decided how he will approach mental health funding for the next biennium.

"The governor, while concerned of course, is not displeased with the level of commitment to the people with mental retardation and developmental disabilities," Finn said.

Privatization

Most perplexing to Lahren is the state's continued reliance on publicly run institutional settings at a time when the rest of the country has been going through rapid decentralization and privatization. The nation's publicly run institutions experienced a population decline from 149,892 to 52,801 from 1977 to 1998, but Nevada's population increased from 118 to 169 over the same period.

Also consider that in 1998, it cost $99,651 to place an individual in a Nevada state institution with one to 15 beds, $17,000 more than in a similarly sized private facility, according to the study.

"That's an argument for privatization," Lahren said. "The state has never been able to operate services cost effectively."

Part of the increase in the state's institutionalized population was attributed to the return to Nevada of adults and children in the early 1990s who had been placed in out-of-state institutions in order for the state to save money. The return was prompted by outcries from relatives and lawmakers who argued that the adults and children would be better served closer to home.

But Luke said the 169 state institutional beds as of 1998 have since been reduced to 140, and that his division is seeking a further reduction to 122 beds. He also pointed out that according to the study, Nevada as of 1998 placed only 10 of every 100,000 residents in public institutions, half the national average.

"Our vision is to have a community-based system, but there are still questions as to whether they can be adequately served in the community," Luke said. "Anything new we've been asking for has been for community services."

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