The Associated Press
LEXINGTON - Kentucky ranks near the bottom nationally in placing the mentally retarded in small, supervised homes, statistics show.
The state ranks 49th of 50 states and the District of Columbia for placing people in supervised homes with 15 or fewer residents, according to 2002 data released this year in State of the States in Developmental Disabilities, a research project administered by the University of Colorado.
Of the state's 3,613 people with mental retardation living in institutions and smaller homes that receive public funding, 45 percent are in homes with 16 or more people.
Nationally, just 23 percent of that population lives in such homes.
"The current thinking in our field is that we really can serve most, if not all, in community settings," said Harold Kleinert, executive director of the Interdisciplinary Human Development Institute at the University of Kentucky.
The more intimate approach is also more cost-efficient, officials say.
The state spends an average of $53,000 per person each year to care for people in group homes and other small settings under the Supports for Community Living program, said Rebecca Cecil, deputy undersecretary for health.
It costs an average of $139,604 per person to provide care at public institutions with 16 or more people in Kentucky each year, according to the study.
The state spends about $100 million a year on care at state institutions, Cecil said.
Eight states, including West Virginia, New Hampshire and New Mexico, have shuttered all their public institutions for people with mental retardation in favor of smaller settings.
Kentucky has moved more slowly to encourage people to live independently or in small groups in part because those methods are "chronically underfunded," Kleinert said.
To live successfully outside institutions, people with mental retardation can require a variety of aid, such as supervision, physical therapy or help with shopping and household tasks. More than 2,000 people are on the waiting list for such services offered through the Supports for Community Living program.
"I hope to see the day when there is no waiting list," said Maureen Fitzgerald, director of the state's Division of Protection and Advocacy.
"There have been some increases over the past few years in community services for people with disabilities. However, Kentucky remains 50th in the nation in state financing of community services."
Protection and Advocacy, an independent state agency, filed a federal lawsuit in 2002, seeking to force Kentucky to get rid of the waiting list and provide services for all who need them. The case is scheduled for trial in January.
The state is trying to address the need by creating a new program in the next six months to a year that would pay for some, but not all, of the services available through the Supports for Community Living program, said Mark Birdwhistell, undersecretary for health in the state Cabinet for Health and Family Services.
Kentucky pays for the care of people in group homes and institutions through Medicaid, but it does not provide enough financial incentives for private operators to serve institutionalized people who can need intense services and sometimes exhibit challenging behavior, said Carolyn Wheeler, who works at the UK human development institute.
The state wants to educate families about alternatives to institutions, Birdwhistell said.
Additional community services will become even more crucial as the population ages, Kleinert predicted.
The state has 10,643 people with developmental disabilities and mental retardation who are living with caregivers over 60 years old, according to the State of the States study. As those caregivers become increasingly frail and unable to care for their loved ones, more community slots will be needed.
"This is going to be in crisis proportions for us," Kleinert said. "We've got a long way to go."
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