Role of LSTC evolves in 113-year history
Reprinted with permission of The Walsh County Record. First appeared in the September 27, 2017 edition. First of a four part feature series.
by Cheryl Osowski
Mission critical is defined as any factor of an existing system that is essential to its operation. Through its 113-year history, Grafton’s current Life Skills and Transition Center (LSTC) has operated with a mission critical to the continuum of services North Dakota has provided for people with intellectual and developmental disabilities.
The facility provided a safe haven for a variety of people with no other place to go. When society’s knowledge and understanding of the needs of the people served evolved and behavioral treatment and training expanded, the Center’s philosophy of care changed. However, the resources provided did not keep up.
Too few staff were charged with the care of too many people, some of whom had no diagnosis of intellectual or developmental delay. Services and alternative housing for these individuals were not available in the numbers required and family members were uninterested or unable to provide. In many cases, the Center was the recommended placement for their loved one.
Over time, leaders of the state and at the Center shifted their philosophy of care. From protectionism and medically driven care, to limited education and training, and finally to a comprehensive view of care and education that included the expansion of services statewide that diminished the need for the Center’s living space. The most dramatic precipitator of change was the implementation order by U.S. district judge Bruce Van Sickle, issued in the 1984 lawsuit Association for Retarded Citizens of North Dakota v. Olson.
Numbers tell the story of these philosophical and mandated shifts in care over the life of the Center. Statistics taken from the comprehensive book on the history of the Center written by Brent Askvig, Ph.D., professor of special education at Minot State University, tell the story of change.
According the Askvig book, six people were admitted on May 2, 1904. By the first of November that year, 75 people resided at what then was named the Institution for the Feeble Minded. Grafton was chosen as the location for this facility in 1901, which was suggested by Walsh County Senator J. C. Cashel.
Training programs were begun in 1904 and focused on training so the people could be happy, comfortable, and so that life there could be useful. The early years also were plagued by infectious diseases which caused over 78 deaths in the first six years the facility was open.
Efforts to survey and consolidate people with disabilities were initiated in 1911, resulting in a census that predicted there to be 1,800 more people who would need institutionalization. The period between 1910 and 1930 noted for “paternalistic and protectionist approach” as Askvig notes in his book.
By 1940, the population of the institution was up to 970 people. Although World War II severely limited expansion, the Refectory was added in 1949 and the hospital building in 1950. During this decade, the population rose to 1,091 people.
During what Askvig terms the “Modernization” period of the 1950s, the population increased to 1,381 residents. During this period psychologists were added to the spectrum of professional care provided, as were educational efforts and a recreation program. The institution’s name had also changed to the Grafton State School.
Spurred by greater public advocacy on behalf of people with disabilities, the decade of the 1960s represented the beginning of significant changes in the way services were viewed by the public and by policymakers. It was also the decade when a second institution opened to “provide custodial care to senile, geriatric patients” – San Haven, a facility which formerly housed North Dakota’s sanitorium for tuberculosis patients. The population at Grafton rose to nearly 1,500 people, while 150 people resided at San Haven.
Between 1970 and 1980, the population at Grafton decreased from 1,351 to 988. San Haven’s population increased slightly from 225 to 248. The overall decline was partly due to the establishment of some community programs and a tightening of admittance procedures. Another lawsuit, a precursor to the 1980s suit, was filed by the ARC alleging denial of public education for students. Increasing public advocacy and changing state and federal law were having an impact. A 1999 U.S. Supreme Court decision, Olmstead vs. L.C., ruled that the unjustified segregation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act (ADA), asserting more pressure to deinstitutionalize.
During the period from the 1980s to today, the change has been drastic. The facility’s name changed twice – the Grafton State School became the Grafton Developmental Center in 1989 and is now named the Life Skills and Transition Center. Residential buildings were remodeled and constructed to mimic group homes. While the number of people living at the facility dropped precipitously, staffing levels increased. In 1981, there were 674 staff positions, but that number increased to 1,072 in 1987.
Today, there are 64 people served at the Center, with the number of full-time positions at 339.94. The current mission of the LSTC is to support people to be viable members of their communities by providing specialized services when their needs exceed community resources.
In addition to supervising people living in community homes located adjacent to the original footprint of the institution, staff of the LSTC supervise a program of staff located statewide known as the Clinical Assistance, Resources and Evaluation Service (CARES). CARES is a team of specialists including clinical and direct support staff who provide a wide range of consultation services, including in-home and on-site supports meant to prevent admission or readmission to the LSTC and to assist in transitioning people from the LSTC.
CARES logs between 150 and 225 service events per year. A CARES Clinic assures that people have access to physical, occupational, and speech therapy services and consults, in addition to providing adaptive equipment, dental and medical services to people under the care of other providers. Behavioral health services are also provided by LSTC staff on a fee-for-service basis statewide.
Since 1989, the Council on Quality and Leadership (CQL) – a national organization dedicated to defining, measuring and improving the personal and community quality of life for people with intellectual and developmental disabilities – has accredited the LSTC. Its current accreditation extends to 2020. The LSTC is the only former institution in the U.S. to achieve this accreditation under the new standards.
Yet, while no longer in the business of providing institutionalized care, the Center is now facing the headwinds of a movement to discard any remnants of the prior institution in favor of services provided by a network of providers in other locations across the state. A resolution advocating a study of the closure of the LSTC failed in the ND Senate in 2017. However, an interim committee study of behavioral services in the state was approved. The study includes a provision that requires “an evaluation of the funding, mission, and caseload at the Life Skills and Transition Center, including the center’s transition plan and number of clients eligible for community placement.”
In addition to these legislative actions, the ND Department of Human Services (NDDHS) has moved a position from the Center to Bismarck. The position was retitled to Transition and Diversion Coordinator, with the responsibility to monitor vacancies across the provider network in ND and the readiness of people living at the Center to move into those vacancies.
The author of the definitive history of the Center at Grafton, Dr. Brent Askvig, continues to give 3-4 lectures per year to students at Minot State University on the contents of the book. He states that his students gasp in horror when hearing how people were treated through the years at the institution. He is glad to say that we are doing pretty good right now.
“I hope we continue to move forward,” Askvig said. “To say that we have solved all the problems at any given time would be inappropriate.”
He is amazed at what is happening with technology and what it can offer in the future. “I get excited when I think about that, he said.”
When asked about the nomenclature of the services discipline and the term institution, Askvig says he would refer to any large facility an institution, including those larger private providers in the state that supervise large congregated housing and training facilities.
“The term is applicable to more than just the Grafton facility,” he said.
In written testimony provided to the interim committee at their first meeting August 1, 2017, Sue Foerster, Superintendent at the LSTC, indicated that ongoing work is needed to transform the LSTC. A transition task force established in 2005 will continue to study the reasons people are admitted to, remain at, and transition home from the LSTC.
She also wants to fully define the safety net role of the LSTC in a way that all stakeholders, NDDHS and community partners agree upon. She also testified that the work of the LSTC Professional Services Institute on Developmental Disabilities to support private provider capacity to support people with developmental disabilities and behavioral health challenges should be continued.
The vacated buildings on campus create a separate and challenging dilemma to the future of the Center. The emptying of the oldest dormitory style buildings on the campus grounds drove a concerted effort by local developers and legislators to redevelop some building on the campus for housing.
Dawn Keeley, executive director of the Red River Regional Council (RRRC), was part of the effort in the 1990s to convert two of the oldest buildings on the grounds, North A and North B, into rental housing units. Keeley noted that in 1993 a regional steering committee was formed to find alternative uses for the campus. With a $100,000 grant from ND Department of Economic Development and Finance to the Walsh County Job Development Authority, the work began.
Several steps were taken to free up the process of transferring ownership of state building assets to new owners. Finance packages were worked out, market research was completed, and developers were sought. Construction was underway on the renovations of North A and North B in 1998 and 1999.
Other buildings such as the newer administration building and hospital building were utilized by other service providers, including the ND Motor Vehicle branch, the Veterans Administration, Northeast Human Services, and day care providers. The auditorium utilized for recreational programming for clients was opened to the entire Grafton community as a community fitness center. Homes built for medical staff and the superintendent on the grounds were converted into independent supervised living arrangements for people still served by the staff at the Center.
Today a collaborative effort including the City of Grafton, the Walsh County Job Development Authority, the Praxis Strategy Group of Grand Forks and the RRRC is underway, working on redevelopment efforts for the remaining vacated spaces. The agencies are also supporting an ongoing role for the LSTC in North Dakota’s core safety net and professional resource for the people who need the quality of care provided.
“The development challenge is two-fold today – retention and redevelopment,” said Keeley. “This threat of closure brings added political challenges that we did not have in the 1990s.”
In the 1990s, the redevelopment efforts had bipartisan support at the highest levels with Sen. Harvey Tallackson as the chair of the redevelopment committee while at the same time serving as the Chair of the Senate Appropriations Committee and Lt. Governor Rosemarie Myrdal also serving on the redevelopment committee. US Senator Byron Dorgan worked to develop an outreach clinic for the Veterans Administration Hospital in Fargo as well as retirement and skilled nursing beds.
Sen. Tallackson recalls the work it took to find leaders who believed in the redevelopment efforts.
“There were many people who just wanted to tear them down,” Tallackson said.
His best advice for the current redevelopment task force is to never give up.
“They should use all the pressure they can muster to get support for the foundational work of feasibility studies from the leaders at the Bank of North Dakota and the Department of Commerce,” said Tallackson. “It’s not an easy pull to get a lot of this stuff done.”
Keeley’s recollection of the efforts match Tallackson’s.
“I recall arranging countless tours, meetings, and trips to Bismarck while exploring many options for redevelopment including a veterans nursing home, housing, veterans’ clinic and more over a more than five-year period,” Keeley said. “A project of this magnitude requires steadfast staffing over a long term to develop the networking and partnerships necessary to result in a high-quality project.”
According to Keeley, the RRRC provided approximately five years of staff time into the project, which resulted in 49 units of rental housing in what is known today as Villa DeRemer and Hancock Place.
Next up in the LSTC series will be a review of the concerns of the legislators involved in the interim study, advocacy groups, and community providers. Current best practices in other states will be noted. The issue of cost of care will be reviewed. Redevelopment ideas will be outlined.
Part 2: Who are the players and what are their concerns?
Part 3: What do those currently receiving and providing services want and need?
Part 4: What happens now?