The Root of the Problem

This week I had a fruitful trip back to the state library and archives in Tallahassee. I found 3 photo albums and two boxes of newspaper clippings in the archives that I had not discovered in my previous searches. The clippings concerned the comings and goings of many administrators during the heyday of the Sunland Centers (1960 - 1975). They also shed some light on some of the controversies that occurred at one or another Sunland during these busy years, when the centers housed 500-1000 patients each.

While there were chronic charges of underfunding and understaffing, there were also occasional incidents that were truly terrible: acts of patient on patient or staff on patient aggression and violence. The question: is it really that different under any other care model? I am not sure that we have answered that question. I think we can start by recognizing the difference between a care model and caring. Without the second, the first is of no consequence.

The move toward community based care began in Florida in 1970. In June of 1975, the state legislature passed a "bill of rights" for retarded patients in answer to attacks on the Division of Retardation within the Department of Health and Rehabilitative Services. These rights included vocational training and movement into more home-like settings such as group or cluster homes. The pendulum started to swing rapidly toward moving patients into smaller, often privately owned and managed facilities.

Unfortunately, just moving patients out of large state facilities did not universally improve their care. In the early 1980's, the Orlando Sentinel reported that in a 1 1/2 year period, at least 15 people died after being transferred to community homes from Sunland Centers.

Perhaps one advantage of outsourcing care is the change in how citizens perceive the role of the state. When patient A is cared for in a state-run facility and a negative incident occurs, the government is criticized and much publicity occurs concerning governmental officials' ability to manage their responsibilities. However, when patient B is placed in a contracted facility that is privately owned and managed, if such an incident occurs, governmental officials can inspect, levy fines and otherwise inflict punishment. Now, however, the appearance is that the governmental role has changed to that of the "good guys". In fact, both patient A and patient B are wards of the state, are they not? Based on the press coverage of some of these incidents, we don't seem to dig very far to seek the root of the problem.