Plight of the Retarded

Not so many years ago large state hospitals for the mentally retarded were often dungeons of despair. Now the apparently humane option of community care is itself turning sour. In too many privately run but state-financed homes the retarded face physical abuse, poor diet, neglect or financial exploitation. State government clearly must return to the question of how best to care for the retarded, and must do so soon.

Times staff writer John Hurst has documented case after case of neglect, even death, among the retarded housed in privately operated centers. In one 1987 case, for example, a 29-year-old woman living in a community-care home west of downtown Los Angeles died of a neglected abdominal infection. Five months later the center’s license was suspended.

Some homes are run by well-motivated people attempting to stretch limited funds. They need the discipline of frequent inspections and help in learning what corners simply cannot be cut. Other homes are run by out-and-out schemers who shortchange patients and pocket the difference. State social-service agencies must actively monitor all the care for which California pays, stiffen the penalties against those who exploit and abuse, and put those who persist in shabby practice out of business.

There are two fundamental problems in grappling with the issue of caring for the retarded. One is financial, the other philosophical. It costs money to provide inspectors and social workers to monitor such programs. California is already in a financial bind, and a state that once was an innovator in social services cannot, for now, respond to all legitimate demands on its dollars.

It may be that the current system of paying private nonprofit regional centers to place the retarded in community homes has simply facilitated buck-passing. State agencies can say that an incorrect placement isn’t their fault. The state should finance some small pilot projects to see whether its own staff could do a better job at both placement and management of community care programs and to determine how much that would cost.

California government has made a philosophical commitment to help the retarded live in community settings rather than large hospitals. In an ideal world, that’s the best approach. But Hurst’s interviews showed that many parents find state hospital care for their children vastly improved and safer than the worst of community-care homes. Honoring a general commitment to community care is not a good reason to ignore the fact that for some individuals state hospitals are more suitable.

Debate on care for the retarded should be reopened. The discussion should focus on how to fashion care to fit individual needs and on deciding how California can best provide that care. Such a debate would benefit both the state and its citizens who are retarded and often ill served today.