Change for the Good at Fairview Center : * Outplacement of Developmentally Disabled Is a Start

The Fairview Developmental Center in Costa Mesa offers a textbook example of changing theories in serving the developmentally disabled in California. With the settlement last month of a lawsuit, more changes are in store. They are likely to be good ones.

The result of the settlement, reached in San Francisco Superior Court, will be to reduce the populations of Fairview and the six other developmental centers in the state. Equally important is the provision of money to finance the outplacements and to provide the high standards of care that the patients deserve.

Fairview opened in 1959, yet it is the newest of the state facilities. Once called a “state hospital,” it now is called a “developmental center.” Those once termed “patients” are now referred to as “clients” by the staff. The “mentally retarded” are now designated “developmentally disabled.”

But more than terminology changed, as Fairview administrators wisely adapted new research into better treatment for those in their care. The Legislature has also kept an eye on treatment of the developmentally disabled throughout the state, as it should, and has updated laws for the treatment of the disabled.

Almost since Fairview opened, however, the prevailing thinking in the state has shifted to trying to move people out of hospitals and into smaller units in the community for anyone able to live in that setting. The lawsuit settled last month was originally filed in 1990, and argued that the state had dragged its feet in transferring patients out of hospitals. The plaintiffs were parents who wanted their children moved into the community and support groups for those suffering disabilities such as autism and cerebral palsy. The state agreed that paring the hospital population was a good idea but argued it did not have the money. But the state did agree as part of the settlement to spend more money on community facilities.

Some parents were understandably upset by the settlement, insisting that the treatment their children receive at Fairview and other hospitals was better than they could expect outside the hospitals. But that is true for only a small minority of patients, those who need such intense therapy that they probably will never be able to leave the hospital. For those, Fairview is best. But for anyone able to leave, the best answer is leaving, and living in a house with five or six others with good medical supervision, rather than at Fairview.

The settlement does not set up quotas to remove patients. The roster of those hospitalized will be reduced by minimizing the number of new patients admitted and by discharges and natural deaths of patients already hospitalized. Fairview now has about 1,000 patients, a substantial decline from its high of 2,600 in 1968.

Another justified concern of some parents was that too many community facilities shut down and forced the transfer of patients back to the hospitals. The settlement provides for the state to increase its activity in the community to keep as many patients there as possible.

A major impetus to the settlement was winning a waiver from the federal government to let more Medicare money earmarked for treatment of patients in hospitals be spent on the same patients in community facilities. That’s a good idea, so long as the homes in the community are carefully monitored to ensure they are providing high levels of care. Both plaintiffs and defendants in the lawsuit said they are pleased with the settlement, a good sign that the developmentally disabled will be protected.