You can view the original article by the Texas Watchdog here.

 

The Texas State Supported Living Centers (SSLCs), which are meant to care for some of the state’s most vulnerable residents — people with intellectual and developmental disabilities — are facing an ever-growing crisis. These institutions, once designed as havens for care, have instead become synonymous with neglect, abuse, and systemic failures that persist despite years of federal oversight and a $112 million settlement. In classic style, the Lone Star State made all the promises to fix the problem but delivered nothing but smoke and mirrors. Beneath a glossy surface of “reforms” lies a cold, brutal reality: Texas’s SSLC system is failing its residents in ways that are not just shocking but also criminal.

SSLC System History: A Slow-Burning Crisis Ignored for Too Long

Texas’s SSLCs were established as a safety net for residents with developmental disabilities, promising care that would be more personal and integrated than cold, institutional alternatives. Over time, these centers morphed into something altogether different — a bureaucratic dumping ground where staff often outnumber residents but abuse is still rampant. The system has become notorious for failing to meet even the most basic care standards. After a 2009 Department of Justice investigation uncovered rampant physical abuse, neglect, and exploitation in these centers, Texas agreed to overhaul its SSLC system. They slapped a $112 million band-aid on the problem, promised sweeping reforms, and went back to business as usual. Fast forward over a decade, and what do we have? Continued abuse. Neglect. Compliance levels so abysmal that it’s hard to believe the state spent even a dime trying to fix anything. As of 2014, five years after the settlement, SSLCs had achieved a pathetic 30% compliance with mandated reforms. Thirty percent. That’s like paying a contractor to fix your roof and they only bother patching up a third of the tiles.

Why the DOJ Stepped In: Abuse, Neglect, and Shocking Fatalities

The Department of Justice didn’t decide to investigate Texas SSLCs out of some bureaucratic routine. No, they were practically dragged into it by the sheer number of horrifying incidents coming out of these centers. Take the Lubbock SSLC, for example, where between 2004 and 2005, 17 residents died under suspicious circumstances. Seventeen people — dead — and nobody could give a straight answer as to why. At the Corpus Christi SSLC, staff were caught on video forcing residents, some with severe autism, to fight each other for their amusement. Yes, a “Fight Club” for the developmentally disabled. That’s the kind of place Texas was running. And it didn’t stop there. Physical abuse at these centers included staff lashing residents with belts, stepping on their throats, and keeping them restrained for hours on end. One man at the Denton SSLC was beaten so badly that he was left in a wheelchair, unable to feed himself. And this, mind you, was the result of Texas’s version of “care.”

Sean Yates: The Tragic Face of Institutional Failure

Perhaps no story highlights the SSLC system’s failings more tragically than that of Sean Yates. Sean was a 35-year-old with severe Asperger’s syndrome and attention deficit disorder who had been living at the Corpus Christi SSLC for ten years. Despite his history of running away, the center’s staff inexplicably decided to reduce his supervision level in early 2014. Big mistake. Sean ran away, and his body was found nearly a month later in the Corpus Christi ship channel. What’s even more appalling is that Sean may have been a victim of the so-called “Fight Club” that was operating within the center. Federal monitors slammed the SSLC for their complete “lack of urgency” in addressing the rampant problems at the facility. Sean’s family had no idea what he had been subjected to, let alone that he had died because of institutional negligence. And Sean wasn’t the only one. Other residents, like a 28-year-old man at the Richmond SSLC, died from blunt force trauma in 2010, leading to criminal indictments for the staff members involved.

Federal Oversight: Window Dressing for a Rotten Core

When the DOJ swooped in, you’d think things would change. The 2009 settlement agreement required Texas to meet 171 federally mandated performance measures, all aimed at dragging the SSLC system into the realm of basic human decency. Independent monitors were assigned to assess the SSLCs every six months. Yet, despite this federal oversight, abuse, neglect, and medical malpractice continued. By 2014, most facilities had barely scratched the surface of compliance, with many only achieving 30% of the mandated reforms. It’s as if the entire system is wired to resist change. Sure, a few hundred staff members were fired or forced to resign in 2014, but let’s face it — that was little more than a PR stunt. For every abuser caught, how many more slipped through the cracks?

The Cost of Doing Nothing: Texas’s Financial and Moral Bankruptcy

You’d think that with all this money Texas is throwing into the black hole that is the SSLC system, someone might ask whether the entire thing is worth it. Spoiler alert: it’s not. In 2015, the average annual cost per SSLC resident was more than $210,000, making these centers one of the most expensive care options for individuals with disabilities. That’s taxpayer money, mind you. And what are we getting for it? Substandard care, abuse scandals, and a system that actively harms the people it’s supposed to protect. Meanwhile, alternative community-based care options, like Home and Community-Based Services (HCS), cost a fraction of what SSLCs do and generally produce better outcomes. But Texas seems hellbent on maintaining these money pits. Even as the state’s budget hemorrhages from the cost of maintaining 13 SSLCs, enrollment has plummeted by 70% over the past three decades. We’re paying more to care for fewer people, and doing a worse job while we’re at it.

Community-Based Care: The Obvious Answer Everyone’s Ignoring

Here’s the kicker: there’s a solution sitting right in front of Texas’s face, but the state refuses to fully embrace it. Community-based care, specifically through the HCS waiver and the Texas Home Living (TxHmL) program, offers a more humane, cost-effective alternative to the SSLCs. These programs provide tailored care, allowing individuals with disabilities to live in their own homes or smaller group settings while receiving the services they need. They’re not perfect — thanks to years of underfunding and long waiting lists — but they’re undeniably better than the horrors going on in the SSLCs. The problem? Texas hasn’t invested nearly enough in these alternatives. The waitlists for HCS services are legendary, with some families waiting more than a decade for help. Meanwhile, SSLCs continue to vacuum up resources, despite overwhelming evidence that they’re outdated, ineffective, and downright dangerous.

Reform Efforts: Politicians Tinker While the System Burns

In response to the ongoing catastrophe, the Texas Sunset Advisory Commission floated the idea of closing six of the 13 SSLCs in 2014. Naturally, this sparked a wave of outrage from families of SSLC residents and various advocacy groups. So the Texas Legislature punted. They shelved the closure plans, leaving the centers open and the problems unresolved. It’s a classic case of Texas lawmakers making just enough noise about reform to look like they care, while quietly ensuring that nothing really changes. In 2015, Senate Bill 204, which proposed closing the Austin SSLC and establishing a restructuring committee for other centers, was defeated. It was a missed opportunity to overhaul a failing system, and it’s the residents who are paying the price.

Staffing Woes: The Workers Are Set Up to Fail

Let’s be clear: part of the reason these centers are such a disaster is that the staff — who are often underpaid, undertrained, and overstretched — are set up to fail. Sure, the state tried to address staffing shortages in 2011 by filling 94% of positions, but that did nothing to solve the larger systemic issues. Even when staffing levels improved, abuse continued. Why? Because the problem isn’t just numbers; it’s culture. The SSLCs have cultivated a toxic environment where abuse is tolerated, medical care is inadequate, and residents’ rights are trampled on. And without meaningful changes in leadership, training, and oversight, no amount of new hires will fix that.

The Path Forward: Burn It Down and Start Over

At this point, it’s clear that the SSLC system, as it exists today, can’t be saved. It’s too expensive, too broken, and too dangerous. The best way forward is to phase it out entirely, focusing instead on expanding community-based care options that actually work. The money Texas is wasting on maintaining SSLCs would be better spent on fixing the waitlists for HCS and TxHmL services, ensuring that people get the help they need when they need it. But that requires political will, something in short supply in the Texas Legislature. Until then, we’re left with a system that fails everyone involved — residents, families, staff, and taxpayers.

A System That Destroys, Not Protects

Texas’s SSLCs were supposed to provide care and protection for the state’s most vulnerable residents. Instead, they’ve become emblematic of a system that destroys more than it protects. The abuses are rampant, the costs are astronomical, and the reform efforts have been a joke. The fact that these centers are still open is a testament to Texas’s refusal to confront its own failures. It’s long past time for the state to shut down these glorified prisons, invest in community-based care, and finally deliver on the promises it made over a decade ago. Until that happens, the residents of Texas’s SSLCs will remain trapped in a system that was designed to care for them but has done nothing but fail them.

View our original article The Texas IDD Caregiver Crisis: How the Lone Star State Abandoned Its Most Vulnerable here. 

In Texas, caring for people with intellectual and developmental disabilities (IDD) was supposed to be a community-based solution—progressive even. Instead, it's become an exercise in government failure so stark, it would make Kafka shake his head in disbelief. Welcome to the Texas IDD Caregiver Crisis, where Direct Support Professionals (DSPs), the underpaid and underappreciated workforce keeping this house of cards from crumbling, are abandoning ship. The predictable result? A human disaster in slow motion, hitting the most vulnerable populations first.

What started out as a decent idea—keeping individuals with IDD out of large institutions and integrating them into the community—has deteriorated into one of the state’s biggest social care crises. The entire system is being strangled by chronic underfunding, neglect, and a workforce exodus that’s turning an already dire situation into a catastrophe. Meanwhile, the state pretends it’s “working on it,” offering piecemeal solutions while the cracks in the foundation grow larger by the day. It’s a slow-motion collapse, and the casualties are the people who need help the most: individuals with IDD and the DSPs who are barely hanging on.

The Great DSP Exodus: A Workforce on the Brink of Collapse

Let’s get one thing straight: the system’s foundation is Direct Support Professionals—the DSPs. They’re the ones who assist with day-to-day needs like eating, bathing, dressing, and taking medication. You know, the stuff of basic survival. For their trouble, Texas pays them a laughable $10.60 an hour, a wage so low it should be considered a public insult. This isn’t work that anyone can walk into. It’s emotionally taxing, physically demanding, and vital for the people they serve. But in Texas, it’s treated like a part-time gig at a fast-food joint.

And here’s the kicker: that $10.60 is after the state authorized a slight bump in wages. Before that? It was $8.11 an hour—less than what most people make scanning groceries. Let that sink in for a second. You’ve got people managing the lives of Texans with serious developmental disabilities, often working 60 to 100 hours a week, and their paychecks wouldn’t even cover rent in most Texas cities.

What happens when you pay people this poorly to do such important work? They leave. In droves. Vacancy rates for DSPs in Texas have climbed to 34% in 2024, up from 30% in 2021. It’s like a slow-rolling tidal wave of attrition. DSPs are quitting, facilities are shutting down, and individuals with IDD are left in limbo, often sent back into institutional settings that are supposed to be the last resort. This isn’t a workforce shortage; this is a full-on labor collapse.

Facilities Closing at Alarming Rates: An Avoidable Catastrophe

The math is simple: fewer DSPs means fewer facilities can stay open. Since January 2023, 179 HCS homes and 50 ICF facilities have closed, with projections showing another 126 facilities will shutter before the end of 2024. These numbers are not some abstract policy issue; they represent people—residents who lose their homes, their caregivers, and any sense of stability.

Families in rural areas are hit particularly hard by these closures. In small towns, when a facility closes, there’s no Plan B. There’s no secondary facility just down the road; there’s nothing. These families are now faced with impossible choices: either move their loved ones to institutions far from home or take on the overwhelming responsibility of care themselves. Neither option is humane. Neither option is right.

A Caregiver Workforce on Life Support

Meanwhile, for the DSPs who are hanging on, the work conditions are absurd. Many are working double or even triple shifts to make up for the shortage in staffing. The result? Burnout, exhaustion, and mistakes. Medication errors in care facilities have spiked by 20% since 2021, and there’s been a 30% increase in behavioral incidents. These are the inevitable outcomes when you ask a workforce to work twice as hard for wages that barely keep the lights on. It’s like trying to build a skyscraper with dollar-store tools.

Texas isn’t just failing DSPs; it’s failing the people they serve. The turnover and shortage in staff mean that the residents—Texans with IDD—are stuck in an endless churn of new caregivers. There’s no consistency, no continuity in care. And for people with IDD, many of whom rely on structure and routine, this is disastrous. Every new caregiver is a disruption, and every disruption can lead to behavioral regressions, anxiety, and emotional distress.

The Hollow Promise of Community-Based Care

When Texas first began moving people with IDD out of large institutions and into community-based care, it was hailed as a major step forward. Instead of warehousing people in faceless institutions, the idea was to give them more independence by offering care in smaller, more personal settings. It was supposed to be more humane, more integrated, and more responsive. But somewhere along the line, Texas stopped funding the vision.

The state’s refusal to adequately fund the system has turned a once-promising model of care into a bureaucratic horror show. The Texas Health and Human Services Commission (HHSC) is tasked with overseeing this mess, but their hands are tied by decades of budget cuts and mismanagement. Despite numerous reports highlighting the workforce crisis and the facility closures, the state has done little more than throw around token increases in funding—none of which come close to addressing the root of the problem.

What Texas Could Do (But Probably Won’t)

Let’s not pretend this problem doesn’t have solutions. The Time to Care coalition and other advocacy groups have been crystal clear: Texas needs to raise DSP wages to at least $15 an hour. It’s not a perfect fix, but it’s a start. Even then, $15 an hour is the floor, not the ceiling. DSPs should be paid in line with the crucial nature of their work, not as an afterthought in the state budget.

Another critical issue is Medicaid reimbursement rates, which are woefully inadequate. Providers can’t pay their staff or keep their doors open because the reimbursement rates for HCS services haven’t kept pace with inflation, let alone the actual cost of care. It’s not rocket science—if Texas wants to keep DSPs in the field and facilities open, it needs to invest in them.

But let’s not kid ourselves about what’s really going on here. Texas has consistently refused to expand Medicaid under the Affordable Care Act, leaving billions of federal dollars on the table. Dollars that could have funded higher wages, better facilities, and shorter waitlists. Between 2014 and 2024, Texas forfeited over $36 billion in federal funding—money that could have gone directly to fixing this crisis. Instead, it went to other states, while Texas’s IDD community is left to rot.

The Real Cost: Lives Put on Hold or Wrecked Entirely

For the individuals with IDD caught up in this mess, the human cost is impossible to calculate. These aren’t just numbers on a ledger; these are real people, real families, facing real consequences. Take the story of Sean Yates, a 35-year-old resident of the Corpus Christi SSLC who tragically died after escaping from the facility. His family had placed their trust in the system to care for him, but the system was too broken to provide even the most basic safeguards. Sean’s death is a stark reminder of what happens when a state refuses to adequately fund and oversee its care systems.

For others, the consequences are less immediate but no less severe. Families are going bankrupt trying to cover the gaps in care, often forced to leave their jobs to care for loved ones full-time. The emotional toll is immense, as parents, siblings, and spouses watch their loved ones languish in a system that treats them as afterthoughts.

A State That Doesn't Care

What’s most galling about all of this is the state’s indifference. Texas is a wealthy state. It could fix this if it wanted to. But fixing it requires political will, and political will requires caring about the lives of people who don’t have lobbyists. The fact that the state continues to underfund IDD care, refuse Medicaid expansion, and ignore the plight of DSPs tells you everything you need to know. The state doesn’t care because it doesn’t have to. The people suffering don’t have a voice loud enough to make them care.

So here we are, in 2024, watching a system that was supposed to be a beacon of progress collapse under the weight of its own neglect. Facilities are closing. DSPs are quitting. Families are breaking under the strain. And all the while, Texas lawmakers sit on their hands, offering up “task forces” and “working groups” as the solution. But until Texas decides to prioritize its most vulnerable citizens, this crisis will continue to unfold. And the people who will suffer the most are those who are least equipped to advocate for themselves.

Conclusion: The Crisis Texas Won't Solve

The Texas IDD Caregiver Crisis is a perfect storm of bad policy, underfunding, and political indifference. The people who need help the most are being left behind, and the workers who care for them are abandoning the profession in droves. What’s left is a system on life support, propped up by temporary fixes and empty promises. The state has the resources to fix this, but so far, it’s shown no interest in doing so. For individuals with IDD, their families, and the DSPs still hanging on, the message from Texas is clear: Don’t expect help anytime soon.

In this eye-opening episode, we delve into the critical crisis facing direct support professionals (DSPs) in Texas. With insights from Time to Care Texas, we uncover the harsh realities these essential workers endure, from low wages to high turnover rates. Discover the human impact behind the statistics and explore the systemic issues that perpetuate this crisis.

We discuss the staggering turnover rate of 48.4% among DSPs and the devastating effects on individuals with intellectual and developmental disabilities (IDD) who rely on consistent, quality care. Learn about the efforts to raise DSP wages and the push for federal occupational standards to professionalize and support this vital workforce.

Join us as we highlight the importance of empathy and collective action in creating meaningful change. Find out how you can get involved and support the fight for better conditions for DSPs and individuals with IDD. This episode is a call to action for a more compassionate and just society.

ARD meetings in Texas can be overwhelming with their acronyms and legalese. This episode is a deep dive to break it all down and equip you to be the best advocate for your child. Join us as we demystify ARD meetings, featuring insights from Mary Jenkins, founder of Above and Beyond Caring. Be sure to check out her original article here.

We discuss the basics of ARD meetings, the key players involved, and their roles. Learn practical tips for preparation, including gathering information, setting goals, bringing in reinforcements, taking notes, and asking questions. Understand your legal rights as a parent and the importance of collaboration with the school.

Discover strategies for resolving disagreements constructively and explore options like facilitated IEP meetings and mediation. We also touch on the significance of student advocacy and how to help your child find their voice.

Join us for this comprehensive guide to navigating ARD meetings, empowering you with the knowledge and tools to support your child's education journey. Check out the show notes for additional resources and insights from Mary Jenkins.

View our original article Texas State Supported Living Centers (SSLC) System Failure: A Critical Investigative Report here. 

Texas’s State Supported Living Centers (SSLCs), facilities meant to care for individuals with intellectual and developmental disabilities (IDD), have been a focal point of controversy due to persistent issues of neglect, abuse, and systemic failures. Despite a 2009 settlement with the U.S. Department of Justice (DOJ), which mandated comprehensive reforms to improve living conditions for residents, widespread abuse, neglect, and civil rights violations continue to plague the SSLC system. This investigative report explores the history of these issues, the legal battles, the impact on residents, and the failure of Texas to address these ongoing problems.

The DOJ Investigation and 2009 Settlement: A Failed Reformation

In 2009, the DOJ conducted an investigation into Texas SSLCs and uncovered shocking conditions that violated the constitutional rights of residents. The investigation found rampant abuse, neglect, and exploitation at several facilities, including instances of staff members physically abusing residents, such as stepping on their throats, lashing them with belts, and forcing residents to fight each other for entertainment. Between 2004 and 2005, 17 suspicious deaths were recorded at the Lubbock SSLC, adding to the growing concerns about inadequate care.

The findings resulted in a $112 million settlement with the DOJ, in which Texas agreed to implement significant reforms. The state was tasked with bringing its facilities into compliance with 171 federally mandated performance measures by 2014. However, five years after the settlement, most SSLCs were found to be only 30% compliant, leading advocates to question whether these facilities were capable of reform at all.

Widespread Deficiencies in Care

The investigation revealed systemic failures in medical and psychiatric care, safety measures, and living conditions. Many residents were not receiving proper medical care or psychiatric support, and basic needs like dental services were often neglected. The DOJ’s monitors, appointed to oversee compliance, reported serious deficiencies in almost every aspect of care at the SSLCs. Despite the federal settlement, abuse and neglect persisted, leading to the dismissal of 375 staff members in 2014 due to confirmed cases of mistreatment.

Tragic Cases of Neglect and Abuse: Sean Yates and Others

One of the most heart-wrenching examples of systemic neglect at an SSLC was the case of Sean Yates, a 35-year-old resident with severe Asperger’s syndrome who had been living at the Corpus Christi SSLC for a decade. Despite Yates’s known tendency to escape, the facility reduced his supervision just days before he ran away in 2014. After nearly a month of searching, Yates’s body was discovered in the Corpus Christi ship channel.

Investigators pointed to a lack of urgency from SSLC staff in addressing institutional problems uncovered after Yates's death. His family later learned that Sean may have been a victim of a “fight club” at the SSLC, in which staff forced residents to fight one another for amusement. Yates’s tragic death highlighted not only the danger posed by inadequate supervision but also the deeply rooted culture of abuse that existed within SSLCs.

Sean Yates’s case is not an isolated incident. In 2010, a 28-year-old resident at the Richmond SSLC died from blunt force trauma, leading to the indictment of two employees for injuring a disabled person. Similarly, in 2013, a resident at the Austin SSLC died after being left alone in a room, moaning in pain, until a staff member found him blue and unresponsive. These tragedies underscore the failure of the SSLC system to provide adequate care for its most vulnerable residents.

Impact on Resident Safety and Well-being

The systemic failures within Texas SSLCs have had a devastating impact on the safety and well-being of the residents. In 2014 alone, there were 572 confirmed cases of abuse, neglect, and exploitation across the state’s SSLCs—more than double the state's goal of 214 incidents. The high number of abuse cases indicates that, despite reforms, the system remains incapable of protecting its residents from harm.

Instances of physical abuse remain a significant concern. Some residents have been subjected to extreme violence, such as being beaten, restrained for hours, or, as noted earlier, forced to engage in fights for the entertainment of staff members. The trauma inflicted on residents by such abuse often goes unaddressed, further exacerbating their mental and emotional health challenges.

Neglect is also a pervasive problem in SSLCs. The inadequate supervision that led to Sean Yates’s death is a prime example of how neglect can have fatal consequences. Many residents, who require close monitoring and individualized care, are left without sufficient support due to staffing shortages and poorly trained personnel. This neglect not only puts residents' physical health at risk but also affects their mental and emotional well-being, as they are left in environments where they do not feel safe.

Federal Oversight and Compliance Failures

Following the 2009 DOJ settlement, federal oversight of the SSLC system was supposed to ensure that the facilities improved and met the necessary standards of care. Independent monitors were appointed to evaluate SSLCs every six months, reviewing their compliance across five key domains: residential services, medical and nursing care, psychiatric care, habilitation, and protections.

Yet, despite this oversight, the pace of reform has been dismally slow. By 2014, five years into the settlement agreement, most SSLCs had achieved only around 30% compliance with the mandated performance measures. This failure to meet key benchmarks has been attributed to a combination of factors, including insufficient staff training, poor leadership, and a lack of enforcement mechanisms.

Legal Repercussions and Ongoing Litigation

The legal challenges facing Texas SSLCs have been ongoing since the 2009 settlement. Despite the financial penalties imposed by the settlement, abuse and neglect persisted, prompting additional lawsuits. In 2011, disability rights advocates filed another lawsuit, claiming that the state continued to violate the civil rights of SSLC residents. This legal action, combined with the individual cases of abuse and neglect, has kept Texas embroiled in costly litigation related to its SSLC system.

In addition to lawsuits, criminal charges have been brought against several SSLC employees for their roles in abusing residents. For example, two employees at the Richmond SSLC were indicted in 2010 for causing the death of a resident due to blunt force trauma. These criminal cases highlight the severe consequences of the state’s failure to adequately supervise its facilities and protect residents from harm.

Financial Burden on Texas: A Costly System

The Texas SSLC system not only fails its residents but also places a significant financial burden on the state. In 2015, the average annual cost per SSLC resident exceeded $210,000—making SSLCs one of the most expensive care options for individuals with IDD. This high cost is driven by several factors, including rising per-resident expenses, declining enrollment, and the need for costly renovations and maintenance at the aging facilities.

The financial burden of maintaining the SSLC system is unsustainable. The Texas Sunset Advisory Commission has repeatedly raised concerns about the inefficiency of the system, noting that the state operates 13 SSLCs despite serving a shrinking population. Over the past 35 years, the average monthly population at SSLCs has declined by more than 70%, yet the cost per resident continues to rise. As a result, the state is spending more on fewer people, while failing to meet basic care standards.

Community-Based Care: A Better Alternative?

Given the systemic failures of SSLCs, many advocates and policymakers are calling for a shift towards community-based care options. Programs like the Home and Community-Based Services (HCS) waiver offer individuals with IDD the opportunity to live in their own homes or small group homes while receiving personalized support. These programs are generally more cost-effective, with the average annual cost of community-based care significantly lower than that of SSLCs.

In addition to being more affordable, community-based care models often lead to better outcomes for individuals with IDD. Studies have shown that people living in community settings experience greater independence, better health outcomes, and improved quality of life compared to those in institutional care. However, despite the clear benefits of community-based care, long waiting lists and a lack of funding have limited access to these services in Texas.

Reform Efforts: Can the SSLC System Be Salvaged?

While the Texas Legislature has taken steps to address the problems within the SSLC system, progress has been slow, and the fundamental issues remain unresolved. In 2014, the Texas Sunset Advisory Commission recommended closing six of the state’s 13 SSLCs, citing high operating costs and declining enrollment. However, strong opposition from families and advocates stalled these efforts, and no closures have occurred to date.

One of the biggest challenges to reforming the SSLC system is balancing the needs of residents with complex medical and behavioral issues who may not be able to transition to community-based care. While advocates for closure argue that SSLCs are outdated and unsafe, families of some residents fear that their loved ones will not receive the level of care they need in a community setting. As a result, any reform efforts must be carefully planned to ensure that individuals with the most complex needs are not left without appropriate care.

The Path Forward: Necessary Reforms and Alternatives

To address the ongoing crisis in the SSLC system, Texas must implement significant reforms and explore alternative care models. These reforms should include:

• Improving staff training and retention: One of the biggest problems in SSLCs is the lack of well-trained and dedicated staff. Texas needs to invest in better training programs for SSLC employees, focusing on abuse prevention, crisis intervention, and person-centered care.

• Enhancing oversight and accountability: Federal oversight has been insufficient in ensuring compliance with the DOJ settlement. Texas should strengthen its monitoring and enforcement mechanisms to hold SSLCs accountable for providing safe and appropriate care.

• Expanding community-based care: Texas must prioritize the expansion of community-based care programs like HCS and reduce waiting lists to make these services accessible to more individuals with IDD.

• Developing a transition plan: For those residents who can transition to community-based care, Texas should create a comprehensive plan that includes individualized assessments, family involvement, and ongoing support during the transition process.

Conclusion: A System in Crisis

The Texas SSLC system is a deeply flawed and costly model that has consistently failed to meet the needs of its residents. Despite years of federal oversight, abuse and neglect remain pervasive, and the state continues to spend exorbitant amounts of money on a system that is failing its most vulnerable citizens. While community-based care offers a more promising and cost-effective alternative, Texas must take action to expand these services and provide a path forward for residents trapped in the SSLC system. The time for incremental reforms has passed—Texas must commit to bold and comprehensive changes to protect the rights and well-being of individuals with intellectual and developmental disabilities.

View our original article at The Texas IDD Caregiver Crisis: A Deep Dive Into A Broken System here. 

In Texas, individuals with Intellectual and Developmental Disabilities (IDD) rely heavily on Direct Support Professionals (DSPs) for essential care and assistance in their daily lives. But a worsening caregiver crisis has left many without the proper support they need. Chronic underfunding, low wages, facility closures, and long hours for workers have all played a role in creating an unsustainable situation, with no easy solution in sight. The repercussions of this crisis are not just felt by the professionals tasked with providing care but also by the tens of thousands of Texans with IDD who rely on these services. In this investigative report, we’ll delve into the causes of the Texas IDD caregiver crisis, the impact on individuals with IDD and their families, and the potential solutions being discussed to fix the system before it’s too late.

What are Direct Support Professionals?

Direct Support Professionals (DSPs) are, essentially, the backbone of the IDD care system. These workers help individuals with IDD manage their daily lives, assisting them with everything from personal care like bathing and eating to more complex support needs like administering medication and managing behavioral issues. Without DSPs, many individuals with IDD would not be able to live in community settings and might be forced into more restrictive institutional care environments.

The Role of DSPs: More Than Just Caregiving

Many people don't fully understand what DSPs do. They don't just provide physical care, like helping someone get dressed or take their medicine. DSPs also help individuals with IDD build skills that can help them live more independently, whether that's cooking, managing money, or socializing in their community. They facilitate inclusion, making sure that those with IDD have the opportunity to live a more fulfilling life, just like anyone else.

However, despite how critical their role is, DSPs are often underpaid and overworked. Their wages are typically low, with the average pay in Texas hovering around $10.60 per hour for community-based DSPs. That's significantly lower than many other care-related fields, even though the responsibilities are considerable.

How We Got Here: The Roots of the Texas IDD Crisis

So how did we get to this point? Texas’s IDD care system didn’t collapse overnight. The caregiver crisis has been years, even decades, in the making, and it’s the result of a combination of systemic failures.

Underfunding and Low Wages

At the heart of the issue is funding, or rather the lack of it. Texas has long underfunded its IDD services, and DSP wages are a key part of that problem. Wages in the IDD field are simply not competitive, and with the cost of living increasing, DSPs in Texas are struggling to make ends meet. This has led to high turnover rates, with many workers leaving for better-paying jobs in retail or other industries. In fact, Texas has one of the highest turnover rates for DSPs in the nation, with some estimates placing it at 50% or higher annually.

This constant churn of workers means that individuals with IDD don’t get the consistent care they need, and facilities are perpetually understaffed. Without the ability to offer competitive wages, care providers are left scrambling to fill shifts, with existing staff often forced to work longer hours to make up for the shortage.

Facility Closures and Staffing Shortages

In 2023 alone, 179 HCS homes and 50 ICF facilities in Texas were forced to close due to a lack of staff. And that number is expected to grow, with an additional 92 HCS homes and 34 ICF facilities projected to close by the end of 2024. These closures are directly tied to the staffing shortages caused by low wages and high turnover, but the ripple effect is devastating. With each closure, individuals with IDD are forced to find new homes, often far from their communities and loved ones. The trauma of moving, combined with the uncertainty of where they’ll receive care next, takes a significant toll on their mental and emotional well-being.

Burnout Among DSPs: Working to the Bone

For those DSPs who remain in the field, the work has become increasingly untenable. Many DSPs report working 60 to 100 hours a week just to make a living wage, often taking on extra shifts to cover for their absent colleagues. The physical and emotional toll of this overwork is immense, leading to burnout and further contributing to the high turnover rate. As one DSP in Texas explained, "We're being asked to do so much, but we're not getting paid enough to make it worth it. It's exhausting, and it feels like no one really cares about us."

Burnout also has a direct impact on the quality of care that DSPs can provide. Exhausted caregivers are more likely to make mistakes, whether that’s administering the wrong dosage of medication or missing signs that an individual’s health is deteriorating. This is not just a staffing issue; it’s a health and safety issue for those with IDD who depend on DSPs for their well-being.

The Impact on Families: Struggling to Provide Care Alone

For families of individuals with IDD, the consequences of the caregiver crisis are overwhelming. Many families are already stretched thin, providing care for their loved ones while juggling work, finances, and their own mental and physical health. But as the state’s IDD care system falters, more and more families are being forced to take on even greater caregiving responsibilities themselves.

The Waiting List Problem

One of the most significant challenges facing families is the waitlist for home and community-based services. Texas has one of the longest waitlists in the country for Medicaid waiver services, with some individuals waiting up to 13 years for eligibility determinations. These waitlists leave families in limbo, unable to access the support services that could make a world of difference in their daily lives.

For many families, this wait is unbearable. One mother of a child with IDD shared her frustration: "We've been on the waiting list for nine years. Nine years. In that time, I've had to quit my job to stay home and take care of my son. We're barely making it." These stories are not unique; across the state, families are bearing the burden of an underfunded and understaffed system, with no end in sight.

Caregiver Burnout Among Family Members

Just as DSPs experience burnout, so too do family caregivers. Providing full-time care for a loved one with IDD is physically, mentally, and emotionally taxing, and without respite services or professional support, many families are pushed to the breaking point. Caregiver burnout among family members can lead to serious health problems, including depression, anxiety, and even physical illnesses caused by chronic stress.

The Consequences: A Broken System and Declining Care Quality

The Texas IDD caregiver crisis isn’t just a workforce issue; it’s a care quality issue. As facilities close and staff shortages worsen, the overall quality of care for individuals with IDD has declined. Facilities that remain open are often operating at or beyond capacity, with fewer staff members caring for more residents. This leads to overcrowding, longer wait times for services, and diminished care for the individuals who need it most.

Rising Rates of Hospitalization

One of the most alarming trends emerging from the IDD caregiver crisis is the rise in preventable hospitalizations. Without consistent access to quality care, individuals with IDD are more likely to experience health crises that require hospitalization. These crises can range from medication errors to preventable infections or injuries that occur because a caregiver was too overworked or understaffed to provide adequate attention.

Between 2021 and 2024, hospitalizations for individuals with IDD in Texas increased by 14%, with many of these hospitalizations deemed preventable. The consequences of these hospitalizations go beyond the individual’s health—they also place an additional burden on the healthcare system, straining resources and driving up costs for the state.

Behavioral Issues and Mental Health Decline

In addition to physical health issues, the lack of stable care has led to an increase in behavioral problems and mental health decline among individuals with IDD. Many individuals with IDD rely on consistency and routine, and the constant turnover of caregivers or the closure of facilities disrupts this stability. As a result, individuals may experience heightened anxiety, depression, or behavioral outbursts as they struggle to adjust to new environments and new caregivers.

One provider explained the impact of these changes: "The individuals we care for thrive on routine, and when we can’t provide that because we're short-staffed or they're having to move from home to home, it really impacts their mental health. We're seeing more behavioral incidents, more mental health crises, and it's heartbreaking because we know it could be avoided if we just had the resources."

Government Response: Efforts to Address the Crisis Fall Short

The Texas Legislature has made some efforts to address the IDD caregiver crisis, but these measures have largely been insufficient to stem the tide of facility closures and staff shortages. In 2021, lawmakers approved a modest wage increase for community-based DSPs, raising the base wage from $8.11 to $10.60 per hour. While this was a step in the right direction, it hasn’t been enough to attract and retain the workers needed to fill the growing gaps in the system.

Advocacy for Higher Wages

Advocates, including the Time to Care coalition, have been pushing for a more substantial increase in DSP wages, calling for a base wage of $15 per hour. They argue that a living wage is essential not only for attracting new workers to the field but also for retaining experienced caregivers who are being lured away by better-paying jobs in other industries. As one advocate explained, "We're losing good people because they can go work at Walmart or Amazon and make more money with fewer responsibilities. That’s the reality we’re facing."

While advocacy groups have made some progress in raising awareness of the crisis, real change has been slow to come. Many in the IDD care community feel that the state government has been too focused on short-term fixes, like wage increases, without addressing the systemic issues that have caused the crisis in the first place.

Systemic Reform Efforts Stalled

Efforts to reform the IDD care system in Texas have largely stalled, with no comprehensive plan in place to address the root causes of the caregiver crisis. Legislative proposals to streamline the waiver system, increase Medicaid reimbursement rates, and improve training and support for DSPs have struggled to gain traction, often stymied by budget constraints and political opposition.

The Road Ahead: Potential Solutions and Necessary Reforms

So, what can be done to solve the Texas IDD caregiver crisis? Experts and advocates agree that a multifaceted approach is needed—one that addresses the immediate workforce shortages while also laying the groundwork for long-term reform.

1. Increase Wages and Improve Working Conditions

The most immediate need is to raise wages for DSPs to a competitive level. A $15 per hour base wage is a minimum starting point, but wages alone won’t be enough. DSPs need better working conditions, including access to benefits like health insurance, paid time off, and family leave. Without these, the turnover will continue, and the workforce shortage will only get worse.

2. Expand Training and Professional Development Opportunities

Another key piece of the puzzle is expanding training and professional development opportunities for DSPs. Many workers feel ill-equipped to handle the complex needs of individuals with IDD, leading to frustration and burnout. By investing in more robust training programs, Texas can help build a more skilled and confident workforce, reducing turnover and improving care quality in the process.

3. Address Funding Disparities Between Care Settings

There’s also a need to address the funding disparities between state-supported living centers and community-based care. The wage gap between DSPs working in state facilities and those in community settings is a major factor in the workforce crisis. Increasing Medicaid reimbursement rates for community-based providers would allow them to offer more competitive wages and retain staff, improving care across the board.

4. Implement Long-Term Systemic Reforms

Finally, Texas must implement long-term systemic reforms to ensure that the IDD care system is sustainable for years to come. This includes reducing waitlists for Medicaid waiver services, expanding access to respite care for families, and creating a more integrated care system that doesn’t rely so heavily on DSPs who are already overburdened.

Conclusion: The Time for Action is Now

The Texas IDD caregiver crisis has reached a tipping point. Without immediate action to address the workforce shortages, facility closures, and declining care quality, the system could collapse entirely. The consequences of inaction are dire—not just for the DSPs who are overworked and underpaid, but for the individuals with IDD and their families who depend on these services for their health, safety, and well-being. It's time for Texas to invest in its IDD care system, ensuring that the most vulnerable members of society receive the support and care they deserve.