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Intention is good, but is the policy?

The Baltimore Sun

We could not humanely care for even the last 150 residents at Rosewood Center - so say various reports of neglect, abuse and patient-on-patient violence - so the governor of Maryland, after one year in office, decided he should close it. This was "after a lot of consideration," Martin O'Malley said from the steps of the center's administration building, deferring to experts who believe Rosewood's severely disabled adults, some of whom were sent there by judges, will live better away from the institution and "in the community."

I say good - and good luck - but mark the date of O'Malley's bold announcement, Jan. 15, 2008, and track the results in two years. Deinstitutionalization is a wonderful concept of noble intention, endorsed by the Supreme Court, and it has been liberating for many, but it has also left a trail of homeless and neglected adults across the fruited plain.

Every time I touch on the subject of drug addiction, mental illness or adults with developmental disabilities, I get letters and phone calls from doctors, nurses, cops and social workers saying that, even in the relatively progressive and wealthy state of Maryland, this is a huge and largely ignored problem. Demand for services far exceeds funding. For those who are disabled and poor, we've set only a flimsy safety net - not enough affordable housing, not enough community supervision, limited employment opportunities - and if not for the nonprofits and charities the resulting homelessness would be even worse.

"While Maryland is the wealthiest state in the nation, it ranks near the bottom in spending for developmental disability services," Michelle Hart, co-director for public policy initiatives of the Maryland Developmental Disabilities Council, wrote to this newspaper last fall. She cited a 2005 report from the University of Colorado that ranked Maryland 44th in the percentage of statewide personal income devoted to funding services for the disabled.

The MDDC says there are more than 16,000 people in Maryland with developmental disabilities stuck on the state's waiting list for services - half in a "crisis category." (Nonetheless, the council supports O'Malley's closure of Rosewood.)

So here we are, on the path of good intentions through a maze of contradictions. Instead of fixing the institutions - hiring better staff and paying salaries that match the enormous challenges of caring for the severely disabled - we close the institutions down, even as places of last resort, even without adequate funding of community resources. We've been doing this for four decades now, and the intent was noble but the follow-up by our society, through our government, pretty lousy. We have aircraft carriers and M1 tanks to buy; we have a political class that caters to a corporate class, while many in need, through no fault of their own, go begging.

His mother called me the other day to report that Howard Fry, a 35-year-old man of limited intellect who has profound disabilities resulting from a severe beating and frostbite - he's a quadruple amputee - is still living on the edge of homelessness. What he needs is a place of his own. That's been the case for more than a year now. He's one of those on the waiting list.

The hard sweat of caring for poor or severely disabled adults would not happen without the support of the charities and nonprofits, the doctors, nurses, social workers and cops.

Ten days ago, a homeless man named David hobbled into the outpatient mental health clinic at the North Baltimore Center in the 2200 block of N. Charles St. He appeared to be in his 70s. Thin and wobbly on his feet, he walked with a cane. He carried clothing in two plastic bags. He wore large corduroy pants gathered with a belt, an oversized plaid shirt and a baseball cap. He wore a hospital tag but carried no other identification.

His steps into the clinic constituted the final steps on a long journey.

This man, who looked to the clinic staff nearly 20 years older than his actual age of 57, appeared to be lost. He'd left his home in Kansas City, Mo., five or six years ago and traveled to Indiana and Pennsylvania to visit relatives, and he'd ended up in a boarding house in Philadelphia - at least, that is what Karen Allen, outpatient clinical supervisor at the NBC, and the staff were able to piece together.

It was clear to Allen that David had dementia, probably brought on by a stroke. He also had diabetes, and he appeared not to have eaten a steady, healthy diet for some time.

David's sister in Missouri told me she'd get a call from him now and then, but she wasn't in constant contact. He wandered away from the boarding house in Philly about three months ago, and that was the last she'd heard of him - when the people at the boarding house called two weeks later to say David had disappeared.

When Allen interviewed David in Baltimore last week, he could not say where he had been, or how or why he'd ended up here. It's miraculous that he survived the journey.

"He was able to tell me the name of his pastor and his church in Kansas City," Allen says, "and that his brother owns a barbershop there." Through her work, and that of staffers Dawn Pollard and Angie Cooper, the NBC was able to track down David's sister in Kansas City. She and another brother bought a plane ticket, and Wednesday Pollard took him to BWI for the flight home.

Meanwhile, David's sister, who spoke with me Friday night but asked that her family's name not be mentioned in this column, arranged to have her younger brother placed in an assisted-living center in Missouri. That's where he is already.

So here we have a happy ending - a man with severe disabilities, and lost, finding a way home through the help of angels. With a little luck, he's back in his community, in a place where he belongs. So many others should be so lucky.


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