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12/9/2004 11:01:00 AM
Changes in health care have profound impact on Muscatatuck

The Republic

By Dave Evensen

The Republic

BUTLERVILLE — Randy Krieble walked through the dim light of Muscatatuck State Developmental Center’s musty, debris-strewn Polk Hall.

Some sights simply were the bizarre chaos that accumulates in abandoned buildings: chairs on top of tables, piles of dead ladybugs, office memos from 1994, faded curtains over murky windows, an old piano sitting haphazardly in an empty room.

But enough order was left to hint what health care used to be. One cavernous room once served as the living quarters for dozens of patients, who slept in long rows of beds and dressed behind thin privacy screens, still standing.

This flies in the face of today’s standards at Muscatatuck, where buildings, such as Lincoln Hall, up the hill from Polk, have been remodeled to add more walls, privacy and the notion that each patient deserves individualized care.

However, Krieble, assistant director of the bureau of state-operated services at Indiana Family and Social Services Administration, guided the tour of old with a hint of sadness.

Through the centuries, the health care field has gone through many revelations, Krieble said, adding that they were for the better.

It’s just that the latest revelation is at least partly responsible for closing Muscatatuck. Lincoln Hall, renovated with the residents’ best interests in mind, has been closed for two years. The remaining halls soon will follow.

Krieble walked back to the administration building through a wide, wet field of grass. He pointed out more landmarks as he went: the unused superintendent’s quarters, last used for living in the 1980s, and the chapel, built with money from families.

“This isn’t a matter of being good or bad,” he said, of Muscatatuck’s closing. “It’s a matter of what’s good for the individual. And not everyone agrees on that.

“It was a forced choice for the parents (of residents),” Krieble continued. “Not everyone is going to agree, but it is the right thing to do.”

Health care changes

Times change. Perceptions change. That’s evident in how the disabled have been treated by society since ancient times.

Historian James Coleman wrote in his 1976 book, “Abnormal Psychology and Modern Life,” that in the Middle Ages, mentally disabled patients were treated by clergy.

As methods spread, they became harsher, and torture was used to chase demons from the body.

Krieble noted that the disabled also at times in history were treated preciously, as if they were holy.

“Times, cultures, values, whatever changes,” he said.

In the United States, large institutions such as Muscatatuck caught a toehold early.

Jacqueline Bouyea, superintendent at Muscatatuck, said there once was little choice for long-term care of the developmentally disabled other than the state institutions.

“There were no alternatives,” she said. “It was either stay at home or come to a place like this.”

The lack of variety made Muscatatuck home sometimes to even the marginally disabled, whom families and communities deemed simply too different to deal with.

Krieble said in Muscatatuck’s early days some residents chopped wood, farmed and helped build the institution.

Muscatatuck no longer accepts new patients, but if it did, admissions would be governed by a definition of developmentally disabled that might have excluded some marginal cases.

The disability, stemming from a mental or physical impairment, or both, must have formed before age 22 for the patient to be accepted. It must be likely to continue indefinitely.

The disability must also impair at least three of seven “life activities,” according to Muscatatuck: self care, communication skills, learning, mobility, self-direction, living skills and ability to support yourself economically.

Typical disabilities come from autism, mental retardation or cerebral palsy, Krieble said. Patients with mental illness, such as schizophrenia, are not sent to Muscatatuck, he added.

The new restrictions have come with more outside living options for the disabled, however. A series of events and new laws during the past half-century brought on the changes, according to Bouyea and Krieble.

Centers opened to care for wounded veterans after World War II, and introduced the idea that other institutions could care for the disabled.

Laws mandated that children had to receive a free education. As a result, more children stayed home rather than come to Muscatatuck. Wage laws said all workers must receive fair pay.

The Americans with Disabilities Act, Krieble said, improved life for the disabled in their home communities and made it less likely they’d be sent to state homes.

In the 1970s, nursing homes began catching on as another method of care, Krieble said.

Then, in 1982, the federal government allowed people to use Medicaid for smaller settings, like group homes, instead of only Muscatatuck-like institutions.

Through the decades, referrals to Muscatatuck fell. In 1980, about 2,600 people lived in state institutions in Indiana. By 1997, that number was down to about 1,000.

The group home population during that period increased from about 300 to 3,800. Other similar alternatives followed the same pattern.

Last days

The shift away from institutions like Muscatatuck is occurring all over the country, Bouyea said.

She and others also feel it is the right thing for people. Bouyea said the home settings that serve as the new alternative to Muscatatuck are less restrictive and more natural.

Krieble said in these home-like settings more attention is being paid to each individual’s care.

“People aren’t (anymore) being grouped and categorized and lumped into one box that you live in,” Krieble said. “They have an opportunity to have a program prescribed to them.

“It’s a philosophy shift. It’s an overt effort by advocates.”

Krieble said despite the change, the closing of Muscatatuck is not a reflection on the employees who work there.

“We have an extremely dedicated staff,” he said.

Cindy Speer, in transitions and outreach with FSSA, said many employees are going to work with former Muscatatuck residents in new settings.

And, she added, many former residents have elected to stay in Jennings County to continue receiving care from Muscatatuck employees.

“We know where every one of these (former residents) are,” Krieble said.

“It isn’t about closing. It’s about arraying better services for people.”

FRIDAY: The story of 50-year resident Dorothy Stewart, who no longer needs to be at Muscatatuck but doesn’t want to leave.

Portions © 2004, The Republic, Columbus, Indiana

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• Changes in health care force residents, employees to leave Muscatatuck
• Woman faces moving day after 54 years at Muscatatuck
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