Collapsed: The fate of Human Services may mirror that of the infirmary’s wing

The recent demolition of the east wing of the county infirmary in Millbrook has renewed interest in its history, wherein it once served as the county’s poor house and later an infirmary. A snow-collapsed roof and asbestos infestation caused the east wing to be torn down in late February. That building is now gone, but the societal needs it once served remain.The Infirmary, alongside the decaying and boarded-up buildings of Poughkeepsie’s Hudson River Psychiatric Center (HRPC) and Dover’s Harlem Valley Psychiatric Center, has been intertwined with our community’s approach to society’s indigent, insane, ill and elderly populations.There is and remains a policy drift as government has struggled and experimented in the approach to society’s vulnerable and less fortunate. In a sense, the Infirmary’s abandonment, demise and collapse mirrors the system meant to care for these populations. An institutionalization policy dominated for decades as society locked away the mentally ill and retarded in centers and the nonworking infirm and poor into poorhouses. While the initial intentions were that communal settings and country retreats were part of the treatment, the notion of hiding away society’s outcasts sometimes in deplorable conditions has long since been condemned.Deinstitutionalization began in the mid-1990s in New York, partly for community integration of the patients, partly for cost savings. The state funding previously spent on institutional care would now be reinvested to provide community supports. In Dutchess, some of this money went toward four adult-home facilities, which in addition to serving the elderly also became repositories for thousands of New Yorkers with psychiatric disabilities.County government soon realized these new nursing homes made county funding of the Infirmary redundant. The Infirmary, when shuttered, served 62 residents with a staff of 80.Fast-forward to 2011. Three of the four adult homes that opened in the late 1990s still exist, but for how long is unknown. A U.S. District Court judge ruled in September 2010 that the state’s reliance on adult homes to meet the communal needs of these populations constituted “segregated institutional settings that impede integration in the community and foster learned helplessness.” This decision was based on the 1999 U.S. Supreme Court case Olmstead v. L.C., which held that individuals in community residences have a right to live in the community under the Americans with Disabilities Act. The September court went further, requiring the state re-house 1,500 residents in New York City’s adult homes in supported housing apartments. Gov. Cuomo’s budget proposes a $31 million increase to comply with the court order.The governor’s budget also questions the continued use of community residences statewide, as well as closures of the remaining hospitals, possibly including Dutchess County’s own HRPC, which currently operates 125 patient beds with 600 employees. Prior to the Deinstitutionalization Movement, Dutchess County had 12,000 beds.Presumably, the likely closures of the remaining hospitals, nursing homes and community residences will help pay for independent housing for these folks (something I dispute). What about those incapable of independent living? Are we not destroying the various levels of the continuum of care that have helped to move people to independence while also serving as a safety net?Perhaps, not unlike the Infirmary’s east wing, the structure of human services in New York is also set to collapse? Michael Kelsey represents Amenia, Washington, Stanford, Pleasant Valley and Millbrook in the Dutchess County Legislature. Write him at KelseyESQ@yahoo.com.