E N Q U I R E R   S P E C I A L   I N V E S T I G A T I O N
Rich county, poor county
Stunning disparity in help

By Debra Jasper
Enquirer Columbus Bureau

Light therapy is used by a Lake County school that caters to the needs of school age children.
(Photo by Michael E. Keating)
In a run-down trailer in the back woods in Vinton County, Frances Malone takes care of a sister, two sons, a daughter and a grandson all five of them mentally retarded.

The 78-year-old grandmother, who's still recovering from her own heart surgery, asks the Lord each morning just to get her through the day.

"There's no activities for them here, no jobs, no nothing," she says. "I'm all they've got."

When it comes to getting mental retardation services, the Malones couldn't live in a worse Ohio county.

Taxpayers spend just $2,800 a year on each mentally retarded person in Vinton. The Appalachian county has just one county caseworker, no medical specialists and a workshop that sits mostly empty.

Haves and have-nots
Tax dollars spent each year on mentally retarded Ohioans varies wildly from $43,800 in Wood County to $2,800 in Vinton County.
County Amount per mentally retarded person Mentally retarded people
Wood $43,798 358
Lake $38,730 951
Clinton $27,624 127
Clark $26,764 773
Richland $24,915 682
Franklin $24,276 6,460
Portage $23,007 634
Columbiana $22,731 398
Trumbull $22,384 1,004
Cuyahoga $22,205 6,210
Hancock $21,791 319
Athens $21,021 269
Summit $20,431 2,166
Jefferson $20,303 390
Geauga $20,269 467
Madison $20,208 204
Montgomery $20,012 2,017
Marion $19,722 295
Fairfield $19,698 380
Wayne $18,457 463
Mahoning $18,276 924
Hamilton $18,184 3,346
Clermont $17,541 657
Fayette $17,372 142
Tuscarawas $17,187 420
Holmes $17,142 236
Guernsey $16,744 193
Lucas $16,530 2,226
Ashtabula $16,415 510
Muskingum $16,388 335
Meigs $16,365 110
Auglaize $16,217 215
Union $16,156 282
Highland $15,714 184
Stark $15,662 1,843
Henry $15,645 329
Butler $15,574 1,333
Medina $15,418 664
Erie $15,258 362
Ross $15,020 403
Defiance $15,001 201
Brown $14,800 118
Warren $14,741 706
Allen $14,560 604
Washington $14,410 415
Ottawa $14,332 300
Morrow $14,331 237
Shelby $14,155 265
Scioto $14,127 433
Miami $14,057 584
Monroe $14,008 97
Ashland $13,742 276
Fulton $13,719 226
Pickaway $13,649 230
Delaware $13,628 586
Hardin $13,544 166
Huron $13,493 221
Coshocton $13,492 283
Adams $13,149 122
Seneca $13,025 407
Greene $12,805 474
Jackson $12,406 114
Lorain $12,079 1,624
Van Wert $12,079 176
Belmont $12,067 418
Gallia $11,775 160
Perry $11,733 255
Licking $11,508 743
Morgan $11,494 81
Wyandot $11,328 141
Pike $11,327 213
Champaign $11,306 334
Carroll $11,281 194
Knox $11,142 280
Crawford $10,721 255
Logan $10,583 377
Putnam $10,279 173
Paulding $10,247 173
Sandusky $10,164 344
Harrison $9,875 134
Lawrence $9,772 394
Darke $9,753 339
Mercer $8,500 295
Preble $7,948 262
Hocking $6,653 175
Noble $6,624 67
Williams $6,162 297
Vinton $2,795 159
Source: Ohio Association of County Boards of Mental Retardation and Developmental Disabilities, 1999 Revenue and Expenditure Report for county mental retardation boards.
Yet across the state in Lake County, on the banks of Lake Erie, taxpayers spend $39,000 a year nearly 14 times more on each mentally retarded resident.

Lake County operates a sprawling, 65-acre complex with soccer fields, wooded hiking trails, medical specialists and even a greenhouse where people can earn money by raising plants.

All of which illustrates a harsh reality: In Ohio, the kind of care mentally retarded people get depends largely on where they live.

Disparities are stunning in a system that depends on local tax dollars more heavily than any state in the nation.

Local tax levies raise 40 percent of the $1.4 billion in non-Medicaid funds spent each year. In most states, local dollars account for just 5 percent of the money spent.

The results are predictable. Poor counties go begging for state help while rich counties pass tax levies to upgrade even more. Residents of poor counties go without such basics as medical care, while those in richer counties work in state-of-the-art facilities, take trips and have access to psychologists, speech therapists and other medical specialists.

It's a funding system that's significantly flawed, says Tom Nerney, director of the Center for Self-Determination, a national group based in Ann Arbor, Mich., which provides training to disability groups.

"There is a simple issue here of justice," he says. "People of equal need ought to have access to equal resources."

Despite the drawbacks, officials say Ohio has a long history of local control and will always lean heavily on county tax dollars. The funding system mirrors the public school-funding formula, which relies so much on local property taxes that the Ohio Supreme Court has ruled it's unfair and unconstitutional.

As with schools, lawmakers are starting to focus on inequities in the mental retardation system. They voted last year to spend $20 million over the next two years to help poorer counties begin to catch up, although advocates say far more is needed.

That new money provides little comfort to Chris Layh, superintendent of the Vinton County Board of Mental Retardation in rural McArthur, 130 miles east of Cincinnati. To get the new money, counties must show they are raising local funds, and his board has failed 14 times in the past decade to pass a tax levy.

It's the only county in the state without one.

"I look around the state and see what other counties are able to do, and I just sit here and burn," Mr. Layh says.

Down the hall from his office Mr. Layh gives a tour of a small warehouse, which is supposed to provide piecemeal factory work and other jobs. Since there's no work, the few mentally retarded people who bother to show up host a regular, but sparsely attended, garage sale. Others just sit around with nothing to do.

"Down here, no one thinks the squeaky wheel gets the grease because everyone knows there is no grease," Mr. Layh says. "It gets really depressing after a while."

The best of care

The difference between services offered in Vinton County and those in Ohio's more prosperous counties couldn't be more apparent.

Lake County, a wealthy suburb of Cleveland, runs a special school, childhood and recreational programs and two busy workshops, which offer people everything from factory work to computer training.

The workshop also provides special adaptive equipment for severely mentally retarded or medically fragile people. It has chairs that swing from the ceiling and vibrating mats that help stimulate people.

The county takes an unconventional approach to "time-out" rooms, too. County workshops often put aggressive or agitated mentally retarded people in bare, concrete rooms where they're supposed to cool off or calm down.

Lake County provides dimly lit, carpeted quarters featuring soft music, colorful lava lamps, waterbeds and other features designed to soothe fragile nerves.

"It's uplifting. It has a calming effect," says Gary Metelko, who directs adult activities at one of the county's workshops.

In addition to services for adults, Lake County operates Broadmoor School, attended by 96 mentally retarded children. They have access to a huge gymnasium, a variety of special-needs devices and a swimming pool.

While the trend in Ohio and nationally is for mentally retarded students to go to public schools with other kids, that's not always the best choice, Broadmoor Superintendent Elfriede Roman says.

"Some parents try the public schools and bring their children back here," she says. "They think their children do better with special attention."

Cari Dorchock is one of those parents. Her daughter, Ashlee, attended a public elementary school but moved to Broadmoor when she turned 13. Ms. Dorchock says Ashlee who has a seizure disorder and operates on the level of a 2 1/2-year-old received little stimulation in the public middle school and ended up sitting in a bean bag chair most of the day.

"I'm a social worker, and I've been to lots of seminars on inclusion and it sounds great," Ms. Dorchock says. "But I don't know that they are ready for some of our kids in a regular school system. I can't even imagine what happens to kids in wheelchairs or kids who use feeding tubes."

At Broadmoor, which has a teacher and an aide for every four students, teachers have more time to work with Ashlee. "It's changed her life for the better 100 percent," her mother says.

Linda Creviston, who has been teaching swimming classes for 25 years, says mentally retarded students like Ashlee benefit from an opportunity to socialize and an activity that provides wonderful physical therapy.

"We have a very nurturing approach to teaching in the water," she says, laughing as she helps two squealing little girls down a twisting slide. "Everyone's learning from each other."

Ms. Roman says the county receives tremendous community support. Lake County voters have approved not one but two levies to support the mentally retarded since 1984. Local business groups such as the Rotary Club raise about $100,000 each year to help pay for extras: field trips for kids, a new gazebo for mentally retarded senior citizens.

The county's recreational specialists take residents to karate and horse-back riding classes. They even helped one man try out his dream of virtual-reality parachuting.

'Life's not fair'

Karate classes and parachuting are beyond even the imagination of Ms. Malone's family.

The mentally retarded members of her family range in age from her sister, Bertha, who's 73, to a grandson, Don, who's 35. A 49-year-old son, Joe, has had three strokes, a heart attack, is diabetic and needs frequent kidney dialysis.

"First thing I do every morning is test Joe's sugar," she says. "Then I give him his shot and his medicine. Then I fix breakfast and do laundry. Then it's time to fix lunch. Then it's nap time for everybody, and I try to clean house. Then I test his sugar again. Then I get supper, clean up after supper and then it's time for bed."

Things were easier for the Malones when a son, daughter and grandson attended the Vinton County workshop during the day. But with no work to do and no trained staff to help fill their time, the three eventually just quit.

Her grandson, Don, hated it there: "I was treated awful. I wasn't allowed to look out the window. They were always yelling at me."

As bad as things are, Ms. Malone has an even deeper fear: That when she dies, another daughter, Sharon, will be left alone to care for everyone. Sitting at her cluttered kitchen table, Ms. Malone rests her head in her hands, exhaustion etching the lines in her face.

"I was born and raised in this county and so was my husband. It makes me really angry to think I'd have to move to another county to get them the services they deserve," she finally says.

Sharon, too, has learned not to rely on anyone else for help.

"They say they don't have any money so maybe that's just how it is," she says. "I've survived chemotherapy, a biopsy and a mastectomy. Life's not fair. I've found that out. But God's spared my life so I can take care of them. And that's what my life will be."

Inside the Report
Failing the fragile
Ohio is supposed to care for 63,000 people with mental retardation but the system is failing.

Twelve who died
Our investigation found a dozen questionable deaths and there could be more.

Unequal system
The kind of care mentally retarded people get depends largely on where they live.

Who is accountable?
The agencies and departments charged with enforcing minimum standards of care.

Slow reform
The agencies and departments charged with enforcing minimum standards of care.

Take control
How to make sure a person with mental retardation is well cared for and safe.

Photographer's album
A visual journey into the lives of Ohio's mentally retarded.

Ohio's Secret Shame

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