DALLAS — Texas officials said Thursday they are near an agreement with federal investigators on fixing problems in the state's 13 large residential facilities for the mentally disabled, where dozens of people have died under questionable circumstances and hundreds of employees have been disciplined for mistreating residents.
The tentative plan calls for more direct care workers and medical staff, such as psychiatrists, pharmacists and dentists, state officials said. The plan also establishes independent monitors to report back to state and federal officials about conditions at the facilities.
"It's a comprehensive action plan to improve the care at all of the state schools," said Laura Albrecht, a spokeswoman with the Department of Aging and Disability Services, the state agency overseeing the facilities.
The plan requires formal approval from the Department of Justice and the Texas Legislature, said Michael Jones, a state spokesman. It must then be filed in federal court.
The Justice Department could sue if there's no settlement.
The agreement won't close any state schools, which can be done only by the Legislature. That possibility was sought by advocates who say large facilities are not the proper venue for treating the mentally disabled. But it was abandoned last month by lawmakers who said state school reform would never pass with such a contentious provision.
Texas has more mentally disabled residents living in institutions than any other state. The 13 facilities in Texas house nearly 5,000 residents — more than six times the national average. On a per-capita basis, Texas has 20.4 people per 100,000 in large institutions. The national average is 12.2 people.
"The plan does dictate the state will continue to make aggressive efforts to provide opportunities to people who want to be served in the community," Jones said.
Waiting lists for those wishing to move into smaller group or community homes have thousands of names on them and take years for approval, said Dennis Borel, the executive director of the Coalition of Texans with Disabilities.
Borel said any agreement on reforming state schools should emphasize community treatment and work on changing the culture of workers. Many of them, he said, "seem to be viewing the residents as somehow not as human, not as equal as they are."
"I do believe we need to ensure the safety of the residents in state schools," Borel said. "We also need to come to grips with the will of the people who want to be served in the community, not institutions."
Alejandro Miyar, a spokesman with the Justice Department, declined to comment "because this matter is open and ongoing."
The agreement developed from a series of Justice Department investigations that revealed widespread mistreatment of mentally disabled residents in the state schools. A federal report released in December said the Texas facilities violate the federal civil rights of mentally disabled residents in the schools by failing to provide adequate mental health services or treating them in settings integrated into local communities.
From September 2007 to September 2008, at least 114 residents died. Although many were considered medically fragile, 53 deaths were attributed to preventable conditions that indicate lapses in proper care, according to the report.
In a three-month period in 2008, the state investigated at least 500 allegations of abuse, neglect and other mistreatment of residents and at least eight facilities were in danger of losing Medicaid funding because of "significant care and safety deficiencies."
The report also noted that in a four-year period ending in 2007, more than 800 employees from the 13 facilities were suspended or fired for mistreating patients.
Since 2007, state schools have hired about 1,300 workers to address staff shortages. Texas is also considering raising the pay of state school workers, including a 10 percent bump for direct care workers and up to a 15 percent raise for medical professionals.