RD549 - Central Virginia Training Center Alternative Use Study - November 30, 2016

Executive Summary:
JTS conducted an assessment of the financial viability of continuing to operate the Central Virginia Training Center beyond the scheduled 2020 closure date. A consolidated Central Virginia Training Center inclusive of the five Lower Rapidan Buildings (Buildings 8, 9, 10, 11 and 12) was proposed. Each of these buildings have recently been renovated.

Our team was tasked to project future census, capital requirements to transition to a smaller campus, impact on CMS (Medicaid) reimbursements, and provide financial models inclusive of operational and capital costs and Medicaid reimbursements. To complete this assignment, we assembled a team including Architects, Engineers, Healthcare Consultants, Operational Consultants, and Food Service Consultants.

Virginia had decided to close the Central Virginia Training Center along with its settlement agreement with the Department of Justice to comply with the Olmstead Decision and the American with Disabilities Act. Although neither the Olmstead Decision nor the Department of Justice mandated the closing of the Training Centers, the mass institutionalization of individuals with Intellectual and Development Disabilities (IDD) was determined to violate the American with Disabilities Act. Thus, the Governor decided to close four of Virginia's five training centers and use the savings to fund Home and Community Based Services for former residents and wait-list individuals.

Even prior to the Department of Justice Settlement, the census at the Central Virginia Training was declining as there was a trend for greater Home and Community Based Services for IDD Individuals. New admissions were greatly reduced, individuals better suited for community care were provided community options, and natural mortality continued to decrease the census.

At its peak, the Central Virginia Training Center was home to over 3,600 individuals diagnosed with IDD. The current census at the Center is 180 residents. The median age of the residents is near 59-years old and the average mortality age for IDD individuals is between 61 and 63 years. Thus, the DOJ settlement has only served as a catalyst for already declining census. Without the DOJ Settlement Agreement, by our projections, in the Year 2030 the census at the Central Virginia Training Center would be, at most, between 5-10 residents and this assumes one new "crisis" admission per year.

The chart displayed on Page 2 of the Executive Summary shows the state projection on the CVTC census if the state had not taken action on the closure plans of the DOJ, and the census projections with closure plans, through 2030. JTS's own reviews generally concur with these census projections.

As part of the financial assessment, our team conducted an assessment of the Lower Rapidan Buildings and determined their anticipated capital needs requirements as well as the capital requirements for transitioning the campus to 80+ buildings to just the five Rapidan Buildings. Based on our assessment, a new support services building will be required to consolidate services that are currently being provided from a wide array of buildings dispersed throughout the campus. Additionally, because the facility has been slated for closure, infrastructure needs have been delayed and some systems have exceeded their useful life and need to be upgraded. We have provided opinions of cost to transition to a condensed campus should the Commonwealth decide to continue to operate the facility.

We have also provided opinions of probable operating costs for the reduced campus. The operating costs were projected based on operating costs of a facility similar in size and mission. A significant portion of these operating costs are fixed and as the census continues to decline, there is not a like reduction in operating costs. Thus, even without the census attrition attributed to the DOJ Settlement Agreement and the training center downsizing, there would be a time shortly after 2020 at which the expenditures of continued operation would become financially unmanageable.