Home invasion: The Arizona Training Program at Coolidge is the only home some developmentally disabled people have known

"I don't think the Coolidge staff are mistreating the residents. I believe their heart is in the right place," he says. "But I also don't believe these Arizona citizens should have to live in a place that's not a community. Secondary to that, it costs so much money."

He may be biased, but there is some truth to what he says. He also points out the state Department of Health Services licensing violations that ATPC has accumulated over the past few years, even going so far as to put them in a binder for a reporter (though he didn't provide the same information on his own facility).

On the surface it appears to be a lot. Some of the violations are mundane: a door wedged open with a dustpan or too much dust on the fan blades. Some are important but not life-threatening: a resident being fed instead of being encouraged to feed himself, for example.

But others are less disturbing if you know the backstory. In a November 2007 report, DHS inspectors found that the facility "failed to monitor three individuals' fluid intake and output, bowel movements, and failed to provide medical studies (colon­oscopy for one individual). Individual numbers 2, 6, and 14 subsequently required hospitalization."

In fact, "Individual 14" died in the hospital.

But the stories the family members tell reveal more than the DHS reports.

"Individual 2" in the DHS report — the one who did not get his colonoscopy and was hospitalized for dehydration — is Dorrell. His mother and sister actually refused the procedure for both brothers, feeling it was too invasive for their delicate bodies to handle.

They also say they know the woman who died.

They don't trivialize her death, but they also known she was quite old and was riddled with arthritis.

After careful review of the report, the line between neglect and natural death is blurry. ATPC was cited for failing to provide adequate physician care, but not for abuse or neglect.

The death of "Individual 14" was the only death cited by DHS in reports dating back to 2005, which is remarkable, considering the average age of the Coolidge residents (most are in their late 50s) and their relatively diminished life expectancy. There are no deaths mentioned that resulted from neglect. That is not the case in Arizona's group homes. In 2007, at least two men died as a direct result of incompetent caregivers: One choked to death on a burrito in front of his attendant; the other hit his head on a wall, with the knowledge of his caregiver, and suffered a brain hemorrhage in bed that night.

Hacienda also has been citied for everything from violating fire codes to violating protection of a client's rights. There are examples of clients who were not positioned correctly for their feeding tubes, or who were not getting enough oxygen.

The similarity between ATPC and other facilities is one that hasn't come up in the Legislature. Of course, one facility is private; the other is run by the state, but according to Brian Abery, of the University of Minnesota, an Intermediate Care Facility for the Mentally Retarded is an institution no matter how you slice it. (For the record, Abery is against nursing homes, too.)

From Abery's perspective, if one has to close, the other does, too.

Much of the focus remains on ATPC's past, and the fact that it is "isolated" from society, as Timmons puts it. It sits in the center of the fastest-growing part of the state.

Deb Henretta, whose brother Vinnie has lived at the facility since he was 15 (he was injured in a car accident), wishes the argument could move beyond whether or not Coolidge is an institution and shift toward finding a way to tap what she sees as an underused resource.

"ATPC serves individuals with the greatest needs and complex medical conditions," she says. "ATPC could fill that need for elderly individuals who have special needs."

In 2002, the U.S. Surgeon General reported that people with developmental disabilities are less likely to receive good health care. Doctors just aren't trained to do it.

The report cites a need for places like Coolidge to figure out how to provide adequate care for a growing population of geriatrics with developmental disabilities, as well as find a way to train healthcare professionals.

One facility, the North Virginia Training Center in Fairfax, is mentioned in the report.

At a cost of $350,000 a year, it provides critical training on how to care for an aging DD population. There are other centers like it in Massachusetts, Kentucky, New Jersey, Washington State, Florida, and Missouri.