Until the 1970s, the only place in Idaho where people who were developmentally disabled could receive therapy was at the Idaho State School and Hospital in Nampa.
The State School and Hospital became home to Idahoans with Down syndrome, autism and other conditions that made learning basic skills a challenge and often caused intensive medical or behavior problems.
Martin Landholm became manager of professional services there in 1964. With about 1,000 patients in the building during its peak, Landholm says the operation was akin to warehousing. Often, patients lived there for decades without seeing family or learning skills that could help them live in another setting, he says.
"It was just a place to reside," Landholm says. "There were so many, many people placed in that capacity."
In 1970, Idaho joined a movement of states removing patients from hospitals and offering local services, including in-home care through Medicaid. The state embraced therapy models used in Sweden and elsewhere that encouraged clients to interact with society.
Landholm, 75, says services - and quality of life - have improved since. The state system has been replaced by private centers, a transformation that starting when he and his wife, Rosalie Landholm, founded Gem State Developmental Center in 1983.
Under the Landholms' ownership, today Gem State operates adult and children centers in both Meridian and Nampa. About 50 employees provide services from 9 a.m. to 3 p.m. to 90 clients, teaching self-care skills, such as washing hands and making a sandwich, and vocational skills, such as sorting and counting money.
The goal is to increase independence, whether that means helping a client move out of parents' homes and into group homes or being able to brush their teeth without assistance.
Nearly 5,000 Idahoans with developmental disabilities received service through Medicaid during fiscal year 2013, says Tom Shanahan, spokesman for the Idaho Department of Health and Welfare. The year ended in June.
Medicaid paid $45.7 million for services provided by developmental disability agencies like the Landholms', Shanahan says. Of that, $13.3 million was paid by Idaho. The federal government paid the rest.
Medicaid paid Gem State $1.1 million for services in fiscal 2013, Shanahan says.
During the 1970s, the state opened community-based centers in each of seven Idaho regions, where clients went for day classes. The state built satellite centers in outlying communities so that clients could come from their homes or from community homes, where people lived in supervised groups. Others lived in certified family homes, which are like foster homes where host families are paid to be caretakers.
Landholm managed services in the Region 3 center in Nampa.
"We knew, and other states also realized, that we needed to do something to treat this population with much more dignity than with institutionalizing," he says. "With community-based programs we could develop skills [for them] just like normal people."
Landholm says deinstitutionalizing was positive, but he saw room for improvement. He also saw a demand for services from people the state previously didn't know about.
"They had been right in their homes all along," Landholm says. "Their parents were uncomfortable sending them to the state institution."
The Landholms opened the original Gem State Developmental Center in Meridian to serve adults. More private centers for the developmentally disabled have sprung up since, prompting the state to shut down its services in 1994. Today, Idaho is home to 70 agencies that operate at 154 locations, including 50 locations in the Treasure Valley.
The State School and Hospital is now called the Southwest Idaho Treatment Center. It houses 29 severely disabled patients needing constant supervision. The center remains open so the state can ensure care for people with the most challenging conditions. "It's a safety net," he says.
Gem State clients have IQs of 75 or lower or have behavior problems requiring supervision. Employees tailor curricula to match each client's ability. For Gwendolynn Roller, a 42-year-old with autism, that includes learning the Dewey Decimal System, which she uses when she volunteers to file returned books, DVDs and CDs at a library once a week.
Roller also learns social skills. She now plays group games Uno and Boggle, which never would have happened before she started attending Gem State seven years ago, says her mother, Pat Roller.
"Like most autistic people, she's quite the loner," Pat Roller says. "They've taught her how to interact with others. Playing games doesn't sound like much, but she used to just sit down and play solitaire."
Groups of adult clients shop, eat at restaurants, exercise at a gym and take part in other off-campus activities. Clients are encouraged to interact with clerks, make purchases and navigate the world on their own. During the summer, groups shop at yard sales, giving clients a chance to learn how to judge quality and price, says Lori Jo Poole, clinical supervisor and 15-year veteran.
"Part of our job is integrating people into the community, which is hard to do if you are only working on counting skills with a money tray sitting on a table in an office building," Poole says. "That kind of preparatory or repetitious work is great. They can learn how to do it. But getting them shopping and interacting with people they don't know is really important."
Treagon Munkres is a developmentally disabled 24-year-old with a functioning age of about 7. His guardian, Mike Munkres, says his grandson has taken strides since he enrolled with Gem State nearly four years ago.
"They're teaching him how to work in the community, how to get out there," Mike Munkres says. "He's gone through a lot of depression. They lift him up. They make him feel good."
Few families of developmentally disabled clients at Gem State - or any similar center - pay the $30,000 to $40,000 annual cost for services out-of-pocket. Medicaid pays for services for about 90 percent of clients, Poole says. Medicaid is the federal and state health insurance program for low-income and disabled people. Medicare, the federal insurance program for the elderly, pays the remaining 10 percent.
Gem State's 10 developmental specialists each make about $40,000 a year. The nearly 40 para-professionals make about $20,000 each. The state establishes the cost of services. Those prices have increased 7.25 percent over the past 23 years, which hasn't left much room for pay raises, Landholm says.
"Unlike Joe Albertson, I can't just raise the price of bread," he says.
Poole says none of the staff members entered social work expecting to make a fortune.
"You have to love the work," Poole says. "Fulfillment from the job has to mean a heck of a lot more than the size of your paycheck."
Landholm declines to disclose revenues or profits, though he says the business is profitable in part because he hasn't taken a paycheck since he reached retirement age a decade ago. He says Rosalie Landholm, 74, takes a salary of $34,800.
"You have to manage your assets very, very carefully," he says. "I've always been very disturbed we can't pay better salaries to our staff. But, like any business, if you are going to stay in business, you have to work within the framework of your budget or you won't be around."
Landholm says he and his wife intend to be around for a while. They could sell the centers if their health declines, but they still come to work every day, and they haven't had a serious talk about selling.
Their daughter, Cara Emigh, works at Gem State as an administrative assistant, handling technology, marketing services and referrals. She could take over the business, Landholm says, but that hasn't been decided, either.
"The question has come up, and the answer is, I don't really know what will happen," Landholm says. "We continue to take it day by day and year by year."
Zach Kyle: 377-6464
COVER PHOTO: Developmental Specialist Junell Swenson helps Rhett Harris with a stretching exercise at Gem State Development Center in Meridian.
PROBABLY WON'T BE USED: BJ Granlund reads the Braille address he just typed on a Braille typewriter loud to check his work on a Braille typewriter at Gem State Development Center in Meridian.
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