Sheltered care homes like the one Madison County has been operating for decades are relics of an earlier time. That doesn’t mean that some people with mental disabilities don’t need the service they provide, but it does mean that the financial model for operating the homes probably is unsustainable.
Last month, the Madison County Board voted to not rebuild its century-old Sheltered Care Home, which occupies part of what once was called the “poor farm” of the county. State officials earlier had warned that the facility would be closed unless it was extensively renovated or rebuilt.
The question now facing the board is how to care for not only the 36 people who live at the home, but also for other county residents who will need similar services in the future.
“I don’t have all the answers. I think the state needs to step up and do more,” County Board Chairman Alan Dunstan said last week. But Madison County also has an obligation to do its part.

Madison County is not unique in the problem it faces, although it is one of just two Illinois counties that still operate sheltered care homes. They function, essentially, as assisted living centers for people with mental disabilities or mental illness.
The Bellefontaine Habilitation Center in St. Louis fulfills a similar function. Its continued operation — and, if so, how and in what form — has been in question for several years.
At one time, all states operated sheltered care homes where people with severe developmental disabilities or mental retardation lived and were cared for. Most of those facilities have been closed in recent decades and the people who lived in them moved into smaller group homes. In some states, that’s worked well. In others, residents ended up in boarding houses and single-room occupancy hotels where they were vulnerable to exploitation.
The 36 people living in Madison County’s home probably will be moved into group homes. Mr. Dunstan said Friday that arrangements already have been made for 31 of them.

In recent years, there has been far too little space available in group homes to meet the demand. The lack of available housing is what caused Missouri Gov. Matt Blunt to scrap his initial plan to close Bellefontaine last year. Missouri’s Department of Mental Health solicited bids from several companies, but none was selected because of their problems with regulators in other states.
Even as more non-profit groups and for-profit companies get into the business of offering sheltered care services, there’s no guarantee that supply and demand ever will balance out, or that beds will be available in the future. That’s especially true for the small number of developmentally disabled adults who have histories of behavioral problems; many private group homes simply won’t take them.
Mr. Dunstan and his colleagues on the Madison County Board are correct in saying that running sheltered care homes — or at least paying for them — is more properly a state function.
But unlike the state, with its perpetual budget crises, Madison County has money set aside to care for mentally disabled residents. It comes from the sale of a former county nursing home, as well as a property tax approved by county residents.
People with severe developmental disabilities and mental retardation need both medical care and a safe, secure, protected place to live. The state certainly will continue to provide medical care. It’s up to the Madison County Board to ensure that the need for shelter isn’t overlooked.
(Post-Dispatch file photo)