SOMERSET, Ky. - Physically, Deron Dickerson was a 38-year-old man. Mentally, he was a toddler who needed constant supervision.
Left alone in a bathtub, Dickerson drowned three years ago in Kentucky's largest institution for mentally disabled adults. In the years since, government investigators have found a pattern of serious problems and abuses at Bluegrass Communities at Oakwood.
One choked to death. Some have been beaten, including a man found with a shoe print on his face. Another needed surgery after swallowing latex gloves. And investigators continue to get about seven reports a month of "major incidents" at Oakwood, which has 220 residents.
Despite the problems, Kentucky political leaders refuse to consider closing Oakwood, one of a dwindling number of large institutions for mentally disabled adults across the U.S.
Oakwood's fate is the latest round in a national debate over how best to house and treat those with mental disabilities.
The trend nationwide is to eliminate large care centers, said Peter Berns, executive director of The Arc of the United States, one of the nation's largest advocacy groups for people with intellectual disabilities.
"There is no need for people to live in institutions," he said. "It's extraordinarily harmful to people."
Instead, the trend has been to move people into apartments, houses or smaller group homes in communities. At least nine states — Alaska, Hawaii, Indiana, Maine, New Hampshire, New Mexico, Rhode Island, Vermont and West Virginia — have closed their large centers, according to The Arc.
"People are not able to live their lives to the fullest of their potential in an institutional setting," Berns said. "They're segregated from the larger community. That in and of itself does great harm to them."
Whatever is decided about Oakwood will have major budget implications for Kentucky.
Federal officials, pointing to the poor treatment of residents, revoked the institution's certification on May 15 — a move that cut off $60 million a year in federal funding.
And, despite a nearly $1 billion state revenue shortfall, Kentucky has picked up the entire cost of operating Oakwood, preserving 1,300 jobs at one of the largest employers in the largely rural region of southern Kentucky. That's a $78 million annual tab.
Berns said job loss is often a concern when there is talk of closing public institutions.
"I don't think it's reasonable public policy to keep people in institutions just because a community needs jobs," he said.
Kerry Harvey, an attorney for the Kentucky Cabinet for Health and Family Services, said the push to keep Oakwood open isn't about jobs but "solely to benefit the individuals who are residents there."
"It was never intended and has never been some kind of local economic development project," Harvey said.
However, University of Minnesota researcher and psychologist Charlie Lakin said it's impossible for state officials "not to feel the pressure" to save those jobs.
Lakin and other researchers from the school released a report last month pointing out that about 150 large centers for mentally disabled people have closed nationwide over the past 20 years. They found that fewer than 60 state-operated institutions that care for more than 200 residents remain open in the U.S.
The researchers also noted that the number of mentally disabled adults living in large institutions has declined over the past 30 years from 150,000 to 37,000.
Advocates differ on the need for places like Oakwood.
Some, including Dickerson's father, say they are necessary for people who are so frail that they can't function in community settings. Others, like Berns, believe all such places should be closed.
"I don't see anything that's provided in institutions that can't be provided elsewhere," Lakin said.
Kentucky Gov. Steve Beshear said he has no intention of allowing Oakwood to close. The state is working with the Oakwood staff to improve conditions to try to convince the feds to restore Medicaid funding, which the state reapplied for Thursday.
"I want to be very clear," Beshear told local residents during a recent visit, "our total focus and 110 percent of our effort right now is to try to make sure that we get Oakwood recertified."
Dr. Nirbhay Singh, appointed by the U.S. Department of Justice to monitor Oakwood, once described it in written reports as "severely dysfunctional" and "on the brink of total chaos." But Oakwood has made significant gains since the Bluegrass Regional Mental Health Mental Retardation Board took over management earlier this year, Singh said.
Singh has been monitoring Oakwood since 2001, when investigators found conditions were so bad that they violated residents' civil rights.
Betsy Dunnigan, deputy commissioner in the Kentucky Department for Mental Health and Mental Retardation Services, said the seven "major incidents" at Oakwood in each of the past six months is a big improvement from years past.
Daniel Dickerson said he had visited his son at Oakwood monthly for 27 years and was unaware of any problems until the night he got the call that his son had drowned.
"Up until that very night, I had all the confidence in the world in that facility," he said.
Newly hired Oakwood manager David Phelps said he is bent on making the institution a safe place for residents.
"But," he said, "I can't undo what has happened here in the past."