In January, the Massachusetts Department of Public Health announced plans to close the Pappas Rehabilitation Hospital for Children, a hospital-school in Canton for students with severe physical disabilities. The decision was celebrated by the state’s public health commissioner, Robbie Goldstein, who believes that many of the school’s children “actually could be better cared for, more safely cared for, more compassionately cared for at home.” But the announcement devastated students, families, and staff, who say that the 160-acre facility is the best place for children with complex medical and developmental challenges. Though public opposition has prompted Governor Maura Healey to “pause” the closure until further notice, Pappas and its students remain in jeopardy.
Founded as the Massachusetts Hospital School in 1907 and renamed in 2017, Pappas is home to some of the state’s most severely disabled students. The school’s sprawling campus hosts nurses, doctors, and specialists, providing a self-contained therapeutic environment and full suite of services. While the facility has capacity for 60 students, federal and state policies that discourage special residential placements for disabled students have reduced its census to 36. Many of these children have nowhere else to go.
Danielle D., who graduated from the then-Massachusetts Hospital School in 2015, was in crisis when she first came to the facility. Diagnosed with limb-girdle muscular dystrophy as a child and eventually confined to a wheelchair, Danielle was physically and sexually abused at home, shuttled in and out of foster care, and routinely excluded at her town’s public elementary school.
“I used to sit there on the couch [at the foster home] and watch the kids run and play, run and play, and I would cry, and I would wish I could run like them and . . . wish I could play like them,” she said. At school, “I would go to recess and I would just sit there and watch all the kids have fun. I would pray to God that my legs worked like them one day.”
Danielle’s health continued to decline, and she often missed class for one of her many specialist appointments. Her life changed after she returned to her father’s custody and was sent to a summer camp for children with muscular dystrophy on the then-Massachusetts Hospital School’s campus.
“It was one of the best weeks of my life. I was in a room for the first time with kids that looked just like me. There wasn’t any more, ‘Oh, I have to sit and watch.’ I can play with all of these kids and I can keep up with them. We’re all the same.”
Danielle’s father admitted her to MHS in 2007, ahead of fourth grade. The adjustment was challenging; she compared her bewilderment on her first night with a scene out of Monsters, Inc. But she came to view the nurses and staff as loving parents, and her classmates as companions in facing disability’s harshest challenges.
“You go to a public school, you’re bullied for being rare, you’re looked at for being different, you have to prove you’re this, or prove you’re that.” At MHS, she said, she could function as a wheelchair user “alongside kids that are going through the same thing that you’re going through.”
Pappas’s exclusive focus on disabled children made Danielle feel welcome. But to some disability-rights activists, this feature of the school is the very reason that it and other facilities like it must close. UNICEF, for example, believes that “residential special education should no longer be permissible in any education system, for any children with disabilities.” The National Council on Disability, an independent federal agency with activist commitments, lamented in a 2018 report that “many students with disabilities remain segregated in self-contained classrooms or in separate schools.” The report, titled “Segregation of Students with Disabilities,” spotlighted Massachusetts as one of the states with “the highest rates of placements in special facilities.”
Michael Poirier, a former patient and later staff member at Pappas, argued in a social media post that Massachusetts “has not wanted to be in the hospital business for years.” He believes that the state’s desire to close the facility is at least partly ideological, arguing that Commissioner Goldstein considers Pappas a “restrictive institution” and “does not believe [that] a person with a disability can be isolated in community settings.”
Massachusetts has relied on similar reasoning to close other public facilities. The state has shuttered five of its seven public institutions for people with developmental disabilities since 1992. Like Pappas’s students, many of those facilities’ residents were admitted voluntarily. And like Goldstein, proponents of those closures believe that the state has a moral obligation to remove the disabled from institutions that they or their guardians have chosen.
Parents felt the sting of Goldstein’s assertion that many of their children would be “more compassionately cared for at home.” “I know it’s not true, but it’s still difficult to hear,” said Nicole Friel, who admitted her developmentally and physically disabled daughter, Abby, to Pappas in 2021. “I guess that is our cross to bear as parents of disabled children, having to wonder whether we’ve done all that we can to give our child the best chance at a happy and healthy life.”
Friel and her family had struggled to care for Abby at home. “There were no services in our community geared to Abby’s level of disability,” she said, and Abby lacked “friends, hobbies, and social activities” outside of school.
“I wondered, initially, if sending her to Pappas was the right move,” Friel said. “But I started to notice that when the bus picked her up after a weekend at home, she would raise her arms in the air and bounce in her chair—a clear sign, if you know her, that she is happy.”
Regardless, Friel and other parents will need to find alternatives if Massachusetts governor Maura Healey proceeds with the closure. Pappas staff sent an email to parents after the initial closure announcement noting that some students may be sent to “nursing home[s]” or to Western Massachusetts Hospital, a state-operated public-health facility in Westfield nearly two hours from Canton.
“Over the coming weeks and months, we will work with all of you to find appropriate placements for each patient’s specific medical needs,” a Pappas staff member wrote. “That may mean a transfer to another sister hospital, nursing home, group home, or your home. Remaining patients who have not completed their hospital-level treatment may be transferred to Western Massachusetts Hospital.”
The Department of Public Health, which operates Pappas and three other facilities, had planned to open a smaller hospital-school for children at the Western Massachusetts Hospital. While Pappas can serve up to 60 children and has an expansive physical plant, the Westfield facility would have been cabined in a much smaller ward and accommodated less than half of Pappas’s capacity.
“There are no clear plans to replicate the educational, recreational, social, and therapeutic services that these kids receive at Pappas,” Friel said. “And 25 beds is simply not enough.” She believes that more families like hers would have admitted their children to Pappas were it not for the state’s years-long policy of downsizing the hospital.
“The reason that there are only 36 children at Pappas today is DPH’s policy of reducing the number of children it accepts while discharging others before their graduation date,” she said.
While parents were relieved that the governor has suspended closure plans, the reprieve may be short-lived. A union representing Pappas employees claimed that staff were still being “instructed to relocate new patients and/or divert new admissions, consistent with a planned closure.” Without new admissions, closure—whether this year or some years down the road—is inevitable.
Facilities like Pappas, rural campuses created exclusively for students with disabilities, buck the prevailing philosophy in education, which insists on “inclusion” above all else. John E. Fish, the first superintendent of the then-Massachusetts Hospital School, noted in 1907 “what a great change takes place in the health of the children” at the facility “after a few months of generous, well-regulated diet, an abundance of fresh air and a careful medical guardianship.” Pappas today offers students, many of whom have suffered years of mistreatment and neglect, a similar place of reprieve.
On a wood panel atop a covered walkway at the heart of campus, Fish etched the words that inspired his work, taken from the Gospels: “THAT THEY MIGHT HAVE LIFE AND THAT THEY MIGHT HAVE IT MORE ABUNDANTLY.” For Pappas students, and for other children who could benefit from its services, closure, whenever it might happen, would mean the end of that vision.
“This is a one-of-a-kind facility,” Danielle said. “There is nothing like this in the world.”
Photo by Suzanne Kreiter/The Boston Globe via Getty Images
