Ohio officials, concerned that nursing homes are becoming dumping grounds for mentally disabled people, are expanding a trial program that will transfer 2,000 people with behavioral problems from nursing homes to managed community settings. Opposing this idea are — you guessed it — nursing homes.
Disability Rights Ohio (DRO), the state’s advocacy system for disabled people, believes that more than 8,000 Ohioans with behavioral problems are improperly placed in nursing homes. “The number has grown significantly in the last 10 to 15 years,” says Michael Kirkman, the group’s executive director. “With proper support, many of these individuals could live in the community.”
Changes in funding for mental-health services and cuts in federal aid to subsidized housing contribute to the problem. Placing people with disabilities in nursing homes is an easy solution for some caregivers, Mr. Kirkman says. Some nursing homes with high vacancy rates advertise their ability to deal with “problem residents” in secure “behavioral units.”
Such residents tend to be isolated and have no contact with the outside world, DRO says. Because of anomalies in the Medicaid program of low-income health insurance, they are not served by community mental-health agencies. What care they do get is typically poor and often consists solely of medication.
Home and community-based services are more effective, more humane, and less expensive, DRO maintains. Failure to ensure that disabled people are served in the most integrated setting appropriate to their needs is a violation of the federal Americans with Disabilities Act.
In 1999, the U.S. Supreme Court held in the case Olmstead vs. L.C. that states must provide community-based treatment for people with disabilities when professionals determine that such placement is appropriate, the people do not object, and state resources can reasonably accommodate placement.
Based on that ruling, the federal court in Columbus was asked to rule on a suit affecting 12,000 Ohioans with disabilities. The lead plaintiff, Nancy Martin, was a 52-year old woman with cerebral palsy, mental disabilities, and depression. She had lived in institutional settings for more than 30 years, after she was involuntarily committed to a developmental center when her father died and her mother was unable to care for her.
Ms. Martin’s pleas to case workers that she wanted to live in a community setting were futile. Her name was placed on a waiting list, where it languished for years.
She and her fellow plaintiffs alleged that the State of Ohio violated the Americans with Disabilities Act by failing to develop community-based services for mentally disabled people and for hindering the expansion of such services in favor of institutional care — all at greater expense to taxpayers.
The state argued that the law did not require the creation of Medicaid programs that would pay for community-based care. But the plaintiffs were not seeking a new program, just the modification of an existing one. The case was settled in 2004, and 1,500 disabled people were moved from institutional to community care.
Under a law enacted last year by the General Assembly, 2,000 Ohioans with behavioral problems who want to live in the community will be transferred from nursing homes by 2016. The law requires them to get the services they need to live independently.
Most will receive help from HOME Choice, a program administered by the Ohio Department of Job and Family Services that helps disabled and elderly people move from institutional care to home- and community-based settings. To qualify, residents must be eligible for Medicaid and need care that can be provided in a community setting. The cost must be no more than 80 percent of what Medicaid would pay for nursing home care.
The nursing home industry responded by lobbying for more state funding to allow 1,000 nursing home residents with behavioral problems to receive enhanced treatment. Gov. John Kasich’s administration balked at the idea, Mr. Kirkman said, but agreed to pay for a study to develop a pilot project — something Mr. Kirkman calls “a big step backwards.”
“We already know that many people with disabilities fare much better in the community than they do in an institutional setting, and helping these people live in the community costs the state less,” he said. “What’s left to study?”
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