Tuesday, May 03, 2016

S.D. case raises issue of medically unnecessary placement of thousands in nursing homes

A lack of community-based services is leading South Dakota to unnecessarily place thousands of residents with disabilities in nursing homes, says a Justice Department report released Monday. That's in direct violation of "the community integration mandate of the Americans with Disabilities Act" an a Supreme Court decision, the report says. "The ADA and the Olmstead ruling require states to make services available to people with disabilities in the most integrated setting appropriate to their needs, regardless of age or type of disability."

The report shines light on a national problem. The Justice Department said there are 250,000 working-age people in the U.S. who are estimated to be needlessly living in nursing homes, Matt Apuzzo reports for The New York Times. "There are more than 1.7 million nursing beds in the U.S, and many Americans require round-the-clock care and the protection of a nursing home. But for untold numbers of others—with mental illnesses, developmental disabilities or chronic diseases—the confines of a nursing home can be unnecessarily isolating. Yet when patients seek help paying for long-term care, states often steer them toward nursing homes, even though it may not be needed."

The Justice Department said some of the people "could live at home, hold jobs and lead productive lives," Apuzzo writes. "Instead, they are confined and segregated from society. Many cannot leave the grounds of their institutions without supervision or perform tasks such as shopping for groceries or cooking meals. One resident told investigators that when friends visited to take him for a car ride, 'they have to sign me out, like a kid.'”

South Dakota—which has one of the highest nursing facility utilization rates in the country—"funds the placement of about 3,400 people in nursing facilities through Medicaid at any given time, and approximately 5,500 people over the course of one year," says the report. "People with similar needs to those living in South Dakota’s nursing facilities successfully receive services at home in other states, and even in South Dakota. The state already offers many of the services people will need to live in their own homes and can increase community capacity and address service limitations to ensure all individuals can choose these services instead of nursing facility placement." The report also found that "people with disabilities living in rural and frontier areas of the state, including those living on reservations, have particular difficulty accessing services in their homes and communities."

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