South Dakota illegally placed disabled people in nursing homes, federal investigation finds
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2532 (Published 04 May 2016) Cite this as: BMJ 2016;353:i2532In violation of federal law, the state of South Dakota unnecessarily placed elderly people and people with disabilities in nursing facilities when they could have stayed in their homes and communities with appropriate support, a US Department of Justice investigation has found.
Under the 1990 Americans with Disabilities Act (ADA) and a subsequent Supreme Court ruling, states must provide people with disabilities services in the most integrated community setting appropriate to their needs, regardless of age or type of disability.
In a 2 May letter to South Dakota governor, Dennis Daugaard, the head of the Justice Department’s Civil Rights Division, Vanita Gupta said that many of the state’s elderly and disabled people were being sent to long term care facilities despite their preference for remaining in their communities.1
“Many of these individuals, and their families, have sought long term care services from the state only to find that a nursing facility is the only available option. And many have never been informed by the state that they could be receiving care while living in their own homes. The segregation of people with disabilities not only violated these individuals’ civil rights but also wastes the state’s fiscal resources,” Gupta said.
Many nursing home residents told investigators that they were unhappy living in nursing facilities, Gupta said. One, a 73 year old man who used a wheelchair after a car accident, told the investigators that he was living in a nursing facility against his “own free will,” compared the facilities to “warehouses, ” and expressed the fear that he would be “stuck” in a nursing home for the rest of his life.
South Dakota’s Medicaid program funded the placement of about 3400 people in nursing facilities, the investigation found. Most were older than 75, but about 450 (13%) of those were younger than 65, and 160 (5%) were younger than 55. Younger patients often had disabilities that they were born with or acquired at a young age, such as cerebral palsy, multiple sclerosis, or mobility impairment due to accidents, Gupta said.
“Many people would need no more than a few hours each day of personal care assistance with tasks such as bathing, shopping, preparing meals, grooming, and medication management; occasional in home nursing visits; and some homemaking assistance,” Gupta said.
The investigation found that the state had chosen to put the “overwhelming portion” of its long term care funds in nursing homes instead of community based services. In 2013, for example, $133m of funds went to nursing facilities with just $26.6m, around 17%, going to community based assistance, far below the national average of 40%.
Community care was often less expensive than nursing home placement, Gupta said, noting that other states provided services in community settings for people with needs similar to those of people living in South Dakota’s nursing facilities.
In closing her letter to the governor, Gupta said that the federal government hoped “to continue working with the state in an amicable and cooperative fashion to resolve the issues identified in the letter.” She added, however, that “in the unexpected event that we are unable to reach a resolution regarding our concerns, the Attorney General may initiate a lawsuit pursuant to the ADA.”
In a statement released in response to the Justice Department’s findings, Daugaard said that South Dakota was making “headway” on the problems identified in the letter and would continue to work to improve access to community based care. He said, “Ideally, we want elderly residents and people with disabilities to be able to stay in their communities and receive the services they need without going to a nursing home. That can be a challenge for a state like ours, which is made up of rural communities.”
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