U.S. alerts states to new policy of shifting patients to home care


WASHINGTON -- In the wake of a Supreme Court decision, states have been told to evaluate hundreds of thousands of people in nursing homes, mental hospitals and state institutions to see whether they could be receiving care in their own homes or elsewhere in their communities.

In a policy statement with far-reaching implications, the administration has informed states that to comply with the court ruling, they will almost certainly have to provide more medical and social services and shift more people out of institutions and into small group homes or apartments.

"No person should have to live in a nursing home or other institution if he or she can live in his or her community," Donna E. Shalala, the secretary of health and human services, said in a letter sent last month to all governors.

Moreover, she said, "unnecessary institutionalization of individuals with disabilities is discrimination under the Americans With Disabilities Act."

People with disabilities welcomed the administration's action, saying it would help them enforce their rights. But state officials said the federal policy went beyond the court ruling and could impose substantial new costs on states.

The state officials said that compliance would cost tens of millions of dollars for individual states and could cost more than $2 billion a year nationwide.

The federal government has some power to force compliance, because the states are required to meet federal standards as a condition of receiving Medicaid money and because the federal government enforces the Americans With Disabilities Act.

But HHS officials said they would prefer that the states cooperate in developing acceptable practices.

People who leave institutions to live in a community often need housing assistance, job training, medical care and personal attendants to help them with everyday activities. Many people spend years in institutions because these kinds of services are not available in less restrictive settings.

Federal officials said they wanted to know about any disabled person being unnecessarily confined to an institution and promised to investigate every complaint. They said they had received 43 complaints from people in 20 states. But the number of people eventually affected by the policy would be vastly greater.

The Supreme Court case, Olmstead vs. L.C., involved two Georgia women, Lois Curtis and Elaine Wilson, who had been confined to a state institution for years, even though doctors had said they could receive appropriate care for their conditions -- mental retardation and mental illnesses -- in their community.

In its 6-3 decision in June, the court said, "States are required to provide community-based treatment for persons with mental disabilities when the state's treatment professionals determine that such placement is appropriate," considering a state's resources and the needs of other people with mental disabilities.

Federal officials say the ruling applies to people of all ages, with all types of disabilities, in all institutions and all state programs.

Michael W. Auberger, a co-founder of Adapt, an advocacy group for disabled people, said state officials "see the Olmstead decision as potentially busting the bank."

William Waldman, who represents state officials as executive director of the American Public Human Services Association, agreed.

"This ruling has deep and profound implications for all states," Waldman said. "It affects not only people in state psychiatric hospitals and centers for the mentally retarded, but also people in nursing homes and children in institutions who want to live somewhere else.

"States can redirect spending from institutions to community services. But very likely there will also be new expenses for states."

Pub Date: 2/13/00

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