Archive for December, 2010

December 10, 2010

A Community Too Far?

by Richard Edwards

What is the price of living in your own community? Surprisingly, it’s both less and more than you might think. In North Carolina and beyond, people with disabilities–not only the aged–are being moved into nursing and assisted living facilities because of inadequate supports for community living. Not only is this a violation of a person’s civil rights according to the Americans with Disabilities Act and the Olmstead Decision, it doesn’t make fiscal sense.

National figures on the cost of nursing home care, versus home health care on a state-by-state basis is available here.  And it’s easy to see that a person can receive 8 hours of in-home care for the cost of living in a nursing facility.  Given that no nursing home provides 8 hours of direct care to its residents, it’s not a hard calculation to see that community care is cheaper, with the added benefit of being legal.

So, that’s why community care is less expensive.

Jim Shapiro from NPR, has an excellent story, here, regarding young adults with disabilities in nursing homes.  The persons interviewed in the story live in Georgia, which is significant, given the similarity of the federal lawsuit against NC’s mh/dd/sa system based upon its failure to provide community living options.

Still, national data shows that utilization of nursing homes for care of young adults is actually on the rise, despite many studies which demonstrate that institutional care is more expensive than community-based care. The problem has always been that you have to pay for the services in the community concurrently with the institutional services in order to build capacity. NC had the opportunity to do that a few years ago, with a rare one-time surplus, but didn’t take advantage, and now we are still facing a dearth of community options and an over-reliance on state hospitals. 

That’s why community care is also more expensive.

As noted in an earlier post, the federal investigation into NC’s mental health system was prompted by a complaint by advocacy group Disability Rights North Carolina, which contends that the state is violating the Americans With Disabilities Act by failing to provide proper housing for the mentally ill. Recently, Secretary Lanier Cansler told NC legislators that he believes the state is moving towards the community-based services that are necessary to prevent NC’s over-reliance on institutional care.  That may be so in some cases, but at the same time, NC is not directing money away from the institutions. Far from it.

My angle is that this the state is caught between the “community care is less expensive argument” rock, and the “funding parallel systems–even for a few years, is much more expensive” hard place. And secretly hoping the lawsuit will jar us all loose.

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December 1, 2010

A Lack of Southern (Psychiatric) Hospitality?

by Richard Edwards

Last week, it was announced that the US Department of Justice has filed a lawsuit against NC, alleging that thousands of people with mental illness are being improperly housed in Adult Care Homes, in violation of the Americans with Disabilities Act and the Olmstead Decision.

Rose Hoban has a great write up of the lawsuit here, but the link to the Georgia settlement isn’t working, so you can read more about that here.

Chris Fitzsimon has a post on the general state of things here, but, in my opinion, his posts are often a bit over-simplified. When talking about the public mhddsas system, it is never good to start a sentence with “It sounds like…”  What it sounds like is just a surface representation of what it actually is, Mr. Fitzsimon. (I would have commented on his post at his site, but his posts don’t allow for commentary, so I’m doing it here.)

The timing of this lawsuit coincides with the closure this month of Dorothea Dix Hospital, raising concerns that the state does not have enough hospital beds. That people with serious mental health issues are languishing in emergency rooms is shameful, and dangerous, but my angle is that more hospital beds is not, in fact, the answer. 

What is missing when we try to fix a struggling community-based system with more inpatient facilities? You can bet Georgia did not resolve their lawsuit by opening more inpatient facilities, and North Carolina shouldn’t–and won’t–either.

December 1, 2010

Just because they can…

by Richard Edwards

According to new statistics released this week, hate crimes against people with disabilities are rising.  I had to make the link eight words long for emphasis–hate crimes against people with intellectual and physical disabilities.  Overall, hate crimes are on the decline, down perhaps 12% year to year, but hate crimes against people with disabilities are rising by roughly the same amount. Now granted, it’s a small number–97 such crimes were reported in 2009. However, there is evidence to suggest that such crimes are vastly under-reported.

Hate crimes against people with disabilities in the UK is getting more attention, and according to a report by the Equality and Human Rights Commission (EHRC), people with disabilities are four times more likely to experience violence against them than non-disabled persons.  While that research is focused on the UK, it suggests to me that the number of hate crimes against people with disabilities in the US has to be higher than 97 annually.

My first angle on this is that it illustrates why social capital is so important–because crimes of any sort are less likely to happen to people who have friends, family and community watching out for them.  This is a crime that occurs because someone has deduced that a person with a disability is an “acceptable target”, which brings me to my second point.

My second angle on this is that if you are someone–and if you’re reading this, I doubt very seriously that you are–committing crimes against people because they have a disability, then hear this: YOU ARE A [edited] LOSER. There, I said it…Because I don’t know any other way to say it.