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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