Posts tagged ‘Olmstead’

May 4, 2011

North Carolina ranks 8th in…Institutional Bias??

by Richard Edwards

Recently, United Cerebral Palsy issued its national report card on inclusion, ranking the fifty states on their attempts to serve individuals with intellectual and/or developmental disabilities in community and family settings.

North Carolina ranked 43rd over all. You can read the press release here, and the complete report here. (Warning: pdf) Most notable to me is that NC continues to rank in the top 10 states nationally in terms of the number of people–over two thousand–housed in large institutional settings (16+ residents).

And while several states have closed their institutions entirely (Go, “Bama!), North Carolina is rebuilding ours.

Just this year, Governor Perdue participated in the ground breaking of a replacement for Cherry Hospital in Goldsboro, NC. And recently, the NC Department of Health & Human Services began seeking bids for the reconstruction of Broughton Hospital in Morganton, NC–a project with a total budget of $154,772,802.

Why, in the face of data that supports downsizing institutions as good policy, and the clear example of our neighbor states, do we continue to invest in these types of large congregate settings? Even with a federal DOJ investigation pending against NC regarding our failure to provide community-based living options for people with disabilities as required by the ADA and the Olmstead Decision?

I am not saying that hospitals are not an important part of the continuum–they are. But consider this–for what we are spending to build a hospital in Morganton, we could invest in community hospital beds in Charlotte and Asheville and serve the vast majority of people who are displaced to that state hospital.

My angle is that we do it, not because it’s truly needed, but because jobs are truly needed. Communities–like Goldsboro, and Morganton, and Butner–depend upon the institutions in their community for employment. Not to mention the construction work that goes into maintaining facilities that are falling apart.

And the problem with this seemingly symbiotic relationship is that people with disabilities are stuck in the middle. As long as we continue to divert funds to institutional care, there will never be enough money to support people living in the community. And as long as there isn’t enough support for people to live in the community, there will always be a need for institutional care.

NC’s people with disabilities deserve better than 43rd in the nation.

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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.

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.