Mass.
plans new push to home care for disabled
By: Alice Dembner
Boston Globe, August 21, 2002
The state is closing Medfield State Hospital and
moving many of its 96 residents, along with nearly 300 other people with
mental and physical disabilities from nursing homes and institutions
across the state, into group or private homes. The action comes largely in
response to federal court rulings requiring that the disabled be treated
in the least restrictive setting possible
In addition, Massachusetts is planning to create 650 new beds in
community settings by June 30, 2003, and offer another 900 people
specialized support services, in an attempt to prevent senior citizens and
mentally ill individuals from being institutionalized in the first place.
The multimillion-dollar expansion of community housing and supportive
care is a significant step toward addressing the most pressing needs of
tens of thousands of vulnerable citizens. But advocates for the disabled
said the administration of Acting Governor Jane Swift chose not to commit
the state to a broad range of additional steps identified in a yearlong
review of services by state officials and advocates.
''It's a mixed bag,'' said Christine Griffin, executive director of the
Disability Law Center in Boston, who helped advise the state on the
report, a copy of which was obtained by the Globe yesterday. ''It's great
that we're going to be able to move more people out of institutions. But
the numbers of people we're still keeping in institutions is
mind-boggling.''
The driving force behind the plan for expanding community-based
services is a 1999 US Supreme Court case brought on behalf of mentally
retarded and mentally ill patients in Georgia. The court found that the
Americans with Disabilities Act requires states to provide services
outside of an institution whenever possible. Both the court and the
federal government advised states to draw up plans of how they would
comply.
Massachusetts lagged behind many other states in planning, but
had begun to make changes piecemeal. The state began deinstitutionalizing
mentally ill and mentally retarded people more than a decade ago and
thousands are now living in their communities. But many were discharged
without appropriate supports and ended up in homeless shelters or nursing
homes.
In addition to the Supreme Court case, advocates filed other federal
suits in Massachusetts to spur change for the several thousand who remain
institutionalized. Two lawsuits settled in 2000 required that the state
move thousands of mentally retarded people from nursing homes into the
community or from the homes of their aging parents into community housing.
A lawsuit over unnecessary hospitalization of mentally ill children is
pending, and advocates have threatened a similar suit over mentally ill
adults.
State officials were unable yesterday to put a dollar figure on the
total cost of the budgeted changes. But they said the report represents
the first phase of an effort to meld scattered state services for the
disabled into one coordinated effort. ''We're trying to change a bias
toward institutionalization and a segmentation of services,'' said Betty
Anne Ritcey, assistant secretary of Health and Human Services. ''Are we
moving as fast as I would like or the advocates would like? No. But if you
don't change the system, all you're doing is putting on a Band-Aid.''
The report recommends a series of steps already funded in this year's
budget, including:
Closing Medfield State Hospital and moving the remaining 96 patients to
the community or other state hospitals. Moving more than 100 additional
adults from the state's four other mental hospitals - in Westborough,
Taunton, Worcester, and Tewksbury - to community settings.
Expanding treatment, rehabilitation, and support services to 450
mentally ill people to help them stay out of hospitals.
Adding 650 community beds for mentally retarded people who are in
nursing homes, waiting at home for community placements, or graduating
from state residential schools.
Expanding support services to about 450 elders to keep them out of
nursing homes.
Developing a pilot program providing comprehensive community care to
enable up to 50 disabled people in the Worcester area to leave nursing
homes.
Developing a single review process through which people can qualify for
services from all state agencies serving the disabled.
Screening all individuals on Medicaid who are seeking institutional
services to see if they can be served in the community instead.
Beyond these steps, the report is short on action or timetables and
long on studies and policy reviews. Advocates of deinstitutionalization
noted that the report doesn't include a recommendation made by a
subcommittee to seek an expansion of federal Medicaid waivers that allow
money designated for institutional care to be spent for community
services. And it would add only three beds for those with brain injuries.
''The plan does very well by people with mental retardation, fair or
moderately for people with mental illness, and not very well at all for
people with physical disabilities,'' said Steven Schwartz, an attorney
with the Center for Public Representation, which brought several of the
lawsuits against the state. ''It completely ignores a whole segment of our
citizens - children with disabilities.''
''The state in many instances was reluctant to pull the trigger'' to
support specific actions that cost money, added Bill Henning, director of
the Boston Center for Independent Living. Henning and Griffin co-chaired a
committee that advised the state on the report. ''I hope it's truly a work
in progress. But we may have to go back to court to pursue some of these
things.''
Alice Dembner can be reached at D embner@globe.com.
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