Missouri reviewing alleged ADA violations of mental health patients in skilled nursing



(The Center Square) – Missouri is violating the Americans with Disabilities Act by unnecessarily placing adults with mental health disabilities in skilled nursing facilities, according to a report by the Department of Justice.

The report stated three agencies are primarily responsible for serving or coordinating services for people with mental health disabilities who live in the community and in nursing facilities. Spokespersons for Missouri’s Departments of Health and Senior Services, Mental Health and Social Services wrote in emails to The Center Square their organizations are reviewing the report, released earlier this week.

In a video message, Kristen Clarke, assistant attorney general in the civil rights division, thanked the Missouri agencies for their cooperation in addition to community stakeholders and many throughout the state with mental health disabilities who participated in the 18-month investigation.

The report also found the state is improperly relying on legal guardianship of those with mental health disabilities to steer them into nursing homes.

“The state’s reliance on guardianships that serve as a pipeline to nursing facilities, rather than engaging people in community-based mental health services, has led to violations of the ADA,” Clarke said.

The 45-page report found thousands of Medicaid-eligible adults with mental health disabilities are confined to nursing facilities and separated from their communities. It found almost half of those nursing facility residents are under 65. Most of those residents require little or no assistance with physical activities and don’t require skilled nursing care.

“While in the facilities, people languish – often for years – unable to choose their roommates, when and what they eat, when to make phone calls and whether they can visit the store or go outside for any reason,” Clarke said. “This is despite the fact that they do not want to live in nursing facilities and that proven community-based services like assertive community treatment and permanent supportive housing could meet their needs.”

The report highlighted the state’s Medicaid reimbursement practices could be contributing to the alleged violations.

“Missouri is aware of and encourages the concentration of people with mental health disabilities in the high-volume facilities,” according to the report. “The State recently changed its payment methodology. It now adds an extra $5 per resident/per day if 40% or more of a facility’s Medicaid residents have schizophrenia or bipolar disorder. This encourages the concentration of people with mental health disabilities.”

The report didn’t address whether changing the current practices for the mentally disabled would increase or decrease costs to the taxpayer.

The report included statements from adults with mental health disabilities who were interviewed during the investigation.

“It cost Missouri Medicaid $5,000 a month to keep me here,” said Angela. “Boy, what I could do with $5,000 a month out in the community. Can you imagine what nice of a place I would have? I can use my Social Security to buy my own groceries, being free” of the facility.

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