article: On December 21, 2016, after a two-year investigation, the U.S. Department of Justice Civil Rights Division released its findings that Louisiana unnecessarily relied on nursing facilities to service people with mental disabilities in violation of the community integration mandate of the Americans with Disabilities Act (ADA) as well as the Supreme Court ruling in Olmstead v. L.C. The investigation focused on Louisiana residents with serious mental disabilities who received care and services in nursing facilities. The DOJ found that individuals who needed to obtain health services from the state for serious mental disabilities were forced to live in nursing facilities to receive proper care. This system isolated these individuals from their communities when they could live in an integrated setting if given access to adequate evidence-based community services. The DOJ found that around 4,000 residents with serious mental disabilities were housed in nursing facilities in Louisiana each year. These residents were generally younger, had less nursing needs and lived in the facilities longer than a typical nursing home resident. Further, the report alleged that Louisiana could likely serve these individuals more effectively and for less money in their communities. The findings letter emphasized four key conclusions: <li>That individuals with serious mental disabilities are confined to nursing home care in Louisiana because the state does not adequately arrange community-based services or properly identify those who would benefit from such services.</li><li>That individuals who would benefit from community-based services don’t know these services are available because the state has not told them.</li><li>That many of the individuals receiving service in nursing facilities can successfully live in the community rather than institutions.</li><li>And that other states successfully provide these services without unnecessarily relying on nursing facilities and the Louisiana already provides many of the necessary services and could serve more people by expanding pre-existing programs. </li> The DOJ and Louisiana reached a settlement to address the findings in the DOJ's report Louisiana agreed to review and augment its current policies for the seriously mentally ill. The DOJ then filed this lawsuit alleging that Louisiana failed to serve people with serious mental illnesses in the most integrated situation appropriate to their needs in violation of Title II of the Americans with Disabilities Act in the U.S. District Court for the Middle District of Louisiana on June 6, 2018, and immediately moved to dismiss due to the settlement. Specifically, the settlement agreement focused on diversion and screening for the target population of Medicaid-eligible individuals over the age of 18 with serious mental disabilities who either reside in nursing facilities or who have been referred for review for placement in nursing facilities. The state agreed to design and implement a system designed to quickly identify individuals under review for nursing home care who would benefit from community-based services and divert them away from institutionalization. The state also agreed to screen all individuals in the target population currently in nursing home care to determine whether they should be allowed to return to the community. The screening process starts with the assumption that all individuals with serious mental disabilities in nursing homes would benefit more from community-based services. The agreement also called for specific elements of the plan such as outreach to affected individuals, transition support committees, post-discharge case management and tracking. It also required the expansion of community-based service programs. These included mandatory crisis support services including a 24/7 emergency hotline, intensive community support services such as psychiatric treatment and housing and tenancy support. In addition, the agreement stipulated that the state had to implement a quality assurance program to make sure individuals in the target population received proper care. The state also agreed to retain a subject matter expert, John O’Brien, who will provide technical expertise to help the state fully comply with the agreement and produce a report every six months on the quality and progress of the plan. The agreement called for an initial plan to be submitted by the Louisiana Department of Health immediately that laid out the goals and details of the first 18 months. After 18 months, the LDH must produce a yearly report detailing goals for the coming year. The agreement was set to expire in five years provided the parties agree that the state has established compliance with the agreement and maintained compliance for one year. Under the settlement, the court retained jurisdiction and DOJ could reinstate the suit at any time to remedy a breach of the settlement as long as it first followed the dispute resolution laid out in the agreement. The case is ongoing for compliance with the settlement agreement.
summary: The Department of Justice filed a lawsuit against Louisiana alleging that their policies of institutionalizing individuals with serious mental illnesses was operated in a manner that too often resulted in unnecessary admission to nursing facilties when community-based services would be more appropriate. The US alleged that this violated Title II of the American's with Disabilities Act which requires that states serve individuals with disabilities in the least segregated manner appropriate to their needs. Louisiana reached a settlement agreement with the US the same day the lawsuit was filed. The state agreed to review its nursing facilities and new referrals for admission to determine whether seriously mentally ill residents would be better served in their communities. They also agreed to expand community-based services for the mentally ill.