Casting doubt on an ambitious state plan to move thousands of mentally ill adults out of nursing homes and into community-based programs, a federal court monitor reported this week that many of the patients don't want to leave the facilities while others were found to be unfit for the community placements.
As part of a sweeping package of nursing home reforms, state officials agreed in a 2010 federal court settlement to offer supportive housing and treatment to roughly 5,000 mentally ill adults who were living in two dozen large nursing homes designated as Institutions for Mental Diseases, or IMDs.
The consent decree gave state officials five years to screen residents and move those who wanted to live in subsidized apartments or group homes where they would receive therapy and other services
But as of last week, only 45 patients have actually moved or signed a lease — far short of the first-year target of at least 256 people.
State officials told the Tribune they have offered placements to close to the 256 target and are examining ways to improve the process. "We're not happy with the number of people moved. We know we can do better," said Gov. Pat Quinn's senior health care policy adviser, Michael Gelder.
"This is a learning process for all of us," Gelder added. "While there's room for improvement, we're meeting our obligations and finding the people and helping them make their plans for transition to the community."
In a 15-page report filed Monday, independent monitor Dennis R. Jones identified shortfalls at several levels of the state's relocation program.
State authorities were slow starting up the resident evaluations, which are conducted by contract workers from the University of Illinois at Chicago. UIC had trouble hiring and retaining qualified staff, Jones wrote. And state officials hadn't anticipated that so many patients would be unwilling to be assessed — or that so many would be deemed ineligible for community placement.
Jones wrote that he had "serious concerns about both the pace and the efficacy of the resident review process," as well as "serious concerns about the nearly 50 percent rate of negative recommendations for community placement."
"This seems exceptionally high," Jones wrote, because the first people to be evaluated were less severely disabled than others.
Jones' report said state authorities are adding more reviewers to speed up the evaluation process, and state officials told the Tribune they project that 256 residents will move into community settings by October.
Advocates for the disabled said they were concerned by the slow start-up and the high numbers of people denied community placement, but they added that state authorities appear to be working hard to correct the problems.
"We are disappointed with the state's level of compliance in the first year under our consent decree, and we are hopeful that the state will take this report as a wake-up call and put its effort in a higher gear," said Benjamin Wolf, associate legal director for the American Civil Liberties Union of Illinois, one of several organizations representing the mentally ill nursing home residents.
"The values the governor has expressed and the promises the state has made have been very positive. The problem has been implementation," Wolf said. "Changing the way the state does business is proving harder than we hoped."
Quinn and state officials worked to settle three linked disability rights lawsuits and to improve Illinois nursing homes after a 2009 Chicago Tribune investigation that detailed numerous reports of sexual assault, violence and drug abuse in the state's most troubled facilities.
A 1999 Supreme Court decision requires government agencies to place people with disabilities in the least restrictive setting appropriate to their needs.
Though some mentally ill residents of Illinois nursing homes receive excellent treatment, others are housed in a subset of institutions that provide little therapy or discharge planning, the Tribune investigation found.
Quinn's ambitious effort to serve people with mental illness in smaller settings comes as the state's budget crisis is forcing some community mental health programs to close or scale back their services.
State officials say they are pressing forward with the reforms and hope to save tax dollars by diverting disabled people from nursing facilities into community settings.
In his report, Jones said he fought hard with state political leaders to limit cuts that could "undermine the state's capacity to comply" with the consent decree. "The court monitor will continue to closely track the budget issues," Jones wrote.
The state Department of Human Services issued a statement Tuesday saying it was committed to fulfilling the consent decree and, "where necessary, will restructure the implementation design to assure these targets are met."
As reported by Gary Marx and David Jackson | Chicago Tribune
http://www.chicagotribune.com/health/ct-met-nursing-home-report-20120704,0,7396495.story
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