A U.S. district judge this week dismissed a class-action lawsuit that alleged that the District failed to comply with a federal mandate to move eligible and interested Medicaid recipients out of nursing homes and into the community.
U.S. District Judge Ellen Segal Huvelle ruled that a single injunction could not remedy the problems experienced by the elderly and disabled nursing home residents because barriers to moving them back into the community extended beyond the system's shortfalls with transition services.
Principle among them: a lack of affordable and accessible housing in the District. Other barriers included few wheelchair-accessible units, and, for some residents, poor credit history or criminal records that made it harder to secure housing.
"The District has little to be proud of regarding its historic inability to comply with Olmstead's integration mandate," said Huvelle in her 91-page ruling, referring to a U.S. Supreme Court decision that public entities must provide community-based services to people with disabilities whenever possible, and that keeping them institutionalized is a form of discrimination.
"However, plaintiffs have failed to demonstrate the existence of a concrete, systemic failure that entitles them to class-wide relief," she said.
An advocate for the plaintiffs said they were still trying to understand the judge's ruling Wednesday afternoon.
"We are incredibly disappointed," said Kelly Bagby, an attorney with AARP Foundation who represents the plaintiffs.
She said she fundamentally disagreed with the ruling and that one solution — a better system of transition services to help the disabled nursing home residents — would have remedied the plaintiffs' common complaint.
Claudia Schlosberg, state Medicaid director for the District, said in a statement Wednesday that the District's Medicaid program is dedicated to providing qualified residents with disabilities "access to services and supports in the most integrated setting appropriate to their needs."
"We know, however, that some individuals who wish to transition back to the community are still living in nursing homes," the statement read. "As the Court recognized, there are individualized barriers that prevent these individuals from being able to transition out of the nursing home and into the community. Housing is one of the most common barriers. We are fully committed to the principles of the Olmstead decision and will continue our efforts to increase access to long term care services and supports in the community."
The suit was filed in 2010 by University Legal Services, AARP Foundation Litigation and the private law firm of Arent Fox. In 2013, the plaintiffs were certified as a class, a designation that was appealed by the District. Thursday's ruling came exactly one year after the case went to trial.
The plaintiffs were nursing home residents in the District who receive Medicaid and are entitled to in-home care.
Federally and state-funded waivers for Medicaid recipients who are elderly or have physical disabilities allow people to receive up to 16 hours a day of in-home services and case management if they need help with at least two activities of daily living such as bathing, eating or dressing. If they need 24-hour care, they can get an additional eight hours through the D.C. Medicaid Personal Care Assistance program.
Surveys consistently show that older people prefer to stay in their homes for as long as they can. Serving people at home is also significantly more cost-effective, advocates say.
The plaintiffs' complaint alleged that between 500 and 2,900 people with disabilities in the District are "unnecessarily institutionalized in nursing facilities, segregated and isolated from their families and friends" and that "these individuals desperately want to return to their communities."
Legal records show just a small number of nursing home patients were moved successfully back into the community each year, including only a fraction of those who were accepted into a federal program that helps Medicaid recipients move out of nursing homes and receive services in the community.
But the District alleged and, the judge agreed, that the lack of available, affordable and accessible housing was a major barrier to serving these residents in the community.
More than 80 percent of nursing facility residents who wanted to move to the community needed publicly funded or subsidized housing, court records say. Waiting lists are exceedingly long, and the availability of wheelchair accessible units is even more limited.
Court documents noted that people with private housing were able to transition much more quickly than those who needed to secure subsidized housing.
Plaintiffs argued in court that the city should be responsible for helping residents to secure housing. In response to the judge's ruling on Wednesday, Bagby noted that unnecessarily lengthy nursing home stays, due to poor transition services, were part of the problem because they exacerbated plaintiffs' housing problems.
"These are people who are on Medicaid and have been institutionalized. Of course they don't have private housing."