Huge number of young, disabled nursing home residents shows poor follow-through on Olmstead: Senate report

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Sen. Tom Harkin (D-IA) is the chairman of the Labor, Health, and Education subcommittee
Sen. Tom Harkin (D-IA) is the chairman of the Labor, Health, and Education subcommittee
Nearly a quarter of a million working-age residents remain “unfairly segregated” in nursing homes because states are not providing the community living support called for by the U.S. Supreme Court and the Americans with Disabilities Act, according to a Senate report.

In its 1999 Olmstead v. L.C. decision, the Supreme Court ruled that people with disabilities cannot be “segregated” in a nursing home if they have the potential and desire to live in a community-based setting. Nearly 15 years later, the number of younger nursing home residents is growing, according to the report from the Senate's Health, Education, Labor and Pensions Committee.

Led by Sen. Tom Harkin (D-IA), the committee solicited information from all 50 states about their efforts to transition disabled people out of nursing homes and other institutional care settings. 

There has been some progress: the percentage of states' Medicaid spending on institutional care decreased from 79% in 1995 to 50% in 2010, with more dollars flowing to home- and community-based services. However, only 12 states were spending more than 50% of Medicaid long-term care dollars on HCBS as of 2010. And the number of nursing home residents younger than 65 increased between 2008-2012, with these people making up 16% of the current nursing home population nationwide, according to the report.

Congress should amend the ADA to clarify the federally protected right of disabled people to live in the community if possible, and amend the Medicaid statute to guarantee Medicaid funding of HCBS, the report recommends. The report also urges the Centers for Medicare & Medicaid Services to finalize a definition of “home and community-based” and calls on the Department of Justice to investigate inappropriate nursing home placements of disabled people.

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