A new report from the U.S. Department of Justice asserts that South Dakota “unnecessarily” relies on nursing facilities to provide services and supports to people with disabilities, leaving them without home- or community-based care options.

The report, released Monday, found that thousands of people who rely on state-run services must live in nursing facilities in order to receive needed services. Many people haven’t been offered or even been made aware of a care option other than nursing facilities, especially those living in rural areas or on reservations, the DOJ found.

More than 80% of the state’s long-term care budget goes toward nursing facilities, leaving little funding for home- and community-based services, critics point out. The agency recommends South Dakota rebalance its long-term care budget to prioritize funding for home- and community-based services, and even suggests the state could save money by increasing the use of those services, instead of turning to nursing facilities.

South Dakota ranks among the top states for nursing home utilization, with a recent Centers for Disease Control and Prevention report finding the state to have a 91.9% occupancy rate.

The heavy emphasis on institutional long-term care services has left South Dakota in violation of the Americans with Disabilities Act, as well as Olmstead v. L.C., which gives qualifying people with disabilities the right to live in communities, rather than nursing homes, according to the DOJ.

Many of the people with disabilities living in South Dakota’s nursing facilities have disabilities they were born with, or acquired at a young age, including cerebral palsy, multiple sclerosis or amputations due to diabetes or accidents, the report found. Others have physical or mental disabilities, chronic illnesses, or age-related conditions that require assistance with some day-to-day tasks.

“People with similar needs to those living in South Dakota’s nursing facilities successfully receive services at home in other states, and even in South Dakota,” the report reads. “The state already offers many of the services people will need to live in their own homes and can increase community capacity and address service limitations to ensure all individuals can choose these services instead of nursing facility placement.”

Click here to read the DOJ’s full report to South Dakota’s Gov. Dennis Daugaard (R).