Massachusetts Plans New Push to Home Care for Disabled

US Court Rulings Drive Move from Institutions

By Alice Dembner, Boston Globe, 8/21/2002

The state is closing Medfield State Hospital and moving many of its 96 residents, along with nearly 300 other people with mental and physical disabilities from nursing homes and institutions across the state, into group or private homes. The action comes largely in response to federal court rulings requiring that the disabled be treated in the least restrictive setting possible.

In addition, Massachusetts is planning to create 650 new beds in community settings by June 30, 2003, and offer another 900 people specialized support services, in an attempt to prevent senior citizens and mentally ill individuals from being institutionalized in the first place.

The multimillion-dollar expansion of community housing and supportive care is a significant step toward addressing the most pressing needs of tens of thousands of vulnerable citizens. But advocates for the disabled said the administration of Acting Governor Jane Swift chose not to commit the state to a broad range of additional steps identified in a yearlong review of services by state officials and advocates.

"It's a mixed bag," said Christine Griffin, executive director of the Disability Law Center in Boston, who helped advise the state on the report, a copy of which was obtained by the Globe yesterday. "It's great that we're going to be able to move more people out of institutions. But the numbers of people we're still keeping in institutions is mind-boggling."

The driving force behind the plan for expanding community-based services is a 1999 US Supreme Court case brought on behalf of mentally retarded and mentally ill patients in Georgia. The court found that the Americans with Disabilities Act requires states to provide services outside of an institution whenever possible. Both the court and the federal government advised states to draw up plans of how they would comply.

Massachusetts lagged behind many other states in planning, but had begun to make changes piecemeal. The state began deinstitutionalizing mentally ill and mentally retarded people more than a decade ago and thousands are now living in their communities. But many were discharged without appropriate supports and ended up in homeless shelters or nursing homes.

In addition to the Supreme Court case, advocates filed other federal suits in Massachusetts to spur change for the several thousand who remain institutionalized. Two lawsuits settled in 2000 required that the state move thousands of mentally retarded people from nursing homes into the community or from the homes of their aging parents into community housing. A lawsuit over unnecessary hospitalization of mentally ill children is pending, and advocates have threatened a similar suit over mentally ill adults.

State officials were unable yesterday to put a dollar figure on the total cost of the budgeted changes. But they said the report represents the first phase of an effort to meld scattered state services for the disabled into one coordinated effort. "We're trying to change a bias toward institutionalization and a segmentation of services," said Betty Anne Ritcey, assistant secretary of Health and Human Services. "Are we moving as fast as I would like or the advocates would like? No. But if you don't change the system, all you're doing is putting on a Band-Aid."

The report recommends a series of steps already funded in this year's budget, including:

Beyond these steps, the report is short on action or timetables and long on studies and policy reviews. Advocates of deinstitutionalization noted that the report doesn't include a recommendation made by a subcommittee to seek an expansion of federal Medicaid waivers that allow money designated for institutional care to be spent for community services. And it would add only three beds for those with brain injuries.

"The plan does very well by people with mental retardation, fair or moderately for people with mental illness, and not very well at all for people with physical disabilities," said Steven Schwartz, an attorney with the Center for Public Representation, which brought several of the lawsuits against the state. "It completely ignores a whole segment of our citizens - children with disabilities."

"The state in many instances was reluctant to pull the trigger" to support specific actions that cost money, added Bill Henning, director of the Boston Center for Independent Living. Henning and Griffin co-chaired a committee that advised the state on the report. "I hope it's truly a work in progress. But we may have to go back to court to pursue some of these things."

Alice Dembner can be reached at: "dembner@globe.com

This story ran on page A1 of the Boston Globe on 8/21/2002. Copyright 2002 Globe Newspaper Company.