Brain Injured To Return To Community
An all-but-final court settlement may soon begin to help as many as 2,000 Massachusetts residents with brain injuries leave nursing homes, in a slow but sweeping exodus that advocates and officials say is unprecedented in the country.
The advocates who filed the lawsuit last year in US District Court in Springfield estimated that among about 8,200 nursing home residents with brain injuries in Massachusetts, at least one-quarter wanted to live outside - and could, with the proper help. The patients are of all ages, and under federal law, they have the right to live as normal a life as their condition allows, the plaintiffs argued.
Until now, Massachusetts residents with brain injuries who needed long-term intensive support or round-the-clock care covered by Medicaid could generally get it only in nursing homes. There was one small exception: a Medicaid "waiver" allowing 100 people to receive community care.
The settlement is expected to greatly expand that community-care exception for people with brain injuries - accident victims, stroke patients, and others - and redirect Medicaid money from nursing homes into community care. It envisions that new living arrangements would be developed for people with brain injuries in group homes, special apartments, or at home with their families, with intensive help. This array of new services might cost no more, on average, than nursing home care.
Under the proposed eight-year settlement, the state would have six months to ask the federal government to allow about 300 nursing home residents with brain injuries to move to new living situations beginning as soon as next summer. And as many as 200 other residents per year are to be helped by a broader Medicaid program that the state is putting into place to provide more long-term care in the community for a variety of conditions, called Community First.
Korab said she and others had pleaded with the administrations of five previous governors for more brain-injury services, to little avail. But the suit's arguments jibed with the Patrick administration's philosophy that whenever possible disabled people and the elderly should live in the community, said Jean McGuire, the state official who oversees disability programs.
From very early on, she said, "It was clear that a settlement strategy was the right strategy." The sides reached a settlement in June. Federal Judge Michael A. Ponsor is expected to approve the agreement soon after a Sept. 16 hearing, but already, McGuire said, state officials are writing proposals and making plans.
Specialists say nursing homes generally do not provide the kind of rehabilitation services people with brain injuries need to improve. "Many people with brain injuries can keep making gains for years with the right help," said Dr. Mel Glenn of Spaulding Rehabilitation Hospital. But if they end up in nursing homes for lack of other options, they are unlikely to keep getting that help, and they often lose ground, both physically and mentally.
Each nursing-home resident who wants to leave will be carefully evaluated to make sure it would be safe, McGuire emphasized. For example, she said, a resident might need help to get better at swallowing or to improve posture in order to be able to sit up and eat in a community setting.
But ultimately, said Steven Schwartz, lead lawyer for the Center for Public Representation, which brought the suit along with the Boston law firm Wilmer Cutler Pickering Hale and Dorr, for hundreds of people the settlement will mean "a ticket home."
- From: “Many brain injury patients poised to quit nursing homes for freer lives: Settlement to let Medicaid cover alternative care”, By Carey Goldberg, Globe Staff, The Boston Globe, August 14, 2008 at: http://www.boston.com/news/local/massachusetts/articles/2008/08/14/many_brain_injury_patients_poised_to_quit_nursing_homes_for_freer_lives/
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