Thousands of Louisiana residents with mental illnesses are being unnecessarily housed in nursing homes, deprived of independent living and cut off from their friends and families, because the state has failed to provide them with more humane options, according to an investigation by the U.S. Department of Justice.
The Justice Department's investigation, which spanned more than two years and was detailed in a letter to Gov. John Bel Edwards this month, found that some 4,000 people with serious mental illnesses are cooped up in costly nursing homes in Louisiana. These people are often much younger and physically healthier than the typical elderly nursing home resident and have no clear path to regaining independence. They also receive minimal mental health services at the nursing facility, the report said.
The report concluded that Louisiana is in violation of state and federal laws, such as the Americans with Disabilities Act, that require states to provide options other than institutionalization to people with disabilities. Chiefly, the state should be improving access to "community-based services," which allow people to be treated in their own homes, often at a lower cost than nursing homes. The Justice Department estimated that the state is spending as much as $7,000 more per person, per year, to treat a mentally ill person in a nursing home instead of in his or her community.
"Louisiana's unnecessary reliance on nursing facilities violates the civil rights of people with serious mental illness," the report said. "By contrast, community integration will permit the State to support these individuals in settings appropriate to their needs and in a cost-effective manner."
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The reason so many mentally ill people end up in nursing homes is because the state lacks an adequate supply of community-based services to treat people in their own homes. Louisiana also does not identify people with mental illnesses, once they're in the facilities, to inform them of their options and plan for a transition back to their homes, the report stated.
The Justice Department reported that 14.5 percent of people in Louisiana nursing homes have a serious mental illness, which is among the highest percentages in the nation. At least eight unnamed nursing homes in Louisiana had such high populations of mentally ill patients that people in the community identified them as psychiatric facilities instead of nursing homes, the report said.
Many of the patients interviewed over the course of the investigation told the Justice Department they hoped to be able to leave, and at least two people said they felt like "prisoners."
Remarkably, the report found that some of the people staying at the nursing homes were fairly healthy mentally and physically.
"One woman with serious mental illness experienced a crisis after the death of a family member, leading to her nursing facility admission. Four years later and still in her fifties, she remained in the nursing facility, despite needing minimal physical and psychiatric care," the report said. "She longed to go home saying, 'I would like to be normal, complete, whole again -- like I used to be.'"
In a emailed statement, Louisiana Nursing Home Association executive director Mark Berger said he had not yet fully reviewed the data to support the Justice Department's findings, which made responding to the allegations difficult. But he said the association would be working with the state to improve mental health outcomes.
"The report mentions hundreds of instances where Louisiana's nursing facilities successfully discharged residents into the community," he said. "It is important to note that nursing facility residents are voluntarily admitted and are free to leave the facility except in the rare case of a court order."
Louisiana currently offers a variety of community-based programs for the mentally ill, such as housing assistance, crisis intervention services and at-home primary health care services. But the report said there aren't enough of these resources available.
Many of the people with mental illnesses who end up at the nursing homes come from private psychiatric hospitals, where they are admitted for acute care after a crisis. State hospitals were another source, discharging 153 people with serious mental illnesses directly into nursing homes, between 2010 and 2014.
"One man's journey into the nursing facility began when he had a mental health crisis a few years ago and repeatedly called 911 about his blood pressure. Instead of connecting him to community treatment services, he was charged with abusing 911, sent to jail, and then admitted to a State hospital," the report said, adding that the man was eventually discharged to a nursing home.
"Six years later, the man, who is in his sixties, remains in the same nursing facility, even though he wants to return to the community and could do so with proper physical and psychiatric supports. This man's story is not unique."
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A spokesman for the governor referred questions to the Louisiana Department of Health.
"Creating a full continuum of care that includes both inpatient care and home and community-based care for people with mental illnesses has been a long-standing challenge in Louisiana that has spanned multiple administrations," said LDH spokeswoman Kelly Zimmerman in a statement. "We will review the Department of Justice's recommendations and will work with stakeholders and legislators to determine the best path forward."
In 2012, under Gov. Bobby Jindal, the state outsourced its public behavioral health services to Magellan Healthcare Inc., a managed care firm, in an effort to improve access to community-based mental health services. But in December 2015, the state reversed course and moved those services to its existing Medicaid managed care program, Healthy Louisiana, formerly Bayou Health. Nursing homes and long term care were exempt from managed care.
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The Justice Department said in its report that if the state declines to enter into negotiations with the federal government to achieve compliance, or if negotiations are unsuccessful, the government may file suit.