Judge rules against state on kids in nursing homes

After a decade-long legal fight, a federal judge Friday ordered Florida to make changes to keep children with “complex” medical conditions out of nursing homes and help them receive care in their family homes or communities.

U.S. District Judge Donald Middlebrooks, siding with the U.S. Department of Justice, ruled that Florida has violated the Americans with Disabilities Act and the rights of children “who rely upon the provision of vital Medicaid services and are trying, in vain, to avoid growing up in nursing homes.”

“Unjustified institutionalization of individuals with disabilities is unacceptable, especially given the advances in technology and in the provision of home-based care,” Middlebrooks wrote in a 79-page decision. “Any family who wants to care for their child at home should be able to do so.”

Middlebrooks criticized the state for not doing more to ensure services such as private-duty nursing that could enable children to live outside of nursing homes and to help children who are at risk of being institutionalized. The case centers on children in the Medicaid program with conditions that often require round-the-clock care involving such needs as ventilators, feeding tubes and breathing tubes.

“Those who are institutionalized are spending months, and sometimes years of their youth isolated from family and the outside world,” Middlebrooks wrote. “They don’t need to be there. I am convinced of this after listening to the evidence, hearing from the experts, and touring one of these facilities myself. If provided adequate services, most of these children could thrive in their own homes, nurtured by their own families. Or if not at home, then in some other community-based setting that would support their psychological and emotional health, while also attending to their physical needs.”

The state Agency for Health Care Administration, which runs most of the Medicaid program, said Monday evening it will seek a stay and appeal Middlebrooks’ ruling.

“During the trial, witnesses testified that their medically complex children were in nursing homes for various reasons unrelated to the state or its policies,” the agency said in a statement. “Not one parent testified that they are ready and willing to take a child home but cannot do so because of the state’s actions or omissions. The court’s conclusion that the state’s actions or omissions force children to live in nursing homes against their parents’ wishes is a generalization unsupported and even refuted by the evidence presented at trial.” 

The Justice Department filed the lawsuit in 2013, after conducting an investigation that concluded the state Medicaid program was unnecessarily institutionalizing children in nursing homes. The state vehemently fought the allegations and the lawsuit, with the U.S. Supreme Court last year declining to take up a state appeal aimed at preventing the case from moving forward.

Friday’s ruling said about 140 children in the Medicaid program are in three nursing homes in Broward and Pinellas counties. It also said more than 1,800 children are considered at risk of being institutionalized.

Jim Saunders – News Service of Florida


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