There is a new 42-page GAO report that contrasts the availability of community-based services in LA, KS, OR and NY. It's a great how-to and how-not-to manual for Olmstead compliance. Is it any wonder that LA was sued? See the news article on the Barthelemy lawsuit, filed by LA nursing-home residents and potential residents who said the state was unconstitutionally condemning them to nursing homes because community-based services were not available at end of this email. The full report is at: GAO lack of c-b services at http://www.gao.gov/ It is summarized in the LA news article that follows. ----------- Services for elderly limited, report says (9/26/02 Times-Picayune, LA) By Bill Wals WASHINGTON -- Despite rising demand for in-home and community-based services for elderly and disabled people, Louisiana continues to spend the vast majority of its long-term care Medicaid budget on nursing homes, according to a federal report to be released today. The U.S. General Accounting Office found that the availability of noninstitutional care, such as in-home assistance with meals and medication, adult day care, and assisted living facilities, varied widely among the four states the agency surveyed for a report to the Senate's Special Committee on Aging. The four states are Louisiana, Kansas, New York and Oregon. The report will be unveiled at a committee hearing today that will focus on gaps in the long-term care services available nationwide. The hearing is the latest in a series the committee has held to nudge states and the federal government to prepare for the impending retirement of 70 million baby-boomers and move away from an "institutional bias" in its spending of public money going to long-term care. This "report illustrates the inconsistencies of long-term care delivery across the nation," said Sen. John Breaux, D-La., chairman of the committee. "Based on these findings, a senior in Louisiana may receive far different care than a senior in New York or in Oregon." The GAO report found that while Louisiana's Medicaid program spends slightly more than the annual $996 national per-capita average on people over 65, the vast majority of its resources goes to nursing homes rather than noninstitutional services that may be better suited to able-bodied people and cheaper for the state. The report said 93 percent of the long-term care spending in Louisiana's Medicaid program goes to nursing home care compared to an 81 percent national average. The Louisiana Nursing Home Association took issue with the GAO, saying the Louisiana figure is 63 percent. The GAO also found that demand is high for alternatives to nursing homes because seniors and those with disabilities would prefer to stay at home and live independently as long as they can. One program in Louisiana offers 1,500 people limited in-home care, environmental modifications to a home, such as building a wheelchair ramp, and respite care. In June, 5,500 people were on the waiting list, the GAO said. Another program offers adult day care to 525 people with 201 on the waiting list in July. One Louisiana caseworker told the GAO that the average wait is a year, although advocates say it tends to be longer. Kansas spent slightly less per capita than Louisiana on long- term care, but served about four times as many people in noninstitutional, community-based programs. Oregon spent about 40 percent less of its Medicaid budget on seniors than Louisiana did, yet offered a far broader array of services, including nutritional counseling, money for bathtub lifts and shower seats, and community residential settings, such as assisted living and adult foster care. Only 58 percent of the long- term care portion of Oregon's Medicaid budget went to nursing homes. New York was, by far, the most generous of the states surveyed spending $2,463 per senior on long-term care and offering a generous menu of services without a waiting list. Louisiana's relative shortage of community-based services has long been an issue for policymakers. A 1999 U.S. Supreme Court ruling and a subsequent state court decision ratcheted up the pressure on Louisiana to offer alternatives to nursing home care for seniors and disabled people. Two years ago, the Legislature created a task force to sketch out a long-term plan for offering a broader array of services. Joe Donchess of the Nursing Home Association warned that boosting money for community-based services could end up short-changing those who need institutional care. Nonetheless, the Legislature this summer began taking steps to broaden the availability of services. ----LA OLMSTEAD LAWSUIT-- Deal to settle rights suit, Marsha Shuler, Capitol news bureau, 8/17/01 The state will spend nearly $120 million over the next four years to settle a major civil-rights lawsuit challenging the care provided Louisiana's elderly and disabled. Department of Health and Hospitals Secretary David Hood unveiled a proposed settlement Thursday in which the state agrees to provide more community-based services so people are not forced to live in nursing homes. The state and lawyers for citizens who claim the state has failed to provide enough choices have signed off on the pact. All that's left now is approval by U.S. District Judge Edith Brown Clement in New Orleans. "With this agreement, Louisiana will soon join with the most-progressive states in better meeting the needs of aging baby boomers," Hood said. More and more people are clamoring for community living options as they grow older, Hood said. Hood said nearly $800 million a year is spent to care for the elderly in nursing homes today under the state's Medicaid program for the poor and less than $10 million is spent on community-based services. Previously, there has been a "lack of resolve," but now the state is willing to "embrace change," Hood said. The federal government as well as many advocacy groups are demanding that change. One of those who sued, Richard Nagle of Arabi, south of New Orleans, rejoiced at the prospect of getting help to live independently. "It will probably have a pretty big impact on my life," said Nagle, a quadriplegic who feared he'd end up in a nursing home once his elderly parents died. Lawyer Nell Hahn, an advocate for the disabled, said the settlement agreement is "a tremendous step forward in providing community services for people." Hahn added that a lot more still needs to be done to provide a full range of living options for citizens with all kinds of disabilities as required under federal law. The lawsuit settlement covers the elderly and disabled in nursing homes and those under "imminent risk" of being forced to live in nursing homes. Under the proposal, the state agrees over the next four years to expand community services to the point that no one will be on a waiting list for more than 90 days. DHH will spend $118 million in state and federal funds to provide home and community-based services for some 1,700 additional residents over the next four years. The elderly and disabled will get such things as personal care, including dressing and bathing help; household support; supervision; home modifications; and personal emergency response systems. No new state tax dollars are needed to fund the initiative, officials said. The money will come from an innovative Medicaid financing plan using local tax revenue that supports publicly run nursing homes to attract federal matching funds. Services will be extended to 650 residents in 2002 at a cost of $18 million, doubling the current number of people served. In the second year, the state will spend $32 million as it adds services for another 650 people. In the third and fourth years, $34 million will be spent annually and another 400 people will get services. In addition, the state will do more outreach programs so people will know what community-living and healthcare options are available. Hood briefly talked about the settlement during a League of Women Voters forum, which featured various speakers talking about nursing homes and elderly and disabled care. The Barthelemy lawsuit, named after a nursing-home resident involved in the case, was filed by Louisiana nursing-home residents and potential residents who said they could live in their homes with help. They said the state was unconstitutionally condemning them to nursing homes because community-based services were not available. A 1999 U.S. Supreme Court ruling known as the Olmstead decision requires states to provide services in "the least-restrictive environment." The Barthelemy lawsuit, filed last year, came at a time when the U.S. Department of Health and Human Services was demanding that Louisiana develop a plan providing "freedom of choice" and a broader range of living options. Those affected include the elderly and those with disabilities ranging from mental retardation to developmental disabilities, mental illness and paralysis from accident or injury.