As the nation prepares to mark the 20th anniversary of the Americans with Disabilities Act next week, the New York Times presents disturbing evidence that cash-strapped states are dismantling home-care services that have been helping elderly people and those with disabilities to live in their communities.

Since the start of the recession, at least 25 states and the District of Columbia have made sharp cuts in programs that, ironically, have been demonstrated to save states money because they keep people out of nursing homes.

“The situation is grim, and it’s safe to say that present trends are expected to continue,” said JoAnn Lamphere, the director of state government relations for health and long-term care for AARP. “Nearly every state has proposed cuts of some sort to Medicaid. Some might seem small, but it’s death by a thousand slashes.”

… Bruce Goldberg, director of the Oregon Department of Human Services, said the agency did not have an estimate for how many of the people losing home care would end up in assisted-living facilities or in nursing homes – or, if they did, how the state would pay for them.

“We’re in new territory,” Dr. Goldberg said. “Long-term care is a cobbled-together system with many holes, and they just got deeper.”

From National Public Radio/Kaiser Health News:

In 2005, when Congress funded a $1.3 billion initiative to move people out of nursing homes and long-term-care facilities, it was anticipated that more than 37,000 moves would be completed by the year 2013. But state data collected by Kaiser Health News shows that only 5,774 people have been moved to date.

Among the difficulties that states are reporting: problems finding affordable housing, resistance from nursing homes, and stringent federal rules that govern who qualifies and what types of community settings are permitted.

Georgia had hoped to move 1,312 people by 2011, but had completed moves for only 221 people through the end of last year. The state has since cut its 2011 target by more than half.

The new health care law adds $900 million in new funding for the program, called Money Follows the Person, extends it until 2016, and loosens eligibility rules.

Families are fearful. Unions promise to fight.

From the Los Angeles Times, San Gabriel Valley Tribune:

California officials this week announced plans to close one of the state’s largest institutions for people with intellectual and developmental disabilities. The Lanterman Developmental Center in Pomona houses 400 people on 302 acres, and employs more than 1,300 people. “It’s just not economical for us to continue it,” said Terri Delgadillo, director of the state Department of Developmental Services.

State officials promised to arrange for residents to get proper care in community-based settings. Family members expressed dismay, saying they feared their loved ones would not be adequately cared for if they left Lanterman.

“It’s devastating for us,” said one woman, whose brother has lived at the institution since 1969. “People like Bobby are more confined in the community. At least [at Lanterman] he can wander the grounds safely.”

The closure requires approval from the state legislature. More than 2,000 people remain in California institutions.

Related story: Toxic Rosewood raises ire, by Jennifer Bishop in the Baltimore Brew

A Maryland state senator has sent a mass email to his constituents warning them that the site of the former Rosewood Center is now considered a dangerous environmental and health hazard. The institution for people with disabilities was closed last year.

Disability advocates reacted angrily. An excerpt:

“The State’s assessment found Rosewood to be so dangerous as to recommend that no one trespass on the property,” said Cristy Marchand, executive director of the ARC of Maryland. “The real question is the response that will be made to the hundreds of children and adults with developmental disabilities whose health was threatened by toxic conditions while living for decades at Rosewood Center.”

From the Philadelphia Inquirer:

While finding employment opportunities for people with disabilities is a nationwide problem, New Jersey and Pennsylvania social support programs are trying to create jobs by competing for piecework contracts. That’s getting more difficult as the recession goes on, and waiting lists for jobs continue to grow.

It’s estimated that more than 70 percent of working-aged people with disabilities are not working, said Bill Ditto, New Jersey’s director of disability services, and about 90 percent of them live in poverty.

Among the barriers to employment faced by people with disabilities: Social misperceptions that they are not capable of working, and fears that a paycheck could jeopardize their federal benefits.

From the Chicago Tribune:

Mental health advocates in Illinois are seeking a major overhaul in the way the state manages patients with mental illness, arguing that the state should not be placing people in nursing homes when they could be treated more cheaply and effectively in community settings.

The volatile mix of felons, mentally ill people and seniors in Illinois facilities today serves none of those populations, advocates said, and records show elderly and disabled residents have been assaulted, raped and even murdered in the homes.

A decade ago, the U.S. Supreme Court ruled in Olmstead that unjustified segregation of individuals with disabilities in institutions is a form of discrimination prohibited by the Americans with Disabilities Act. The case was interpreted as directing states to provide community-based supports rather than continue unwarranted segregation in institutions.

Sue Jamieson and Talley Wells of the Atlanta Legal Aid Society write in the Atlanta Journal-Constitution that Georgia, the state where Olmstead originated, is still “woefully out of compliance” with the court’s mandate to move people out of its psychiatric hospitals. At the same time, the state continues to undergo federal scrutiny for systemic violence, neglect, and abuse in its hospital system. An excerpt:

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From the AP/Chicago Tribune:

A new “premise alert program” allows families in some areas of Illinois to share information about medical problems and disabilities with local police and fire departments. Advocates say the information will allow emergency responders to act with greater speed and sensitivity.

The point of the program is to prepare officers approaching a person with a disability during an emergency and to understand, for example, that they may fear loud noises or be unable to hear spoken instructions. Firefighters would know if a burning home is likely to contain someone who can’t get out. Advocates say Pennsylvania is the only other state to offer the service so broadly.

Itasca deputy police chief Dean Myles, who serves on the board of the Autism Society of Illinois, said the service could help prevent potentially fatal encounters between police and disabled people, including one in 2005 that killed Hansel Cunningham of Des Plaines.

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