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- 2012 - September - 13th -

State on defensive about children in nursing homes

by Jim Saunders, The News Service of Florida

Facing the possibility of a federal lawsuit, Florida health officials Wednesday tried to rebut a highly critical report that alleges the state is violating the Americans with Disabilities Act by unnecessarily placing disabled children in nursing homes.

Liz Dudek, secretary of the Florida Agency for Health Care Administration, said the agency this week has sent staff members to visit nursing homes that care for children and also will contact parents. But she made clear the state will dispute the report’s allegations when it files a response by a Friday deadline to the U.S. Department of Justice.

“I believe that we’re already in compliance, and that will be our response,’’ Dudek told reporters during a conference call.

Dudek and Florida Surgeon General John Armstrong defended the state amid a controversy that started with the Department of Justice releasing a 22-page report last week. The report, which was in the form of a letter to state Attorney General Pam Bondi and followed a federal investigation, said the state has unnecessarily placed disabled children in nursing homes instead of providing adequate services that would allow them to live with their families.

The report said, in part, that some children have remained in nursing homes for years and have not received proper education services. It gave state officials until Friday to indicate whether they are “interested in working cooperatively with the Department of Justice to resolve this matter.”

“In the event we determine that we cannot secure compliance voluntarily to correct the deficiencies identified in this letter the (U.S.) attorney general may initiate a lawsuit pursuant to the ADA,’’ said the report, signed by Thomas Perez, an assistant attorney general in the Justice Department’s civil rights division.

Armstrong, who also is secretary of the Florida Department of Health, said 221 “medically fragile” children are getting care in nursing homes. The needs of the children vary but, as an example, Armstrong said about a third are on ventilators.

The Department of Justice, which informed the state in December 2011 that it had opened the investigation, focused on part of the American with Disabilities Act that requires public agencies to ensure that disabled people “receive services in the most integrated setting appropriate to their needs.” The investigation included visiting nursing homes in Miami, Fort Lauderdale, Orlando, Tampa and St. Petersburg.

Dudek provided little detail about what the state will include in its response this week to the Department of Justice. She also said she was not aware of circumstances in which children might not be receiving proper education services.

“Many children entering nursing facilities in the state are unnecessarily separated from their families and communities for years,’’ the report said. “With adequate services and supports, these children could live at home with their families or in more integrated community settings.”

But Armstrong said a state team evaluates the needs of the children and tries to make sure they are served in the “least restrictive setting” possible. Those evaluations are updated periodically.

Dudek also emphasized that if “there’s a medically needed service, it gets provided.”

But the Department of Justice report took a different view of the state’s efforts and cited parents who told investigators they wanted their children to be able to get care outside of nursing homes.

“Rather than ensuring the availability of these services when medically necessary and appropriate, the state’s system of services overly relies on institutional care in nursing facilities,’’ the report said.

Meanwhile, the Florida Health Care Association, a nursing-home industry group, is defending the services provided to children in the facilities.

“The unfortunate reality is that these pediatric facilities are the safety net for children who cannot be cared for at home because either their medical needs are too complex or they have no family to rely on,’’ the association’s executive director, J. Emmett Reed, wrote in a blog post. “ ‘Fragile’ does not begin to describe their care needs – they require ventilators, feeding tubes; they have traumatic brain injuries or may even be comatose.”

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