Louisiana Starts Work To Offer More Services To Mentally Ill


BATON ROUGE, La. (AP) — Louisiana is spending $13 million this budget year to start obeying terms of a federal legal settlement aimed at resolving accusations the state illegally warehouses mentally ill people in nursing homes rather than helping them live in their communities.

The court-monitored deal with the U.S. Justice Department requires Louisiana's health department to expand home- and community-based services for people with mental illness and screen those in nursing homes to determine if they can be diverted to less-restrictive settings.

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The 30-page, five-year settlement drew little public attention when announced in June. But it came after a two-year federal investigation determined Louisiana violated the Americans with Disabilities Act by its over-reliance on nursing homes to house mentally-ill people.

Louisiana has one of the highest percentages of adults with serious mental illnesses living in nursing homes, according to DOJ documents filed in federal court. At least 3,800 people, or 14.5 percent of all nursing home residents in 2016, were mentally ill, federal officials say.

"Individuals with serious mental illness in nursing facilities in Louisiana who express a desire to leave the facility and return to their own communities routinely receive little or no assistance to do so," the Justice Department wrote.

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The federal government received a discrimination complaint in 2014 that prompted the investigation, releasing findings to Gov. John Bel Edwards in December 2016 and sparking talks with the state health department over settlement terms to avoid litigation.

The Louisiana Department of Health agreed to assess all nursing home residents with mental illness and all new referrals to nursing homes to determine if they could be served in home- and community-based settings. The state must expand those service offerings, such as case management, crisis supports and housing assistance.

Assessments have started with more than 140 nursing home patients screened and 16 transitions to less-restrictive settings underway, the health department says. A larger plan to explain how Louisiana will comply with the settlement is due to federal officials in September.

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"We have improved screening of people with serious mental illness who are entering nursing facilities, and are on a more frequent basis reviewing their need to remain in the facility," Steve Russo, executive counsel for the health department, said in an emailed statement.

U.S. District Judge John deGravelles is overseeing the settlement, along with an expert chosen to make sure the state is following the agreement. If Louisiana is deemed to meet the settlement terms, oversight ends in five years.

Bruce Blaney, a former state health official and leader of an association of more than 300 in-home support providers, said he's confident federal oversight will force change in a state where the nursing home industry holds powerful sway with officials.

"The Justice Department doesn't mess around. They play with fines and jail terms. (The health department) basically has no authority but to fund this thing and take orders," he said.

Costs of the five-year settlement deal remain unclear.

Louisiana's spending $9 million in state money and $4 million in federal funds on compliance efforts in the budget year that started in July, according to the health department.

Russo said the department doesn't have cost estimates for future years. Like federal officials suggested, Russo said the state could save money because home- and community-based services often are cheaper than institutional care.

"This system will be designed to be more cost-effective," he said.

Blaney, however, said Louisiana doesn't have affordable housing options needed to meet the settlement terms and suggested the health department could face millions in costs to meet service gaps.

– by Melinda Deslatte, AP reporter

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