The US Department of Justice has continued its push to ensure state long-term care operators and government agencies are in compliance with the Americans with Disabilities Act. On Tuesday, it released report findings that indicate Missouri unnecessarily “segregated” patients with mental health disabilities in nursing homes.
The report implicates multiple Missouri government departments with failing to offer reasonable community-based treatments that could have kept more than 3,000 people in less-restrictive settings.
DOJ investigators also made note of Missouri’s frequent use of legal guardianships, in effect to control the living situations of patients with mental health disabilities, they said.
Court-appointed guardians have significant power to make medical and living situation decisions for people who are considered incapacitated.
“The State routinely relies on guardianships, particularly under public administrators, for adults with mental health disabilities who are harder to engage in treatment,” the DOJ report claims. “And guardianship, in turn, serves as a pipeline to unnecessary institutionalization. More than 60% of the nursing facility residents in the sample we reviewed have guardians, and of those individuals nearly all were placed in the facilities by their guardians.”
Federal agencies have stepped up their oversight of nursing homes in general in recent months. While other areas, such as financial transparency, have drawn more attention from many media outlets, ADA allegations have been one of the many routes the government has taken to bring states and providers into line.
One such case was Colorado, which was targeted with a federal ADA lawsuit over similar allegations in fall 2023.
The DOJ’s full report warned that this tactic may be used again if Missouri’s case cannot be addressed another way.
“We look forward to working cooperatively with the State to reach a resolution of our findings,” the report notes. “We are required to advise you that if we cannot reach a resolution, the United States may take appropriate action, including bringing a lawsuit, to ensure the State’s compliance with the ADA.”
The DOJ report noted that a small number of nursing homes are responsible for the care of most of the affected patients. These facilities allegedly often maintain a high degree of limitations over residents’ activities, including limiting their opportunities to contact those outside the nursing home, the report says.
The DOJ notes that alternative forms of treatment and care settings exist in Missouri and could reasonably be used to restore more freedom for many of these patients — some of whom are much younger than the typical nursing home population.
“There are community-based services that are specifically targeted at this population and are alternatives to this segregation,” the report states. “Missouri could, but has not, used these services to prevent nursing facilities admissions.”
