The concept of “one-stop shopping” for health care is nothing new to thousands of District adults with disabilities. Unfortunately, that “one stop” has long been inside a nursing home.
Under the city’s health-care system, many disabled residents have been forced into institutions, due to restrictive Medicaid rules and a lack of affordable, accessible housing (“Before Their Time,” 10/27/00).
In 1999, the U.S. Supreme Court ruled that state and local governments are violating the Americans With Disabilities Act if they fail to provide alternatives to institutionalization. That decision, Olmstead v. L.C., created a nationwide mandate for increased handicapped access to home- and community-based care.
In response, District officials promised to give traditionally institutionalized patients somewhere else to go. Two years ago, D.C.’s Department of Health announced that it would create a resource center to serve as a “single point of entry” into long-term care for senior citizens and adults with physical disabilities or mental retardation.
That project, modeled after Wisconsin’s Family Care facilities, was a central piece of the District’s 2001 application for federal health-care-reform funds. Under its plan, caseworkers and benefits counselors at the center would advise patients on their range of health-care optionsincluding home care and assisted livingand channel them toward the most suitable ones. The feds responded with a grant of more than $1.3 million.
But the District’s July 2003 target date for opening the facility has come and gone, and the center exists only on paper. Officials are still mired in negotiations with the contractor that would run it. Next month, the project comes up for annual review by the federal Centers for Medicare and Medicaid Services (CMS), which awarded the grant funds. If the feds determine that the District hasn’t met the terms of the grant, the money could be yanked.
The Delmarva Foundation, a private contractor, is bidding to staff and run the resource center for the city. But contract talks have been ongoing since January with no end in sight. “We’re all ready to go,” Delmarva Executive Director Orlene Grant told the Washington City Paper in February. “We’re just waiting for the go-ahead.”
And waiting. And waiting.
Wanda Tucker, interim director for D.C.’s Medicaid Assistance Administration, blames the delay on “a lack of meeting of the minds on both sides as to what the resource center should be and how those services should be provided.”
In the meantime, the District continues paying the higher costs of institutionalization. The D.C. Primary Care Association, a group of health-care providers, estimates that an individual in community care would cost the city $28,000 per year, compared with $52,000 a year in a nursing home.
“It’s just egregious that the city has not moved on this,” says Sharon Baskerville, executive director of the association, “not only from a fiscal perspective, but out of respect for independence for people struggling to have some kind of quality of life.
“To not give them the necessary support, which is both fiscally sound and the compassionate thing that the government should be doing, is just reprehensible,” Baskerville says.
“Allowing people to live in their own homes while receiving the care they need is better for everybody,” says Linda Royster, executive director of the Disability Rights Council, a regional advocacy group. “People with disabilities in nursing homes are essentially in jail. They can’t get out to live their lives in the community.”
Losing the federal funds would set the plan back still further. “We told CMS that we will develop a resource center with this money,” says Bobby Coward, a disabilities-rights activist who sat on the grant committee. “If we don’t, CMS can pull that grant.”
But Tucker says the District isn’t in danger of losing the funds. The resource center, she says, “was just one of the concepts” included in the grant application. “That money is for a much broader concept of which the resource center is a part,” she says. CP