Consumer advocate Steve Gold has issued an Information Bulletin entitled, "Why Are People with "MR/DD Status" Still In Nursing Homes?". The following is that report.

Why Are People with "MR/DD Status" Still In Nursing Homes?

Information Bulletin # 279 (3/09)

There are 57, 673 people in nursing facilities who have an "MR/DD status -MR/DD with no organic condition" and their "MR/DD status were manifested before age 22 and are likely to continue indefinitely." This information was reported to CMS from each nursing facility. See Minimum Data Set, Table AB10F as of 12/31/08.

Under the federal Medicaid statute, all of the 57,673 people must have a "plan of care," which must be "revised ... after each assessment," and each assessment "must be conducted ... no less often than once every 12 months."

This assessment must also be "based on" the MDS. Each nursing home must "certify as to the accuracy" of the assessment. This "plan of care" requires that the nursing facility provide services "to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident...."

Some of the 57,673 people probably have another diagnosis, in addition to the above "MR/DD status," which could qualify them for nursing facility level of care, despite the "MR/DD status." For those who do not qualify, however, they are statutorily supposed to be discharged from the nursing facility.

The important point is that whether or not a person with the above "MR/DD status" "requires nursing facility services" (because they have another diagnosis) or does not require nursing facility services, your State must ensure that they receive the appropriate "specialized services for mental retardation" - the same services that they would be entitled to receive outside a nursing facility.

Here are the two handles: if the people "qualify for nursing facility level of care," then your State must ensure that the specialized services are being provided while they reside in the nursing facility. If they do not qualify for a nursing facility, they are supposed to be discharged to an appropriate community-based program where they can receive the "specialized" services.

We have not heard of any State that complies with the above. We do not believe that the 57,673 people are receiving "specialized" services of any sort, let alone "to attain or maintain their highest practical ... well-being."

What are advocates and their lawyers doing to ensure that these requirements are being enforced?

Advocates can obtain information about each person by name, nursing facility, address and should be advocating for them to receive these services.

The good news is that State-by-State, the numbers are manageable. Yes, if your State wanted or if the advocates addressed the issue, it's a solvable problem.

Minimum Data Set, Table AB10F (12/31/08)

Alabama 1,420
Alaska 21
Arizona 283
Arkansas 1,095
California 3,734
Colorado 503
Connecticut 1,082
Delaware 190
District of Columbia 70
Florida 2,047
Georgia 1,990
Hawaii 125
Idaho 154
Illinois 2,699
Indiana 1,962
Iowa 1,153
Kansas 752
Kentucky 1,234
Louisiana 1,267
Maine 192
Maryland 879
Massachusetts 1,464
Michigan 1,295
Minnesota 772
Mississippi 730
Missouri 2,091
Montana 456
Nebraska 604
Nevada 197
New Hampshire 202
New Jersey 2,445
New Mexico 160
New York 3,742
North Carolina 1,918
North Dakota 248
Ohio 3,390
Oklahoma 1,056
Oregon 349
Pennsylvania 3,003
Puerto Rico 29
Rhode Island 175
South Carolina 626
South Dakota 244
Tennessee 1,280
Texas 4,285
Utah 286
Vermont 77
Virginia 1,512
Washington 819
West Virginia 590
Wisconsin 708
Wyoming 67

NATIONAL TOTAL 57,673