Legal Advocacy
Nursing Home Lawsuit Breaks New Ground in Home and Community Based Care
Recent court approval of a landmark settlement paves the way for new approaches to long-term care. Attorneys with AARP Foundation Litigation were co-counsel with California disability rights advocates and lawyers in private practice who represented residents of the Laguna Honda nursing facility, the largest residential care facility in the United States, who sought to enforce their civil rights and avoid unwanted institutionalization.
The dispute
Chambers v. City and County of San Francisco alleged that the City and County-owned nursing home is violating the federal Americans with Disabilities Act (ADA) and the Rehabilitation Act by forcing residents into institutional care. At 1,200 beds, Laguna Honda Hospital is the largest nursing home in the country. For many years it has been in poor physical shape, with open wards and a vulnerability to earthquake.
In 2001, residents of Laguna Honda sued the governments of San Francisco and California. They charged that the City and State failed to provide adequate services and failed to inform residents of, or allow them to exercise their legal right to, community-based care. The case was settled in 2004. As part of the settlement, the City agreed to develop a system of assessment and discharge planning that would allow residents the option of receiving community-based care. California agreed to change state policies regarding assessment and treatment of patients with psychiatric disabilities that required broader consideration of the full range of community-based alternatives.
Assessments of Laguna Honda residents done pursuant to the 2004 agreement revealed that approximately 80% could, and wanted, to live in the community with adequate supports. However, San Francisco made little progress in actually providing home and community-based services, requiring Laguna Honda residents to remain in the nursing home. San Francisco is in the process of rebuilding the facility whose services yet again emphasize institutional care over home and community based care. “The case is not about stopping the rebuild, it’s about making sure that people aren’t confined to Laguna Honda, whether the old Laguna Honda or the new Laguna Honda,” Elissa Gershon, an attorney with a disability rights group (California Protection and Advocacy Inc.) told the San Francisco Business Times.
Background
The ADA as well as federal and state health care programs require governments to provide alternatives to institutionalization in government-provided health programs. This fundamental right was reiterated in a strong decision handed down in 1999 by the U.S. Supreme Court, L.C. by Zimring v. Olmstead. That decision dealt with two people who were living in a state psychiatric hospital. While treating physicians had determined that the women were able to participate in a community-based treatment program, Georgia had decided to keep them in a more restrictive hospital setting, citing lack of funds for community programs. The Court ruled that the ADA – which requires public entities to administer programs in the most integrated setting appropriate – requires that if a government agency uses funding as a rationale for limiting opportunities for integration, then the agency must include all possible sources of funding. For example, they must include the availability of federal waivers that would free up Medicaid and other funds. The Court also ruled that a government program that retains in an institution people who want and can get services in the community is discrimination.
Millions of people with disabilities need some assistance but prefer to live in their own homes as independently as possible and for as long as possible. Olmstead unequivocally articulated important safeguards enabling people to age in place. The latest Chambers settlement should put to rest the problem of unnecessary and discriminatory institutionalization of person desiring to receive long-term services in their homes or in the community.
The settlement
Among the most notable provisions of the settlement approved by federal district court for Northern California are:
- An innovative program to coordinate services across city departments, enabling San Franciscans with disabilities who live at, or are referred to, Laguna Honda, to instead receive community-based housing and services. Eligible individuals will be assessed for, referred to, and provided with subsidized housing, attendant and nursing care, case management, substance abuse treatment, mental health services, and assistance with meals.
- New availability of several hundred Medi-Cal Home and Community-Based waiver slots, which allow people who meet certain qualifications to receive long-term health care in their homes instead of in institutions.
- Development of a new rental subsidy program, through which San Francisco will, over the next five years, secure and subsidize scattered-site, accessible, independent housing for approximately 500 people with disabilities and seniors who are eligible for community-based services.
- Mark Chambers, lead plaintiff in the lawsuit and a resident of Laguna Honda Hospital since 1999, told the Judge in the case that he looked forward to moving out on his own, with services and supports. He hopes to be first in line to qualify for one of the accessible housing units that San Francisco will secure under the Agreement.
What’s at stake
The settlement represents a fundamental shift in how long-term care is handled in San Francisco. By making available new tools for people who want to remain in their homes, the settlement allows older people and adults with disabilities to avoid unwanted institutionalization. By coordinating services among local agencies, the settlement helps ensure that no one who needs assistance slips through the cracks.
And by establishing a systematic process for enabling housing across a wide variety of locations and neighborhoods, the settlement not only allows individuals to age in place independently, but it demonstrates a changing attitude about disability that stops regarding people with long-term disabilities as “patients” or “residents” but instead recognizes them as full-fledged members of our community.
AARP Foundation Litigation attorneys served as co-counsel in Chambers along with attorneys from the California Protection and Advocacy Inc., the Disability Rights Education and Defense Fund, the Bazelon Center for Mental Health Law, and the private law firm of Howrey, LLP.
Contact person:
Bruce Vignery
bvignery@aarp.org
(202) 434-2060