Federal judge OKs historic agreement to serve people in community settings
By Gary Marx and David Jackson, Tribune reporters7:25 PM CDT, September 30, 2010
A Chicago federal judge has approved a landmark agreement that will enable thousands of people with mental illness currently living in nursing homes to move into community settings that experts say are more appropriate and less expensive.
U.S. District Judge William Hart's 24-page order, signed Wednesday and made public Thursday, paves the way for sweeping nursing home safety reforms signed into law by Gov. Pat Quinn this year. And it sets in motion a schedule for state officials to offer about 4,300 mentally ill people the opportunity to move out of two dozen large nursing facilities known as institutions for mental diseases, or IMDs.
"It is a critical step in reforming an outdated system in Illinois," said Benjamin Wolf, associate legal director for the ACLU of Illinois, one of five legal organizations representing the mentally ill nursing home residents.
Hart's ruling gives final court approval to a consent decree hammered out between state authorities and a class of mentally ill nursing home residents who sued five years ago on the grounds that they were not being housed in the least restrictive setting appropriate to their disabilities, as required by federal law.
The ruling will bring federal court oversight to Quinn's push for alternative treatment and housing options for psychiatric patients currently housed in nursing homes. More than any other state, Illinois relies on nursing facilities to house younger adults with mental illness, including thousands with felony records. A recent Tribune investigation detailed incidents of violence and drug abuse in some facilities where psychiatric patients got little treatment or supervision.
In his ruling, Hart acknowledged a substantial segment of IMD residents or their families opposed the settlement because they feared the specialized facilities would close, leaving residents "out on the street" without medication or food.
But Hart said the consent decree "expressly provides that residents will not be left without appropriate housing options due to an IMD closing and that no one will be discharged from an IMD prior to appropriate housing arrangements being made."
Opponents of the consent decree also said in court papers that it "purposefully" lacked details on how the new housing and treatment would be administered. But Hart rejected that argument, too, writing: "The decree sets forth details of the type of community services to be offered. ... The level of detail in the decree itself is sufficient."
Under the settlement, every resident of an IMD will be offered an evaluation to determine whether he or she is eligible to be moved into a less restrictive setting and what is needed for that person to thrive there. The evaluation is voluntary, and residents can decline to take part and remain where they are.
All IMD residents must be offered an evaluation within two years and then annually after that. The settlement outlines a strict timetable for moving those who want to leave the IMDs — slowly for the first two years, then more rapidly as the state builds its capacity for serving and treating people in communities.
Those who move will be placed in so-called supportive housing — subsidized apartments or group homes where staff are on-site or visit frequently to provide therapy, job and life-skills training, substance-abuse programs, and case management.
Under the consent decree, state officials made a legal commitment to provide the housing and support services, and the court will appoint an expert to monitor compliance.
Hart agreed with state officials that the community care will be less costly for the state than housing people in IMDs, which are supported by 100 percent state funding. As people move into community-based settings, he wrote, the state will be eligible to receive federal Medicaid reimbursements for their medications and health care.
Hart ruled that the state must now pay nearly $2 million in attorney fees and costs to the ACLU and the other groups that brought the case, but he called the amount "reasonable" given the years of litigation involved. The fees won't be kept by the attorneys, he said, but will go to advocacy groups for the disabled that supported the litigation.
Hart also noted that the U.S. Justice Department filed court papers urging him to approve the decree.
U.S. District Judge William Hart's 24-page order, signed Wednesday and made public Thursday, paves the way for sweeping nursing home safety reforms signed into law by Gov. Pat Quinn this year. And it sets in motion a schedule for state officials to offer about 4,300 mentally ill people the opportunity to move out of two dozen large nursing facilities known as institutions for mental diseases, or IMDs.
"It is a critical step in reforming an outdated system in Illinois," said Benjamin Wolf, associate legal director for the ACLU of Illinois, one of five legal organizations representing the mentally ill nursing home residents.
Hart's ruling gives final court approval to a consent decree hammered out between state authorities and a class of mentally ill nursing home residents who sued five years ago on the grounds that they were not being housed in the least restrictive setting appropriate to their disabilities, as required by federal law.
The ruling will bring federal court oversight to Quinn's push for alternative treatment and housing options for psychiatric patients currently housed in nursing homes. More than any other state, Illinois relies on nursing facilities to house younger adults with mental illness, including thousands with felony records. A recent Tribune investigation detailed incidents of violence and drug abuse in some facilities where psychiatric patients got little treatment or supervision.
In his ruling, Hart acknowledged a substantial segment of IMD residents or their families opposed the settlement because they feared the specialized facilities would close, leaving residents "out on the street" without medication or food.
But Hart said the consent decree "expressly provides that residents will not be left without appropriate housing options due to an IMD closing and that no one will be discharged from an IMD prior to appropriate housing arrangements being made."
Opponents of the consent decree also said in court papers that it "purposefully" lacked details on how the new housing and treatment would be administered. But Hart rejected that argument, too, writing: "The decree sets forth details of the type of community services to be offered. ... The level of detail in the decree itself is sufficient."
Under the settlement, every resident of an IMD will be offered an evaluation to determine whether he or she is eligible to be moved into a less restrictive setting and what is needed for that person to thrive there. The evaluation is voluntary, and residents can decline to take part and remain where they are.
All IMD residents must be offered an evaluation within two years and then annually after that. The settlement outlines a strict timetable for moving those who want to leave the IMDs — slowly for the first two years, then more rapidly as the state builds its capacity for serving and treating people in communities.
Those who move will be placed in so-called supportive housing — subsidized apartments or group homes where staff are on-site or visit frequently to provide therapy, job and life-skills training, substance-abuse programs, and case management.
Under the consent decree, state officials made a legal commitment to provide the housing and support services, and the court will appoint an expert to monitor compliance.
Hart agreed with state officials that the community care will be less costly for the state than housing people in IMDs, which are supported by 100 percent state funding. As people move into community-based settings, he wrote, the state will be eligible to receive federal Medicaid reimbursements for their medications and health care.
Hart ruled that the state must now pay nearly $2 million in attorney fees and costs to the ACLU and the other groups that brought the case, but he called the amount "reasonable" given the years of litigation involved. The fees won't be kept by the attorneys, he said, but will go to advocacy groups for the disabled that supported the litigation.
Hart also noted that the U.S. Justice Department filed court papers urging him to approve the decree.
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