Landmark decision in Illinois to shift people with mental illness from nursing homes into community settings

From Chicago Breaking News:

Thousands of psychiatric patients are likely to move out of nursing homes and into community-based settings in the next five years under a landmark legal agreement designed to reshape Illinois' troubled long-term care system.

The agreement, expected to be filed Monday in federal court in Chicago, lays out a schedule for state officials to offer approximately 4,500 mentally ill nursing home residents the choice to move out of two dozen large facilities known as "institutions for mental diseases," or IMDs, and into smaller settings that experts say are more appropriate and less expensive.

"This is a momentous day for people with disabilities in Illinois," said Benjamin Wolf, associate legal director for the ACLU of Illinois, which filed a lawsuit in 2005 that led to the agreement. "It is the beginning of transforming a system that has been focused on institutionalizing people for decades into one that actually delivers what people want and need."

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 numerous reports of sexual assault, violence and drug abuse in some facilities where psychiatric patients got little treatment or supervision. Some of the homes failed to create adequate programs or discharge plans for residents who milled about or watched TV in dreary common areas.

One of the state's most troubled IMDs, Somerset Place in Uptown, was shuttered Friday after Tribune reports and state and federal inspections documented a pattern of abuse, violence and substandard care.

The ACLU sued Illinois for reform, citing a 1999 U.S. Supreme Court ruling known as the Olmstead decision that requires states to place patients in the least restrictive setting appropriate to their disability.

Settling that lawsuit was considered critical to 38 proposals recently introduced by Gov. Pat Quinn's Nursing Home Safety Task Force, formed in reaction to the Tribune's investigation. Chairman Michael Gelder said a settlement would bring federal court oversight to Quinn's push for alternative treatment and housing options for psychiatric patients.

The panel's proposals also were designed to make facilities safer for elderly and disabled residents. State lawmakers are negotiating with industry representatives and advocates to transform the recommendations into law this spring.

While Monday's settlement covers only residents of the IMDs, there are at least 10,000 other mentally ill people living among elderly and disabled residents in other nursing homes that are not classified as mental institutions.

In a statement, Gelder said, "several thousand new units of supportive housing will be identified in partnership with community providers over the next five years to serve those who no longer wish to receive care in such nursing homes. This commitment can be fulfilled, even in this severe recession, by receiving significant federal financial support for care in the community."

Another advocate, Mark Heyrman, a University of Chicago Law School professor and chair of public policy for Mental Health America of Illinois, said it was "a very happy day for everyone who cares about persons with mental illnesses in Illinois. Many years ago the state embarked upon an ill-conceived policy of placing thousands of our most vulnerable citizens in nursing homes where they received little care and little effort was made to help them recover. ... Hundreds of millions of tax dollars have been wasted. This settlement marks the beginning of the end of this tragedy."

Under the settlement, every resident of an IMD will be evaluated to determine whether he or she is eligible to be moved into a less-restrictive setting, and what is needed to thrive there. The evaluation is voluntary, and residents can decline to take part and remain where they are.

All 4,500 IMD residents would be evaluated within two years, and then annually after that. The settlement outlines a strict timetable for moving those who want to leave the IMD -- slowly for the first two years, then more rapidly as the state builds its capacity for serving and treating people in communities.

The former nursing home residents 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.

State officials made a commitment to provide adequate therapeutic, vocational and life-skills programs to support the former IMD residents as they transition into communities. The court will appoint a mental health expert to independently monitor the state's compliance with the agreement.

"The main thing is to have someone who has independence and expertise," said Wolf's co-counsel Barry Taylor, legal advocacy director at Equip for Equality.

The lawsuit's plaintiffs contend the agreement will be less costly than the state paying for housing people in IMDs. The state also will be eligible to receive federal Medicaid reimbursements for medications and health care that the former residents receive in a community-based setting. Ed Mullen, managing attorney for community integration at Access Living, said the state could save more than $50 million over the next few years.

The papers expected to be filed Monday ask U.S. District Judge William Hart, who is overseeing the case, to schedule a "fairness hearing" to consider the specifics of the plan. There will be a period of at least two months in which interested parties can file objections, Wolf said.

In reaching the settlement, the state denied violating the Americans with Disabilities Act and other laws that protect people with disabilities.

Tony Zipple, head of the community mental health provider Thresholds, called Monday's settlement a "historic moment for public mental health in Illinois. This is probably the single best opportunity in 10, 20 years to really do systemwide reform and not have people relegated to nursing homes."