FRANKFORT, Ky. (8/16/13) – Kentucky Protection and Advocacy (P&A) and the Cabinet for Health and Family Services (CHFS) today announced that the two agencies have reached an agreement that will provide much-needed community supports and services to eligible individuals with serious mental illness (SMI) who reside in or are at risk of residing in a personal care home.
CHFS and P&A have been negotiating the terms of the agreement for the last several months, which will avoid litigation on behalf of individuals with SMI served by the state’s programs who can receive those services in an integrated community setting. The agreement is based on Title II of the Americans with Disabilities Act (ADA) as interpreted by the United States Supreme Court in the landmark decision in Olmstead v. L.C., which found that it is discrimination to not provide services to persons with disabilities in the most integrated setting.
Personal Care Homes (PCHs) are long-term care facilities that provide care for persons who do not require the intensive medical care normally provided in a hospital or nursing home, but who do require care beyond solely room and board. These services include basic physical and behavioral health and health-related services, personal care services, residential care services and social and recreational activities. The majority of persons living in these facilities receive state financial assistance to supplement federal dollars to help enable them to live outside of a higher cost facility. P&A, in a report entitled, "Personal Care Homes—Home or Institution?” found that PCHs have many indicia of an institution, where persons, most of whom have an SMI, live regimented lives, isolated from the rest of the community with few options to live elsewhere. Similar facilities in other states have been found by courts and the United States Department of Justice to be institutions.
“The Cabinet recognizes the importance of the issues P&A has identified related to the shortcomings of personal care homes in the Commonwealth to address the needs of individuals living with serious mental illness,” said CHFS Secretary Audrey Tayse Haynes. “This agreement is an important first step that formalizes our commitment to increasing the amount of community services and supports available to help these individuals transition to or stay in community settings whenever possible. We believe, as does P&A, that this approach will result in better outcomes and improved quality of life for these Kentuckians.”
Secretary Haynes further acknowledged the important role that several agencies within the Cabinet must play in the success of this agreement, including the Department for Behavioral Health, Developmental and Intellectual Disabilities, the Department for Community Based Services, the Department for Aging and Independent Living and the Department for Medicaid Services.
P&A Director Marsha Hockensmith noted that her agency has visited many personal care homes across that state over the last four years and this agreement represents a top priority for the agency.
“P&A staff have met with and listened to the requests for assistance from personal care home residents and witnessed their isolation,” Hockensmith said. “Persons with mental illness represent some of the last to receive funding for comprehensive community services and supports in Kentucky. This agreement will afford choice in terms of living arrangement and service array to many persons with mental illness and represents a serious systemic change in Kentucky's treatment of individuals with mental illness. We applaud CHFS’s leadership under Secretary Haynes to address this matter and look forward to assuring that this agreement creates the necessary infrastructure to allow all persons with SMI to successfully live in the community, as is their right.”
The agreement reached by CHFS and P&A calls for CHFS to provide community-based supported housing assistance and services, including Assertive Community Treatment, Case Management, Peer Support Services, Crisis Services and Supported Employment to 600 individuals over a three-year period. Initially, these services will be provided by the fourteen regional Community Mental Health Centers. In addition, CHFS will allow all individuals currently receiving state supplement dollars and living in personal care homes and those eligible to receive the state supplement to continue to receive and use that money to prevent institutionalization regardless of their living situation. The agreement is modeled after an agreement between North Carolina and the U.S. Department of Justice.
“If given the needed supports, the majority of individuals would choose to live in their own housing rather than in a licensed, congregate facility,” said Betsy Dunnigan, acting Commissioner of the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities. “This agreement expands the needed supports and will allow people to live in homes within the community, assist them in seeking employment if they desire, and participate in real community life.”
It is estimated there are some 2,300 persons, most with SMI, currently receiving the state supplement and residing in personal care homes. As noted in the agreement, “P&A and the Cabinet acknowledge that the relief . . . will not initially afford relief to all potential class members, but enter into this agreement in good faith based upon the Cabinet’s promises . . . that such supports and services will be expanded to include other individuals in a subsequent agreement.”
“You don’t get help like this every day,” said Donald Dyer, a long-time resident of Waynesburg Manor in Lincoln County and one of the potential named plaintiffs. “Many people don’t know we are out here sick and alone. Waynesburg Manor was not my home. I am happy and joyful I am leaving the personal care home and getting my own place.”
Information provided by Jessie Luscher (Department of Public Advocacy)
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