More Top Picks Best Hose Nozzle
player ready...Thousands of mentally ill patients as young as 22 are being improperly warehoused inside the nation’s geriatric nursing homes, constituting a forgotten and misplaced population often subjected to inadequate care, a federal investigation has found.
A six-month probe by the inspector general of the U.S. Department of Health and Human Services followed acknowledgment by dozens of states, including Illinois, that mentally ill patients have been improperly placed in geriatric facilities, sometimes with disastrous results.
The Tribune reported in 1998 that Illinois had secretly and improperly transferred thousands of mentally ill patients to nursing homes in a now-defunct scheme to improperly bolster Medicaid funding.
The practice led to dozens of deaths and injuries–including murder and rape– sparked by inadequate treatment of those patients and the mixing of the mentally ill and elderly.
The government study released Monday called for immediate reform in the screening and tracking of patients, improved training for health care workers and increased oversight of Medicaid reimbursements.
Some government agencies report that mentally ill young adults account for less than 2 percent of nursing home residents, but the report by the inspector general put that figure at 20 percent.
Placing mental patients in nursing homes instead of psychiatric facilities is a way for many states to try to force the federal government to pay most of the treatment costs for the mentally ill, the report concluded.
In 1999, the Supreme Court ruled that such patients must be housed in the least restrictive settings possible, such as government-subsidized apartments. But mental health advocates say that thousands of young mentally ill patients in Illinois remain trapped by finances and circumstances inside nursing homes.
“There are at least 6,000 mentally ill patients in Illinois nursing homes, and about one-third, or 2,000 people, don’t belong there,” said Mark Heyrman, a board member of the Mental Health Association inIllinois and a clinical law professor at the University of Chicago.
By transferring 2,000 mentally ill patients to apartments, the state could save $60 million, which could be redirected to subsidize rent and treatment, Heyrman said. But the proposal has gone nowhere.
State officials on Monday defended Illinois’ mental health programs. The state spends $611 million annually on services, ranging from community-based treatment programs to employee training to special programs earmarked for children.
Likewise, the state has formed a task force to assess compliance with the 1999 Supreme Court ruling, and the assessment will be submitted to legislators this year, said Reginald Marsh, spokesman for the state Department of Human Services.
The inspector general report called mentally ill people the “unidentified population” because most states do not track the population well, even when they are paying for their care.
Indeed, officials for Human Services, which is responsible for overseeing mental health treatment in nursing homes, were unable to determine on Monday how many mentally ill patients reside in nursing homes.
The Tribune analysis of public health records shows that there are 28 Illinois nursing homes predominantly filled with psychiatric patients, who number about 6,000. An additional 2,000 patients are scattered among more than 500 geriatric facilities.
Nationally, an estimated 70,000 mentally ill residents as young as 22 are living in nursing homes, but the number could be substantially higher, federal investigators said.
The move to place mentally ill patients in nursing homes is the legacy of shutting down state-owned psychiatric institutions.
In many municipalities, de-institutionalization occurred without adequate funding to community-based treatment programs. As the fifth-largest state, Illinois ranks 30th for its level of mental health funding, federal studies show.
The financially struggling nursing home industry has willingly opened its doors to the mentally ill as a way to fill an increasing number of empty beds.
“I rarely see treatment for mentally ill patients in nursing rooms,” said Wendy Meltzer, an attorney and director of the Chicago-based Illinois Citizens for Better Care.
Public health investigative files reveal dozens of homes cited for treatment deficiencies, but the state most often doles out token fines.
“The mentally ill are not attractive politically,” said Meltzer, who monitors state-enforcement actions and sits on several legislative task forces. “They are not the middle class. The prognosis for them is not good. There’s seldom any good, short-term solutions.”
More Top Picks Best Biometric Pistol Safes
State and federal officials have been engaged in a long-standing tug-of-war over who should bear responsibility for treatment of the mentally ill.
In response to the inspector general report, federal Health and Human Services officials say state agencies need to step up oversight and services.
Currently, states are required to bear all costs of nursing home treatment where half or more of the beds are filled with psychiatric patients.
In geriatric homes, costs are paid by a combination of state and federal funds.
To get around federal restrictions, state Department of Public Aid officials manipulated hundreds of medical records in 1998 to list thousands of mentally ill patients as physically impaired.
In one case, the record of a severely mentally ill 65-year-old woman was altered to reflect that she suffered primarily from arthritis and cranial dermatosis–more commonly known as dandruff, the Tribune found.