A Win for Access to In-Home Care

The District of Columbia will now have to inform thousands of residents in long-term care facilities about alternative home- and community-based care options — and help them apply to move into one — under a recent court ruling in a long-running legal battle over residents’ right to live independently.

In a Dec. 31 decision, a judge ruled that the city had violated the rights of nursing facility residents with disabilities who want to move to less restrictive housing but could not get the proper assistance to make that transition.

In his ruling, U.S. District Court Judge Paul Friedman wrote that the city’s failure to tell eligible residents about alternative care violates the Americans with Disabilities Act.

As many as 3,000 District of Columbia residents whose care is paid by the city’s Medicaid program are stuck in nursing facilities, even though they are able and would prefer to live in a home- or community-based setting, says Kelly Bagby, vice president of litigation for AARP Foundation, a charitable affiliate of AARP. The foundation sued the city over the issue 15 years ago.

“A lot of the people in D.C. nursing facilities don’t even realize that this is a possibility for them,” she says. “They’ve never been told that they don’t have to live out their days in a nursing facility.”

The ruling applies to people with disabilities who receive Medicaid-funded long-term care services in a local nursing facility and are eligible for home- and community-based care but need city services to make the transition.

The District has asked Friedman to amend his decision; he heard arguments on that motion on April 15. Bagby says she expects the city will appeal if Friedman doesn’t budge.

A spokesperson for the District’s attorney general’s office declined to comment for this story, citing the ongoing litigation. But in court filings, the District had argued that it already had a comprehensive plan to place qualified people with disabilities in less restrictive settings, with a waiting list that moved at a reasonable pace.

During the trial, one of the plaintiffs, an Army veteran named Larry McDonald, testified about living in a long-term care facility for 17 years and having no privacy or control over his daily life. He said he could cook for himself but needed help with other tasks, such as managing his medications and shopping for food.

“I want my own place,” he told the court.

In continuing to fight the decision, the District is “looking at the short-term problem that they would have to hire staff to help do this kind of case management, and they don’t want to make that short-term investment,” Bagby says. “It really is a simple problem that the District has made into a very complex problem because they’ve failed to act for so long.”

Friedman ordered the city to inform eligible nursing facility residents, upon admission and every three months thereafter, about community-based long-term care alternatives; to provide them with assistance with the application process; and to ensure sufficient community services exist for the transition.

Similar cases brought by AARP Foundation in other jurisdictions have settled without a trial. As the District’s case continued, several of the plaintiffs died in nursing facilities.

McDonald, the Army veteran, moved to an independent living facility after the trial ended and is doing well, Bagby says.

—Mary Dieter