What has been done and remains to be done?

1) Connecticut is moving forward with submitting a Medicaid Home & Community Services Waiver targeted to people with serious mental illnesses in nursing homes or at risk of being admitted to nursing homes, as recommended by the Lieutenant Governor’s Mental Health Cabinet. This will allow the state to spend Medicaid funds that pay for the nursing home stay for home and community based services. However, the waiver only targets 72 people a year which will not stop or have a major impact on the rate of increase in admissions of people with serious mental illnesses into nursing homes.

2) In 2006, a lawsuit was brought by the Office of Protection & Advocacy and the Bazelon Center for Mental Health Law regarding Olmstead violations of people with serious mental illnesses institutionalized in nursing homes when they did not need this level of care and did not want to be there. The law suit is currently suspended.

3) Some people do need nursing home care for complicated medical problems that cannot be managed in the community, or for rehabilitation for a major health problem that can be ameliorated. However, no person should remain in institutional care, once this level of care is no longer needed. Therefore, the following solutions are proposed:

a) A process established to document that:

i. There is no less restrictive community alternative for persons with mental illness being admitted to nursing homes;
ii. persons being admitted for short term placements have their housing protected to the fullest extent possible to allow for timely discharge;
iii. mental health providers maintain or establish contact with DMHAS eligible clients admitted to nursing homes to monitor their status and promote timely discharges.

b) Regularly updated individual treatment plans

4) There is no systematic oversight of the mental health services provided to nursing home residents with serious mental health issues or comparison of the services that an individual receives with those recommended by the assessment conducted prior to the resident’s admission.