FOR IMMEDIATE RELEASE
Monday, Feb. 3, 2003

Contact: Christopher Burley, Bazelon Center, 202-467-5730 x 133 or leec@bazelon.org

Court Decision Establishes Right to Services for
People with Mental Disabilities in Nursing Homes

Read the Rolland Decision Issues: Aging Issues:Medicaid

(Washington, DC) Feb. 3, 2003—In a move that has important implications for people with mental disabilities, the First Circuit Court of Appeals on January 28th issued an extremely significant decision in Rolland v. Romney. The ruling requires states to provide “specialized services” to nursing home residents with mental retardation or other developmental disabilities who need such services. Specialized services help people with mental disabilities to achieve maximum independence. The Rolland decision is the first court of appeals case to establish the rights of individuals with mental disabilities to specialized services in nursing facilities.

In 1998, disability rights advocates filed a complaint in federal district court on behalf of Loretta Rolland and approximately 1600 other residents with mental retardation and developmental disabilities, alleging that Massachusetts had violated several federal statutes, including the Americans with Disabilities Act and the Nursing Home Reform Amendments (“NHRA”) to Medicaid. In the portion of the lawsuit relevant to the Rolland v. Romney decision, the residents sought to have the Commonwealth provide specialized services to nursing home residents with mental retardation and developmental disabilities who need those services.

The NHRA requires states to screen applicants to and residents of nursing homes to ensure that people with mental disabilities are not warehoused in such facilities, and to ensure that they receive specialized services for their mental disabilities when needed.
Under the law, anyone suspected of having a mental illness, mental retardation or a related condition must be screened prior to admission to a nursing facility. Individuals who are determined to have a mental disability must then be screened to determine whether they need nursing care and/or specialized services. Those who do not need nursing care cannot be placed in a nursing home. Those who need specialized services must receive those services.

Massachusetts argued that:

• the NHRA only required it to provide specialized services to individuals who do not need nursing care;
• those who do need nursing care cannot enforce the right to receive specialized services, even if they have such a right; and
• specialized services do not require “active treatment”—an individually tailored series of programs and therapies designed to help an individual with mental retardation or other developmental disability reach an optimal level of independence.

The court rejected all of the Commonwealth’s arguments. It held that the NHRA affords a right to receive specialized services, including active treatment, to all individuals with mental retardation or developmental disabilities who need those services, whether they reside in a nursing home or in the community. Most important, the court held that plaintiffs could enforce that right.

The appellate court’s decision establishes an important precedent for the enforceability of the NHRA and other Medicaid requirements, advocates say. The ruling holds that the nursing home screening provisions of the Medicaid Act are enforceable under the tests set forth in the Supreme Court’s Gonzaga and Sandoval decisions, two recent rulings limiting the enforcement of federal law by private citizens. Advocates believe that the court’s analysis will also prove helpful for enforcing many other Medicaid provisions with similar structure and language.

The plaintiffs were represented by Steve Schwartz and Cathy Costanzo of the Center for Public Representation and were aided by an amicus brief written by national law firm Howrey Simon Arnold & White on behalf of ARC-USA, the National Health Law Program, the National Senior Citizen’s Law Center, the National Association of Protection and Advocacy Systems, the National Mental Health Association, the National Alliance for the Mentally Ill and the Bazelon Center for Mental Health Law.

The decision is available online at http://laws.lp.findlaw.com/1st/021697.html.

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The Bazelon Center for Mental Health Law is the nation’s leading legal advocate for the rights of people with mental disabilities.