Older People with Mental Illnesses Remain Unnecessarily
Segregated
in Nursing Homes, Institutional Settings
Community Services Limited for Older Americans,
Says New Report
(Washington, DC) March 10, 2003 – Older Americans with mental
illnesses remain unnecessarily segregated in nursing homes and other
isolating environments, according to a new report by the Bazelon
Center for Mental Health.
The report, Last
in Line: Barriers to Community Integration of Older Adults with
Mental Illnesses and Recommendations for Change, finds that
states have largely ignored older adults in planning for the Supreme
Court-mandated expansion of community services for institutionalized
people with mental disabilities.
“Many older people with mental illnesses or dementia are still
isolated in nursing homes and other institutions, where they may
receive no more than custodial care,” said Robert Bernstein,
executive director at the Bazelon Center.
Almost 20% of individuals 55 and older experience mental disorders
that are not a normal part of aging, according to the Surgeon General’s
Report on Mental Health. Yet remarkably few receive mental health
services. According to the federal Administration on Aging, older
Americans constitute 13% of the US population, but represent only
6% of those receiving community-based mental health services.
In 1999, the Supreme Court ruled in Olmstead v. LC that
people with disabilities— including mental disabilities—have
the right to receive publicly financed services in the most integrated
setting possible. Since that ruling, federal and state agencies
have begun planning to reduce needless institutionalization and
expand community programs. But the rights of older Americans have
received little attention in this process, according to the Bazelon
Center.
“More than a dozen years after the Americans with Disabilities
Act’s passage, many state agencies are still shirking their
legal obligation to older Americans with mental disabilities,”
said Bernstein. “They’ve opted for convenience over compliance.”
Community care is often less expensive, but the way many services
for older people are financed exacerbates the problem, according
to the report. For example, the rules that govern Medicaid—
a key resource for mental health services—provide incentives
to place older people in nursing homes, rather than community settings.
The Bazelon Center analyzed national data and literature on the
issue, then focused on five states: Pennsylvania, Alabama, Illinois,
Michigan and Nevada. The legal-advocacy group interviewed mental
health and aging advocates, service providers, state and local government
officials, and consumers. The Bazelon Center also conducted site
visits in the five states and reviewed relevant state documents,
such as long-term care studies, legislative bills, testimony and
geriatric mental health training materials and manuals.
“Our findings offer a snapshot of neglect and disregard of
the rights of older Americans with mental illnesses all across the
country,” said Bernstein. “The problems we found in these
states typify those we’ve seen and heard about elsewhere.”
The report identified numerous barriers to community integration
for older people with mental illnesses, including:
- stigma among older adults about the receipt of mental health
services;
- lack of knowledge about geriatric mental health issues on the
part of primary care physicians, mental health providers and senior
service providers;
- lack of coordination between aging and mental health agencies;
- lack of transportation to assist seniors in accessing services;
- a dearth of in-home mental health services;
- inadequacy of Medicaid and Medicare reimbursement schemes to
finance community-based mental health services for older adults;
- lack of housing;
- lack of political will for reform;
- the limits of screening to prevent unnecessary confinement of
individuals with mental illnesses in nursing homes;
- the exclusion of dementia from many state community mental health
programs; and
- delays in states’ Olmstead planning for community integration.
“While daunting, these barriers are not insurmountable,”
said Bernstein. “We know the solutions, it’s just a question
of whether states will muster the political will to tackle the problem.”
The report includes general recommendations to address the barriers
to community integration identified in virtually every state. An
addendum includes recommendations to address specific problems in
the five states the Bazelon Center studied in depth.
“This is a call to action for states to not simply plan services
for older adults, but also to address the underlying reasons why
older people continue to be segregated,” concluded Bernstein.
“Older adults with mental disabilities have waited far too
long for the community integration that is their right.”
The executive summary of Last in Line is online at http://www.bazelon.org/issues/elders/publications/lastinline.htm.
The full report is available for purchase from the Bazelon
Center's online bookstore. Media can obtain a copy by contacting
Christopher Burley at 202-467-5730 x 133 or leec@bazelon.org.
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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.
Robert Bernstein, Ph.D., is executive director for the Bazelon
Center for Mental Health Law and a psychologist who for 19 years
was the architect and director of one of the nation’s oldest
and largest mental health and aging programs.
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