Evict, Reject, Discharge: Are Nursing Homes Following the Rules or Is the Problem Bigger than “Rules”?

My colleague Becky Morgan posted earlier this week on the AP news story on nursing homes’ attempts to evict difficult patients.  This week the ABA Journal also linked to the AP story,  plus tied the statistical reports of a nation-wide increase in  complaints about evictions, rejections and  discharges to one man’s struggle to return to his California care center following what should have been  short term hospitalization for pneumonia. 

The story of Bruce Anderson is a reminder that a need for high-quality, facility-based “long term ” care is not limited to “elderly” individuals.  But it is also a reminder that individuals with serious behavioral issues, not just physical care needs, complicate the picture.  Anderson experienced a severe brain injury at age 55 following a heart attack,  but his younger age, lack of “private pay resources,” and  a history of apparently problematic behavior, are all reasons why a “traditional” nursing home may seek to avoid him as a resident.  

The ongoing California litigation over Mr. Anderson and similarly situated residents heightens the need to think critically about whether we’re being naive as a nation about “home is best” shifting of funding resources.  Certainly there are many — and probably too many — individuals in facilities when they could  be maintained at home if there was more funding to supplement family-based care.  

At the same time, I tend to see this as downplaying the very real needs for high-level, behavioral care for individuals who aren’t easily cared for by families or “traditional” nursing homes, much less by hospitals organized around critical care.  It is about more than mere eviction, discharge and rejection statistics.  The 1999 Olmstead decision was a watershed moment in recognizing the need for de-institutionalization of those with disabilities.  But it may have pasted over the real need for quality of assistance and care in any and all settings, and what that means in terms of costs to a nation.   

My thanks to Professor Laurel Terry at Dickinson Law who took time away from the fun of grading her exams to send us the ABA story.