Federal officials slam Florida for warehousing disabled kids

MIAMI — Florida health and disability administrators have been systematically dumping sick and disabled children — some of them babies — in nursing homes designed to care for elders, in violation of the youngsters’ civil rights, the U.S. Justice Department says.

Hundreds of Florida children are spending their formative years in hospital-like institutions, sometimes growing up in the equivalent of hospital rooms with virtually no education or socialization, the Justice Department’s Civil Rights Division wrote in a 22-page letter to Attorney General Pam Bondi.

Ms. Bondi’s office is defending the state against a previously filed lawsuit that claims the institutionalization of children violates federal law.

The letter, written by Assistant U.S. Attorney General Thomas E. Perez, is the federal government’s first attempt to weigh in on the controversy. At the end of his letter, Mr. Perez outlined steps the state could take to reduce its reliance on nursing home beds for frail children. If state leaders fail to “correct” the practice, Mr. Perez wrote, “the Attorney General may initiate a lawsuit” of his own.

Some youngsters remain in nursing homes for much of their lives: “a number” of kids, the report said, have spent a decade or longer institutionalized, including some children who entered the facilities as infants and toddlers.

“Indeed, the state has planned, structured and administered a system of care that has led to the unnecessary segregation and isolation of children, often for many years, in nursing facilities,” the report said.

Under the federal Americans with Disabilities Act, people with disabilities or medical conditions must be housed and treated in community settings whenever possible, not in large isolated institutions as most states did in previous decades. Since the law was passed in 1990, advocates for disabled people and children have used it to shut down often squalid institutions and to move disabled and mentally ill people into their own homes or into group homes that are part of larger communities.

In recent years, however, Florida health administrators have relied upon nursing homes to house hundreds of children who could safely live at home with their parents — often at less expense to the state, advocates claim. In his letter, Mr. Perez said the state has cut millions from programs that support the parents of disabled youngsters, refused $40 million in federal dollars that would have enabled some children to stay or return home, encouraged nursing homes to house children by increasing their per diem rate — and even repealed state rules that limited the number of kids who could be housed in nursing homes with adults.

Such policies, the Justice Department says, are not only contrary to federal law, they hurt children: Housed in nursing homes that are ill-equipped to care for them, youngsters often are deprived of an education, are unable to see their own parents and siblings — many of whom live hundreds of miles away — have no ability to socialize with typically developing peers, and sometimes are forced to sit for hours in front of a television for lack of recreation or other activities.

In court pleadings, and in a statement Thursday to The Miami Herald, state health regulators say they are complying with all provisions of the landmark law.

The state provides all services that are “medically necessary” to sick and disabled children — including skilled nursing care and home health aides — “up to 24 hours a day, seven days a week,” said Shelisha Coleman, a spokeswoman for the state Agency for Health Care Administration, or AHCA, which is a defendant in a 2012 lawsuit that makes the same claims as the Justice Department.

Health administrators chided the Justice Department for essentially ambushing the state Thursday by releasing the strongly worded report on a DOJ website without first providing the state with copies of documents, transcripts of interviews and nursing home inspection reports upon which the Justice Department based its findings.

In a court pleading last June, AHCA said federal law allows the agency to “place appropriate limits on a service based on such criteria as medical necessity” and cost-cutting.