Case: DOJ Investigation of Missouri's Skilled Nursing Facilities
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Case Summary
The U.S. Department of Justice (DOJ) opened an investigation into Missouri's skilled nursing facilities (otherwise known as a nursing homes or Level II facilities) on November 16, 2022, after receiving a complaint. The investigation was initiated pursuant to Title II of the Americans with Disabilities Act (ADA), which requires states to make reasonable modifications to enable adults with disabilities to live in the most integrated setting possible.
DOJ's investigation involved extensive interviews with staff and individuals living in nursing homes, as well as interfacing with the three agencies in Missouri primarily responsible for coordinating services for people with mental health disabilities: the Department of Health and Senior Services (DHSS), the Department of Mental Health (DMH), and the Department of Social Services (DSS).
DOJ issued a findings report on June 18, 2024, finding that thousands of Medicaid-eligible adults with mental health disabilities were unnecessarily separated from their communities and placed in nursing homes, despite approximately half of eligible individuals with disabilities being under 65 and very few of them requiring assistance with basic physical activities. Individuals with mental health disabilities were clustered in 39 of the state's 500 nursing facilities. In addition, many of the individuals were under guardianship, with guardianship under public administrators found to serve as a pipeline to unnecessary institutionalization (public administrators in Missouri average a caseload of 91 people). Missouri's nursing facilities were found to be highly segregated institutions, preventing individuals from pursuing educational and job opportunities outside of the facility. In addition to physically segregating people, some nursing facilities also prevented residents from communicating with outside individuals.
DOJ identified several remedial measures that Missouri had to engage with in order to comply with the ADA, including: (1) making more community-based services available (Assertive Community Treatment; peer support; supported employment; mobile crisis response; etc.); (2) increasing integrated housing; (3) ensuring that individuals in nursing homes are made aware of alternative living settings; (4) ensuring effective diversion from nursing facilities; and (5) ensuring appropriate transition from unnecessary guardianship for adults with disabilities. DOJ expressed that it was looking forward to working with Missouri to institute remedial measures.
Implementation of necessary remedial measures is ongoing.
Summary Authors
Hannah Juge (6/22/2024)
Documents in the Clearinghouse
Docket
Last updated Aug. 30, 2023, 1:25 p.m.
Docket sheet not available via the Clearinghouse.Case Details
State / Territory:
Case Type(s):
Intellectual Disability (Facility)
Key Dates
Case Ongoing: Yes
Plaintiffs
Plaintiff Description:
The U.S. Department of Justice's Civil Rights Division
Plaintiff Type(s):
U.S. Dept of Justice plaintiff
Attorney Organizations:
U.S. Dept. of Justice Civil Rights Division
Public Interest Lawyer: Yes
Filed Pro Se: No
Class Action Sought: No
Class Action Outcome: Not sought
Defendants
State
Missouri Department of Health and Senior Services
Missouri Department of Mental Health
Missouri Department of Social Services
Defendant Type(s):
Facility Type(s):
Case Details
Causes of Action:
Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.
Other Dockets:
Available Documents:
Outcome
Prevailing Party: None Yet / None
Relief Granted:
Source of Relief:
Issues
Disability and Disability Rights:
Intellectual/developmental disability, unspecified
Discrimination Basis:
Disability (inc. reasonable accommodations)
Case Summary of DOJ Investigation of Missouri's Skilled Nursing Facilities, Civil Rights Litig. Clearinghouse, http://www.dev.clearinghouse.net/case/43890/ (last updated 6/22/2024).