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A 1993 peer-reviewed study of existing cost comparison literature on found that community settings for persons with developmental disabilities are not always less expensive than facilities, as some advocates claim. (Walsh, et al., "Cost Comparisons of Community and Institutional Residential Settings: Historical Review of Selected Research, Mental Retardation, Volume 41, Number 2: 103-122, April 2003). A 2009 update by lead researcher, Kevin Walsh, confirmed that the 2003 conclusions remain valid in 2009 and beyond.
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State officials and legislators often hear that Olmstead requires community placements. Such interpretation is not accurate.
In actuality, the Supreme Court, in its landmark Olmstead v. L.C. ruling, embraced the need for a range of services to respond to the varied and unique needs of the entire disability community: “We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings...Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it.” 119 S. Ct. 2176, 2187 (1999).
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VOR's Abuse and Neglect in Community Settings document provides a bibliography of investigative media series, state audits and peer-reviewed research in more than half the states that detail systemic concerns with regard to quality of care in community-based settings for persons with developmental disabilities. Tragedies range from physical, emotional, and financial abuse, neglect and even death. Many of these outcomes are associated with a zest to move to a "community for all" vision people with developmental disabilities without adequately considering the ramifications of separating vulnerable people from specialized care and then doing away with a critical safety net (a/k/a deinstitutionalization). The lessons learned from more than 25 states should cause policymakers and lawmakers to take pause and recognize that a range of needs requires a range of service options. |
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The allegation of a Medicaid institutional bias for people with mental retardation and developmental disabilities (MR/DD) is simply not true. It is based on two false premises: (1) that all institutional services are mandatory and all home and community-based services (HCBS) are optional, and (2) that more dollars are spent on institutional services than on HCBS services.
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Community Resource Centers (CRCs) are specialty, out-patient clinics situated at existing residential facilities that provide desperately needed quality medical, dental, and other therapeutic services to citizens with mental retardation and developmental disabilities living in communities, who have significant difficulty obtaining these services. CRCs also function as university-based centers of education, training, and research for medical and dental students, residents, externs, fellows, and professionals. There are proven models in several states.
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Most states opt, as part of their Medicaid plan, to provide services to some people with MR/DD the option to receive services in Medicaid funded and certified Intermediate Care Facility for Persons with Mental Retardation (ICFs/MR). ICF/MR residents are the neediest, most fragile, and most disabled citizens of in your state. ICFs/MR provide cost effective, comfortable and safe living for them. A vast majority of the families and guardians of ICF/MR residents are very satisfied with the care their loved ones receive.
Yet, the very existence of ICFs/MR is threatened in many states. Often, the decision to downsize or close an ICF/MR is made unilaterally by a State’s Governor or his/her designee (hereafter, “State’s Administration”), without any involvement of the state’s legislature.
The decision to downsize or close an ICFs/MR should not be made unilaterally by a State’s Administration. When an ICF/MR is closed, a state’s most fragile citizens are removed from their long-time home and often separated from life-sustaining specialized services. Furthermore, nearly every state has thousands of people waiting for services. The decision to eliminate any service option must not rest in the hands of one governmental entity.
Some states have addressed this concern with legislation.
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