Justice Department Finds South Dakota Unnecessarily Relies on Nursing Facilities to Provide Services to People with Disabilities
Following a comprehensive investigation, today, the Justice Department released its findings that South Dakota unnecessarily relies on nursing facilities to provide services to people with disabilities, in violation of the community integration mandate of the Americans with Disabilities Act (ADA) and the Supreme Court’s decision in Olmstead v. L.C.
South Dakotans with disabilities do not have a meaningful choice to receive the services they need in their own homes and communities. The ADA and the Olmstead ruling require states to make services available to people with disabilities in the most integrated setting appropriate to their needs, regardless of age or type of disability.
The department’s findings, detailed in a letter to South Dakota Governor Dennis Daugaard, follow an investigation into the state’s system of care for people who receive services and supports in nursing facilities. The department found that thousands of people who rely on South Dakota for needed services must live in nursing facilities to receive those services, isolated from their communities. With access to adequate home- and community-based services, these individuals could instead live in their homes and communities.
“Regardless of their age, people with disabilities deserve privacy, autonomy and dignity in their everyday lives,” said Principal Deputy Assistant Attorney General Vanita Gupta, head of the Justice Department’s Civil Rights Division. “Our findings reveal how South Dakota’s current system of long-term care violates federal law and fails to give people with disabilities the choice to live in their own homes and their own communities. South Dakota officials have expressed their desire to provide meaningful opportunities for people with disabilities to receive home- and community-based care, and we look forward to working with South Dakota to build a more effective, more efficient and more just service system for all.”
An analysis of South Dakota’s current spending and national data shows that South Dakota – which has one of the highest nursing facility utilization rates in the country – may even realize cost savings and be able to serve more people by increasing the state’s use of home- and community-based services. The state funds the placement of about 3,400 people in nursing facilities through Medicaid at any given time, and approximately 5,500 people over the course of one year.
Nursing facility residents in South Dakota range in age, and include many older adults and almost 450 people under the age of 65. In addition to older adults with age-related disabilities, many of these individuals have disabilities they were born with or acquired at a young age, such as cerebral palsy, multiple sclerosis and amputations due to diabetes or mobility impairments due to an accident.
The findings letter examines the widespread impact of the state’s nursing facility system. For example, one 51-year-old man told the Justice Department that he had entered the nursing facility to recover after a leg amputation, but had been trying to leave the nursing facility for months, without help.
The department’s findings letter includes the following key conclusions:
- Thousands of people who need long-term care have no choice but a nursing facility because South Dakota does not adequately arrange for community-based services or identify residents appropriate for transition.
- Many people who rely on state services do not know that they could choose community-based services instead of a nursing facility because the state has not informed them of or offered them these services.
- South Dakota spends more than 80 percent of its long-term services budget on nursing facilities but could rebalance these funds to prioritize home- and community-based services.
- Most residents have physical disabilities, chronic illnesses or cognitive disabilities and need some assistance with some day-to-day tasks, rehabilitative therapy or nursing –services that the state can provide in community-based settings rather than in institutions.
- People with similar needs to those living in South Dakota’s nursing facilities successfully receive services at home in other states, and even in South Dakota. The state already offers many of the services people will need to live in their own homes and can increase community capacity and address service limitations to ensure all individuals can choose these services instead of nursing facility placement.
- People with disabilities living in rural and frontier areas of the state, including those living on reservations, have particular difficulty accessing services in their homes and communities.
The full findings letter can be found at www.ada.gov. Please visit www.ada.gov/olmstead to learn more about the division’s ADA Olmstead enforcement efforts, and www.justice.gov/crt to learn more about the laws enforced by the Justice Department’s Civil Rights Division. Additional information about the U.S. Attorney’s Office of the District of South Dakota is available on its website at www.justice.gov/usao-sd.
The investigation was conducted by the Civil Rights Division with assistance by the U.S. Attorney’s Office of the District of South Dakota. The United States is represented by Trial Attorneys Alexandra Shandell, Joshua Rogers and Mathew Schutzer of the Civil Rights Division’s Special Litigation Section and Assistant U.S. Attorney Alison Ramsdell of the District of South Dakota.