Missouri is putting people in nursing homes who don't belong there, DOJ says

by John Murphy

The department found Missouri puts adults with mental disabilities in nursing homes who do not require that care, violating the Americans with Disabilities Act.

After an 18-month investigation, the U.S. Department of Justice has determined the state of Missouri is violating the Americans with Disabilities Act by unnecessarily institutionalizing adults with mental health disabilities in nursing homes.

The department said in its Tuesday report that Missouri is failing to provide community-based services for these people. 

Supportive community-based services include assertive community treatment, case management, supported employment, mobile crisis response, crisis stabilization services, permanent supportive housing, peer support and supported decision-making, according to the report.

The Justice Department alleges Missouri is violating Title II of the ADA.

“People with mental health disabilities should not have to be confined to a nursing facility because they cannot access the community-based services they need," Kristin Clarke, the assistant attorney general of the Justice Department's Civil Rights Division, said in a news release. 

Nearly half of these people unnecessarily placed in nursing facilities are under the age of 65, the investigation found.

"Most require little or no assistance with basic physical activities and simply don't need skilled nursing care," Clarke said in a video posted to the Department of Justice's website. 

Julie Schupp is the founder and CEO of Boone Supported Living, which helps people with mental health disabilities find community-integrated living accommodations.

Schupp said some of her organization's work includes getting people out of nursing homes. 

"That's one of the most fun things about my job is getting people out of the nursing homes that don't need to be there," Schupp said.

She said her organization receives 40% of its funding from the state and the other 60% from Medicaid, making it fully publicly funded — though it is independently operated.

Schupp said Boone Supported Living's biggest budget constraint is finding and paying employees. She said it's not only hard to find workers, but it's also hard work once they're hired.

"What we do is people's lives are in your hands," Schupp said. "This is a big job. You have to be a nurse, you have to be a taxi driver, you have to be a social worker. You have to have all these skills, and we have trouble staying above the curve." 

Schupp said living conditions for people with mental health disabilities have improved drastically from decades ago, including in nursing homes. 

Mathew Gass is the president of the Central Region of Burrell Health.

He said his organization has grown in staffing by 30%, but that still isn’t enough.

"I think individuals that are working in the mental health field or organizations that are hiring people to grow their mental health work force would also say a skilled workforce, the number of people that are going to college to study the mental health field — none of that has caught up with the increase in demand organizations like us have seen since the pandemic," Gass said.

KOMU 8 reached out to the Missouri Department of Mental Health regarding the Justice Department's report. It said it is currently reviewing the report.

As part of its report, the Justice Department encouraged anyone with relevant information to the matter to leave a voicemail at 833-610-1242 or email Community.Missouri@usdoj.gov.

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Missouri is putting people in nursing homes who don't belong there, DOJ says