Florida's top health administrator told lawmakers in at a Senate committee meeting Wednesday she was "enraged" by "sensational" reports that her agency was funneling sick and disabled children into nursing homes designed for adults.
"We do not place our medically complex or medically fragile children in nursing homes," Liz Dudek, secretary of the Agency for Health Care Administration, told members of the Senate Health Policy Committee, adding that parents are given the choice of where their children live and receive care. "The last place we want children is away from their parents."
Federal civil rights administrators see it differently.
The U.S. Justice Department's civil rights division sent Attorney General Pam Bondi a 22-page report in September, accusing the state of violating the Americans with Disabilities Act by placing severely disabled children in geriatric nursing homes. Florida, the justice department says, has "systematically" packed children into nursing homes by drastically cutting nursing hours for parents who care for disabled children at home, while giving nursing homes financial incentives to accept such children.
Dudek's appearance before the health committee comes at a critical time for her agency: The Justice Department set a deadline of last week for Florida health administrators to accept or reject the federal government's demand that the state sign an agreement to move disabled children out of nursing homes, and allow a federal judge to oversee the agreement. The state insisted it was "already in full compliance" with all federal health laws, and called any oversight of the state's Medicaid program "unwarranted."
Earlier this week, a separate state agency, the Department of Children & Families, outlined a new policy that requires high-level agency approval before any foster child can be placed in a nursing home. DCF now has 31 children in state care in such facilities, and an agency head said DCF would seek to move those kids into family homes or foster homes where parents have specialized medical training. The new policy was distributed in the wake of a series of stories in The Miami Herald saying state records show many children are essentially warehoused in nursing homes, receiving little or no education or stimulation. One girl whose story was detailed died at a nursing home after only 12 hours when caregivers neglected to give her life-saving medication.
As she has maintained consistently in recent weeks, Dudek said the parents of children whose care is paid for by Medicaid, the insurance program for needy and disabled people, make the decision as to where the youngsters will live.
AHCA has spoken with the parents of all 222 or so children in nursing homes to help them change locations if they are unhappy with their care, she said. Only one parent asked for a change.
Dudek also denied claims that children go to nursing homes so the state can save money, or that children are unnecessarily separated from their parents.
"The issue of cost is not one we look at," she said. "It breaks my heart and partially enrages me to read in the clips that...we have this funding scheme for children in nursing homes. That's not at all the case."
AHCA's own records, however, show the state saved $25.8 million between July 1, 2011 and June 30, 2012, by reducing private duty nursing services to children receiving Medicaid who live with their families.
State records suggest the cuts are targeted at families with the greatest need. In 2011, the percentage of Medicaid recipients who got an average of 16 hours or more per-day of nursing care dropped from 23.percent to 19.6 percent. The percentage that received an average of 12 hours or more per day declined from 37.7 percent to 33 percent.
As part of a federal lawsuit, Juliet Duncan, nursing director at Broward Children's Center, a home health service for 18 families in South Florida, wrote in a declaration that she had "seen AHCA routinely and consistently reduce or deny home care services and private duty nursing to all of our children."
"These reductions are made when there is no change in the child's medical condition. In fact, in many instances, the children's conditions have worsened or their families' condition has changed. Many parents have had to terminate employment to care for these children when private duty nursing hours are reduced or denied," Duncan wrote.
Dudek told lawmakers Florida was in full compliance with a federal law, called the 1987 Nursing Home Reform Act, designed to protect against inappropriate institutionalization by requiring the state to medically evaluate every child before he or she is sent to a nursing home. But the state's records show that, among 575 children whose cases were provided to a civil rights attorney suing the state , nearly half have had not been evaluated for nursing home diversion.
At the committee meeting, Dudek also touted proposals by Gov. Rick Scott's assisted living facility workgroup and told lawmakers she would bring them proposals to streamline regulations for the ALF industry and increase credentialing requirements for administrators.
Scott formed the workgroup in response to a two-year Miami Herald series that exposed systemic abuse and neglect for elderly and disabled people in ALFs. Critics accused Scott of stacking the panel with industry representatives, and said several of the proposals would deliver breaks to the powerful ALF industry.
"Let's focus on the poor-performing providers to bring them up or get them out of the system," she said.
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