Report: State leans too much on institutionalizing disabled

Cy Ryan and Ed Koch

Wednesday, Feb. 6, 2002 | 9:16 a.m.

Chris Smith, a 28-year-old with the mentality of a 3-year-old, earns a small weekly paycheck operating the paper shredder at Opportunity Village.

The job and other services provided by the nonprofit group that trains and employs the mentally disabled allow him to live with his mother, Linda, a longtime executive there.

It's an arrangement that both Linda and Chris prefer over the more common alternative in Nevada -- putting him in an institution -- and one that saves the state more than $120,000 a year, Linda Smith says.

"If Chris had to be institutionalized, it would cost the state $300 to $350 a day -- $450 to $500 if he weren't as functioning as he is -- to care for him," Smith said. "Alternatives to institutionalizing people make financial sense."

But paradoxically, Nevada spends more on institutions and less on home-based care for the disabled.

An interim legislative committee studying services to the disabled heard Monday that last year 79 percent of Nevada's Medicaid spending on the disabled went to nursing home or institutional care.

Only 21 percent was spent to provide services in the community, Stephen F. Gold, an attorney for the Public Interest Law Center in Philadelphia, told legislators.

The state spent $11.05 per 1,000 people for community-based services, compared with the national average of $60, Gold said.

That made Nevada the second highest in spending for nursing homes, and the last in the nation in spending on community services, he said.

The trend doesn't make sense to Linda Smith, who estimates the state has saved $3 million or more over Chris' lifetime in institutional care.

"Nevada may be the only state where institutions are growing," she said.

The state has been improving, state Human Resources Director Mike Willden said. In five years, he said, the percentage sent to long-term care facilities has dropped from 90 percent to 79 percent.

"But we could still divert more people," Willden said. "It's unfortunate that we're rated at the bottom. It comes from years of underfunding."

A U.S. Supreme Court decision requires the disabled be given a choice of a nursing home or residence in their community, Gold said.

Most mentally retarded and the disabled would prefer to stay in the community with assistance in such things as transportation, vocational training and personal care, he said.

In addition, Nevada has not taken advantage of federal money available for nursing homes, Gold said. The counties are picking up the full cost of residents who have a certain income, he said.

In Las Vegas, community support for the disabled is being cut back. The Regional Transportation Commission has said it will raise rates on the local paratransit service, a personalized bus service for the disabled. That makes it tough for Opportunity Village employees, some of whom make stipends of $20 a week.

"Families have to weigh whether it is worth sending their (mentally retarded) children to Opportunity Village, when the cost of transportation in some cases now is twice the amount of the paychecks they earn," Smith said.