“State policies and practices have favored institutional care at the expense of community-based services,” the letter said.

Some children, the Justice Department said, “have been in a facility for a decade or longer, including some who entered a facility as toddlers.”

Both nursing home industry groups and the Agency for Health Care Administration, which regulates the industry, have defended the practice, saying some youngsters are too frail or too disabled to live at home.

“Nursing homes serving children must meet different criteria than facilities that serve only older adults,” AHCA told The Miami Herald in a prepared statement. “They are strictly regulated to ensure that the appropriate services are provided specifically for children. Nursing homes that serve children are designed to service persons with complex medical needs; they provide a safe, secure and enriching environment for the children in their care.”

The Florida Health Care Association has called the federal report that criticized the practice — and the media reports that followed — “an attempt to demonize these facilities.”

“The unfortunate reality is that these pediatric facilities are the safety net for children who cannot be cared for at home because either their medical needs are too complex or they have no family to rely on,” J. Emmet Reed, the association’s executive director, wrote in a statement. “ ‘Fragile’ does not begin to describe their care needs — they require ventilators, feeding tubes; they have traumatic brain injuries or may even be comatose.”

Reed said youngsters in nursing homes live separate from frail elders, and receive care specific to the needs of developing children. Nurses, therapists and aides “care for them and love them as if they were their own,” Reed wrote.

“You’ll find handicap-accessible playgrounds, toys, stuffed animals and a brightly colored, kid-friendly living environment. Education is an important component, and through collaboration among the families, medical team and school system, each child’s schooling needs are met. You’ll also find more than twice the number of staffing hours per child than that which is required for seniors.”

The healthcare agency’s own records, however, as well as records from other groups, show that is often not the case.

‘Social isolation’

As far back as 2009, AHCA inspectors found nine children sitting around a TV watching cartoons at 8:30 a.m. “with no hands-on activity” at the Westminster Community Care of Orlando nursing home. Two caregivers were in the “activity room” watching the residents as they sat before the television, a report said, adding “there [was] no interpersonal interaction observed between staff and the children.”

Inspectors said one frail resident was supposed to receive daily visits from “activities” staff to prevent “social isolation,” but no such visits occurred.

Another resident, who suffered from cerebral palsy, seizures and had a feeding tube, was supposed to have daily visits for socialization and stimulation, home schooling, and music. But during a two-day inspection, observers found only a TV tuned to a news program. An administrator acknowledged the child was receiving no education.