With Florida under heavy fire for funneling sick and disabled children into nursing homes designed for elders, child welfare administrators have quietly enacted a new policy aimed at keeping sick foster kids in community settings.
The Department of Children & Families has distributed a new agency policy that requires high-level approval before any child in state care can be admitted to a nursing home, or move from one institution to another. DCF also will ramp up its efforts to recruit foster parents who are specially trained to care for children with significant special needs. Such medical foster homes reduce the need for nursing homes.
DCF has custody of 31, or close to 15 percent of the 220 or so disabled or fragile children who currently live in nursing homes, and child welfare bosses have no authority over the remaining youngsters.
But the move sends a powerful message: DCF, the “parent” to 19,000 Florida children in state care, no longer favors the institutionalization of kids. The new policy runs counter to that of another branch of state government, the Agency for Health Care Administration, whose funding formula has forced some parents to put their disabled kids into institutions.
“A core mission of DCF is to ensure that children are raised in families,” wrote Assistant Secretary for Operations Pete Digre, whose signature will be required before a foster child can be institutionalized.
The Florida health agency’s decision to shunt very sick children into nursing homes has come under attack in recent weeks as the U.S. Justice Department has threatened to sue the state to curtail the practice, which, civil rights lawyers say, violates the Americans with Disabilities Act. The landmark 1990 federal legislation, signed by President George H.W. Bush, requires that people with disabilities be allowed to live and receive care outside large, segregated institutions.
Forcing children into nursing homes, advocates say, is especially cruel because isolation and lack of socialization can stunt their development and lead to psychological disorders. Records reviewed by The Miami Herald show that, at many nursing homes, children receive little education or stimulation; some children appear to spend their days in virtual isolation.
The policy appears to be an about-face, comes on the heels of Miami Herald reports about the death of a 14-year-old girl with cerebral palsy and a seizure disorder hours after she arrived at a Miami Gardens nursing home. Marie Freyre, sent to the home against her mother’s strong objections, had been in DCF care for two months.
In a letter to a children’s advocacy group three months ago, DCF Secretary David Wilkins defended his agency’s actions regarding severely disabled foster children.
“These children have very complex medical diagnoses requiring a 24-hour nursing environment,” Wilkins wrote to Christina Spudeas, who heads the advocacy group Florida’s Children First. “As part of our review of the children in long-term care facilities, we take special care to ensure that their case managers are providing strong, active advocacy and oversight.”
In recent months, the U.S. Justice Department’s civil rights division has accused the state of “systematically” forcing disabled children into nursing homes through a combination of deep cuts to in-home nursing care that enables parents to keep their children — as well as offering financial incentives to nursing homes that accept children. AHCA will pay homes $506-per-day to care for children, double the per-diem for elders.