Forced confinement vs. community living: it’s about morals, not money

People with disabilities faced forced confinement in many situations and are rapidly filling nursing homes

Marca Bristo fought along Justin Dart to help pass the Olmsted Act to prevent forced confinement

Marca Bristo fought along Justin Dart to help pass the Olmsted Act to prevent forced confinement

The Civil Rights Division of the US Department of Justice has threatened to sue the state of New Hampshire where people are allegedly facing forced confinement in nursing homes. These are people with mental illness labels who are are medically able to live in the community. If true, the state is violating a federal law that says people with disabilities must be housed in the least restrictive environment possible. (The Americans with Disabilities Act and the U.S. Supreme Court’s Olmstead decision.)

No fair, say the state attorney general and health and human services commissioner.  We’re working to eliminate forced confinement.  We have a 10-year plan.

Forced confinement in a medical facility of a person with no medical need to be there, who can live in the community, while you work on a 10-year plan to get him out, is not justice delayed or justice denied.  I call it kidnapping.

There are complexities with the statement “reducing forced confinement saves money.”

Forced confinement is also a foolish waste of the taxpayers’ money since community-based treatment is so much cheaper, about 1/3 the cost.  But saving money is not the most important reason to reduce forced confinement of people who can live in less restrictive settings.

The economic argument against forced confinemnt does not persuade administrators and policy makers. Nursing home, hospital, and jail administrators say reducing forced confinement in their institutions does NOT save money unless you close a whole wing, and permanently reduce the facility’s capacity. Why make a financial argument to finance experts, who won’t listen because you’re not a finance expert?

Su and Dennis Budd, some of Kansas' staunchest advocates against institutionalization and forced confinement

Su and Dennis Budd, some of Kansas' staunchest advocates against institutionalization and forced confinement

They have a financial  answer to your financial argument, and their financial expertise trumps yours, they believe. Empty beds cost a facility money, unless enough are empty to allow the facility to close a whole wing, and reduce the facility’s capacity permanently, administrators say. They also argue that hospitals and jails need to be ready if large groups of admissions come all at once.

When the NH consumer leadership argued that voluntary crisis respite centers are cheaper than forced confinement in the NH Acute Psychiatric Hospital, the administrators said that it wasn’t enough people to save money.

The moral and legal argument for reducing forced confinement is more convincing

The biggest truth about forced confinement that it’s definitely illegal. Advocates fought hard for the Americans with Disabilities Act and the Supreme Court’s Olmstead decision, which requires that people with disabilites be housed in the least restrictive environment possible. Nothing in the law says “least restrictive environment the bureaucracy finds convenient.”

Forced confinement makes people more disabled and dependent. It cuts them off from family, friends, community, and the chance for a normal, fulfilled life. Forced confinement is immoral whether it’s expedient for administrators and taxpayers or not.

by Ken Braiterman


3 comments to Forced confinement vs. community living: it’s about morals, not money

  • Brenda Ross

    I read your article and would like to get some input on my family situation. My father was placed in a rehab center/nursing home after heart surgery. He was on a bypass machine too long, so he had some brain damage. He had to learn to swallow again and get stronger. This goal was done within a month. My sister and his wife do not want him out of the nursing home as it is to their financial advantage. My brother and I have taken this to court, but we are told if a doctor says he has to stay there then he has to stay. This doctor has only laid eyes on my dad 2 times since his admitance in Aug. That was 2 x before court.They will not let us take him to another Dr as it is facility policy they they only have the one Dr. So a doctor can force you to stay and PAY in a facility that he is the only Dr. Please let me know if you have heard of this or if there is someone we can contact to help. Thank You

  • I’m so sorry you and your brother are going through this heartache. It makes me furious.

    I never heard of an ethical doctor who gave a patient a hard time about getting a second opinion. Good doctors welcome and encourage it. I’d seek a court order to allow another doctor to examine your father and give an opinion to the court. Then, I would ask the court to order the nursing home to pay for it — as a penalty for denying you and your father your legal rights. Maybe they’ll change their policy when it costs them money.

    If it turns out they are keeping your father confined when he is capable of living in the community with supports, they are violating the federal Americans with Disabilities Act, and possibly state law where you live. I’m sure your state has an agency that regulates nursing homes, and another one that investigates complaints of elder abuse. Shop those forums and see what response you get.

    First, find a private non-profit agency that can advise you on the best way to pursue action by state regulators. Each state has a federally-funded agency of “protection and advocacy” lawyers, who protect the rights of people with disabilities. They can’t afford to take every individual case to court, but they will give you an intake and an idea of what to do next. If there is a potential for big damages under state or federal civil rights laws, a private attorney will risk taking the case for a percentage of what you recover.

    Don’t let these bastards push you and your father around. If there is a medical need to keep him confined, make them prove it.

  • Hey There Wellnesswordworks,
    This might be off topic, however, Non clinical nursing jobs are not jobs that many people are aware of in the nursing industry. A job in nursing, unbeknown to many, is not just limited to clinical work in the hospital. Nursing is a dynamic and widespread career which branches out a lot more than most people realize. Nursing remains a specialist field where professional knowledge and care is needed. There are a number of non clinical nursing jobs for those who choose not to be limited to just purely hospital work.
    Kindest Regards