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.
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“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.
The Herald has reported that AHCA’s own records show many medically complex children are being essentially warehoused: Despite requirements that children receive an appropriate education, inspections show many kids are parked in front of televisions or sit in their beds all day. Some children have experienced grave neglect — including Freyre, whose caregivers did not provide her with her life-sustaining anti-seizure drugs.
In an interview with The Herald Tuesday night, Digre said his agency already has visited and reviewed the cases of every foster child who is living in a nursing home. Such reviews will continue, with caseworkers re-examining the care plans for every child monthly. The goal will be to find homes — either through reunification with birth parents or adoption — for every child in state care who has medical complexities.
Digre said his agency also wants to expand the use of medical foster homes, in which medically fragile children can live with families trained to use feeding and breathing tubes. “There is general consensus that recent efforts for expanding foster parents for medical licensure have lagged, and this is an excellent opportunity to invigorate our recruitment in this area,” he wrote.
Going forward, caseworkers will need the approval of Digre himself before moving a foster child into a nursing home, or from one nursing home to another.
Spudeas, at Florida’s Children First, said Tuesday that simply slowing down the movement of kids into nursing homes isn’t enough. DCF, the legal “parent” for foster children, “should also take out the kids who already are stuck there.” As well, she added, the state needs to move quickly to remove all children from institutions.
“It’s a travesty,” Spudeas said. “There is no doubt at all that children need proper supports in the home environment.”
As concern over the institutionalization of disabled children intensified, DCF launched an internal accounting in recent weeks. Records obtained by the newspaper show that many foster children in institutions have no social interaction except with caregiving and medical staff.
A caseworker who visited one Port St. Lucie-area child in a Broward nursing home wrote this, for example: “R.W. has no visitors.” Under “visitors” for a Tampa-area child, D.C., also in Broward, a report noted “None other than her case manager.”
At the Plantation Kidz Korner nursing home in Broward, DCF inspectors described the pediatric wing as “run down” and in need of “touching up in most areas.” During a recreation period, a report said, the children were “completely packed” in a small space watching caregivers make brownies, “which truly had nothing to do with the children.”
“We asked if specific items were used to stimulate the children, but did not see any being used,” a report said. “Not sure how these children benefit from making brownies.”
Since the parents of most of the kids had lost their parental rights, the children had virtually no visitors “for years,” the report said, except foster care case workers, who usually see the children only monthly. One child, the report said, had been at the nursing home since 2003, and had seen family members only once.
A representative of Miami-Dade’s privately run foster care agency, Our Kids, wrote bluntly in her report to DCF: “The facilities do not offer adequate activities to the children.”
She added: “Case workers should visit these children more frequently, and the visits should be unannounced.”