[p.1] ...we notified Mayor Willie Brown that the City and County of San Francisco ("San Francisco" or "City") was violating Title II of the Americans with Disabilities Act of 1990 ("ADA"), 42 U.S.C. § 12131 et seq., by failing to ensure that Laguna Honda Hospital and Rehabilitation Center ("LHH") residents were being served in the most integrated setting appropriate to meet their needs.1
[p. 2] Based upon our review, we find that the City continues to be in violation of the ADA and continues to fail to ensure that LHH residents are being served in the most integrated setting appropriate to meet their needs.
[p. 2] We also found that LHH was violating the constitutional and statutory rights of its residents by not ensuring residents’ reasonable safety, not providing adequate health care services, not providing an adequate living environment, and engaging in unjustifiable and dangerous restraint practices.
[p. 3] A significant number of LHH residents are unnecessarily isolated in the nursing home.
[p. 4] Medi-Cal pays LHH $236 per day for skilled nursing care. However, the actual operating cost per bed for LHH is reported by the facility to be $347 per day, for an annual cost of approximately $126,655 per year per skilled nursing bed.
[p. 6] The regulations promulgated pursuant to the ADA provide that "[a] public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities." 28 C.F.R. § 35.130(d)(the integration regulation). The preamble to the regulations defines "the most integrated setting" to mean a setting "that enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible." 28 C.F.R. pt. 35, App. A at 450.
[p. 6] In construing the anti-discrimination provision contained within the public services portion (Title II) of the ADA, the Supreme Court held that "[u]njustified [institutional] isolation ... is properly regarded as discrimination based on disability." Olmstead v. L.C., 527 U.S. 581, 597, 600 (1999). The Court explained that "institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life." Id. at 600. The Court added that "confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment."
[p. 7] LHH has increased its admission rate for younger individuals disproportionately to other long term care facilities in California over the last ten years. The proportion of males at LHH under the age of 55 has tripled from 1990 to 2000. The proportion of residents over the age of 89 has decreased from 30 percent in 1990 to less than 6 percent in 2000.
[p. 8] Our consultants concluded that a significant number of these residents do not require skilled nursing care in an institutional setting.
[p. 9] These individuals included residents with disabilities who require minimal supports and services; persons with developmental disabilities; and persons with mental illness. Some residents are unnecessarily isolated at LHH after plainly meeting the requirements of Olmstead.
