A lawyer for the Public Interest Law Center on Monday urged lawmakers to reduce dependence on "institutional" programs for the disabled.
Stephen Gold of Philadelphia told the legislative committee studying services for the disabled Nevada can get more for its money by expanding home and personal care services. And he said it's better for the clients.
He said his figures show that 79 percent of Nevada's total Medicaid long-term care expenditures went to institutional care such as nursing homes. Only 21 percent went into community based services.
He said under a recent Supreme Court decision, the state must offer the disabled non-institutional services if they want them and their doctors say they are appropriate candidates.
Nevada, he said, has a long way to go in providing those services. The state is 50th in percentage of home health recipients, 24th of 30 among those states providing personal care attendants and 50th in overall community based long term care recipients.
He said while other states are reducing the number of institutional care beds for the disabled, Nevada is increasing its number of beds.
Gold said it's important to keep the disabled from ever entering an institution in the first place.
"People who are in nursing homes become infantilized," said Gold. "It really does take away from one's independence."
He said after someone is in an institution for a few months, they lose much of their ability to do things and make decisions for themselves.
"If you can divert people from going into institutions, it's much easier than getting them out," Gold said.
Human Resources Director Mike Willden agreed Nevada has a long way to go in expanding those services. But he said he thinks some of the numbers are skewed by the state's huge population growth. Nevada has nearly double the number of residents it had 10 years ago.
"Unfortunately, Nevada is ranked at the bottom of these services from years and years of underfunding," he said. "But the numbers don't take into account the population explosion."
"I agree in most cases it's time to move to community services," said Willden.
He said the 2001 Legislature took steps in that direction by expanding support for personal care attendants and community based services.
Willden also agreed the state can get more for the money by reducing the number of disabled in institutional long term care. He said living in and contributing to the community is not only cheaper for the state but better for the individual receiving the services.
Willden said he would be recommending program changes to the governor for the next budget cycle to incorporate some of those types of changes.
