Confined to Nursing Homes, but Longing (and Ready) for Home

Marvin L. Dawkins was a 53-year-old AT&T manager when a blocked blood vessel left him paralyzed. It took 11 years, one lawsuit, repeated tangles overMedicaid rules — and a chance meeting on a church van — before he could extract himself from a nursing home outside Baltimore.

Now he lives in an apartment with the assistance of an aide, gets out for a job that he says gives him purpose, socializes with new friends and old ones, and revels in his freedom. “I determine what happens to me,” he said. “I was there at the nursing home basically just laying in bed and watching TV. I didn’t think it was much of an existence.”

Across the nation, many other Americans who could live elsewhere with help are unwillingly confined to nursing homes or long-term care facilities. Nearly 20 years after the Supreme Court ruled that disabled people requiring public support were entitled to live in their community, rather than in institutions unless medically necessary, the federal government and states are still far from achieving that goal. Because of budget cuts, inflexible rules, a patchwork of programs and a widespread failure to bolster alternative care, others like Mr. Dawkins describe feeling stuck in deeply unsatisfying, sometimes miserable, settings.

- The New York Times

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