TALLAHASSEE — Marguerite Pace, 48, has a business degree, a law degree and passes her time in a Sarasota nursing home bed. Renal failure and collapsed vertebrae have kept her from moving around on her own since 2006.
But she harbors a vision about what life could be. She would like an apartment of her own, a motorized wheelchair, an aide to help her bathe and dress and, most of all, a job.
"I want to work," Pace says. "I don't need legs for that."
Her story and those of dozens of other nursing home residents are playing out this month in a federal lawsuit over how Florida treats some of its frailest citizens.
Southern Legal Counsel and AARP have sued the state under the Americans with Disabilities Act, alleging that Florida's Medicaid program too often relies on nursing homes instead of bringing services to people's homes. The disabilities act requires states to integrate people into their communities.
Similar lawsuits have sprung mentally ill people from institutions. This case extends the debate to nursing homes.
Battle lines were drawn Monday in opening statements.
Lawyers for the state noted that Florida serves about 50,000 frail Medicaid clients at home or in assisted living homes, compared to 40,000 to 45,000 in nursing homes. Since 2009, state agencies have transferred 1,700 nursing home residents back into the community.
"We have had a flat nursing home population for a decade while home and community based programs are expanding," said Justin Senior, general counsel for the Agency for Health Care Administration. "It's a pretty dramatic success."
Plaintiffs' lawyers say the state has not done enough. They want U.S. District Court Judge Robert Hinkle to order Florida to expand its at-home programs.
"We think thousands of people could come out" of nursing homes, plaintiffs' attorney Stephen Gold said. "If they can reside in the community with appropriate services, the failure to do that is discrimination."
Pace, who appeared in a video deposition, was the first witness as plaintiffs began to put on their case. She can use a cell phone and a computer and has researched programs that teach disabled people how to drive.
But Medicaid workers had rejected her request for at-home care. They were not worried about money. Both sides agree that supporting people at home or in assisted living is usually less expensive than a nursing home.
But Pace wouldn't be safe outside the nursing home, Medicaid said. She lacks support in the community, the Medicaid report said. She needs "24-hour observation and care" and can't leave "because of safety issues."
Jacksonville resident Clayton Griffin was also denied at-home care while living in a nursing home. He also needed 24-hour care and observation, Medicaid evaluators said.
Griffin, 58, simply moved out two years ago, trying to pay his own way from a Social Security check. But it was nowhere near enough. In September, Judge Hinkle ordered the state to start providing him at-home services, so now he gets frozen meals he can microwave and aides about four hours a day to get him out of bed, clean his house and do laundry.
Testifying by telephone, Griffin said he attends church, does his own shopping in a motorized wheelchair, goes to the movies and socializes with neighbors in his apartment.
"I have a sense of independence," he said. "I have the fellowship with people my own age. Well people. They aren't sick."
Gold asked him if he was still seeing a "lady friend."
"Yes," said Griffin.
"No further questions."
The nonjury trial is expected to last two weeks. Later this week or early next, the state gets to put on its defense, to explain in detail why people like Pace and Griffin might, in fact, be unsafe in the community.
Hinkle could take months to rule.