April 18, 2015


Welcome to the Rolland v. Patrick Active Treatment Review website. Rolland v. Patrick was closed by order of United States Magistrate Judge Kenneth P. Neiman on May 23, 2013 in his Final Memorandum and Order which incorporated a Consent Decree and dismissed the action, while noting its success. 


This site is published by the former Court Monitor, Lyn Rucker, to provide information about the origin, expectations, and finally the closure of the Rolland Class Action suit.  From this website you can access a brief history of the Rolland v. Patrick case (click on the “history” tab to the left). You can also view or download and print some of the relevant orders issued by the Court.


On October 28, 1998, seven named plaintiffs filed a complaint on behalf of themselves and more than 1600 nursing home residents in Massachusetts with intellectual and other developmental disabilities (“I/DD”), challenging what they claimed was their unnecessary confinement and segregation in nursing facilities, as well as the lack of federally-mandated specialized services in those facilities. The complaint, as amended, alleged that Defendants were violating several federal statutes, including the Nursing Home Reform Amendments (“NHRA”) to the Medicaid Act, 42 U.S.C. § 1396r(e)(7) and its implementing regulations, 42 C.F.R. § 483.100 et seq., the Americans with Disabilities Act (“ADA”), 42 U.S.C. § 12101 et seq., and other provisions of the Medicaid Act.


The named plaintiffs and most of the class members with I/DD in nursing facilities did not primarily require skilled nursing care, but rather, assistance with activities of daily living such as bathing, dressing and eating.  They could have lived in the community with appropriate supports, but due to the dearth such community-based services, they remained confined and segregated in facilities.


After extensive negotiation and mediation, the plaintiffs and defendants entered into a comprehensive agreement, which was approved and entered as an order of the Court on January 10, 2000.   The Agreement, which became known as the First Settlement Agreement, required the Commonwealth of Massachusetts to meet the federal active treatment standard and provide specialized services to all class members appropriate to their needs on an accelerated timetable.  It also  required the state defendants to create a diversion program to prevent unnecessary nursing facility admissions and to develop a community placement schedule to move about  1100 class members out of nursing facilities over  a seven-year period from 2000 to 2007.   The agreement allowed the defendants to meet their active treatment obligations by providing class members with appropriate residential and other supports in the community.


But the defendants’ efforts fell short, and within six months of the Court’s order, the plaintiffs filed the first of many noncompliance motions against the Commonwealth.  Over the course of the next few years, the Court issued additional orders on specialized services and active treatment.  In a major ruling issued in April of 2007, the Court found the defendants failed “to substantially, let alone fully, comply with the court’s orders to provide active treatment.”  See Rolland v. Patrick, 483 F. Supp. 2d 107, 117-118 (D. Mass. 2007).   As a result, the Court appointed a court monitor to assess class members still in nursing facilities and to oversee the state’s compliance.


During the fall and winter of 2007 the plaintiffs and defendants convened a series of meetings to discuss the reality of providing active treatment to more than 750 class members scattered in nursing facilities across the Commonwealth.  Ultimately, the parties negotiated a different approach to achieve system-change: dramatically expand community options for 640 class members over four years, provide enhanced services to class members awaiting placement, and provide active treatment consistent with the Court’s orders and the federal standard to those not likely to leave nursing facilities.


In March of 2008, a Second Settlement Agreement setting forth these provisions was proposed by the parties and submitted to the court. The court held a fairness hearing on May 22, 2008, and heard supporting testimony from class members and DDS Commissioner Elin Howe, as well as objections from a number of guardians whose family members were then at Seven Hills, a pediatric nursing facility in Groton. The court approved the agreement on June 16, 2008. See Rolland v. Patrick, 562F.Supp.2d 176 (D.Mass. 2008). In doing so, the court concluded that the agreement “will enhance services to class members as well as significantly increase the number of community settings where the needs of many of them could be better served.” Id. At 179.*


As described by both Plaintiffs and Defendants, the implementation of the Second Settlement Agreement has been characterized by significant collaboration. Plaintiffs have agreed that Defendants’ Final Report demonstrates substantial compliance with the final two requirements set out in the Second Agreement for dismissal of this action. Over 640 individuals have been transitioned from nursing facilities to community homes and the Court Monitor’s recommendations for active treatment have been substantially achieved. At the time of dismissal of the suit, there were only 135 class members residing in 48 nursing facilities, down from over 1600 individuals in 300 nursing facilities at the beginning of the litigation, with many others coming and going in the interim. Moreover, active treatment is accorded to a larger percentage of individuals in nursing facilities, particularly at the three remaining pediatric facilities.


The celebration of this success, as reflected in the presentations at the May 8, 2013 hearing, is tempered by the fact that, as described, much work remains to be done. But the time had come for Defendants to regain autonomy in the provision of critical services to this vulnerable population. Given their substantial compliance with the Second Settlement Agreement and pursuant to its terms, Defendants had earned that respect and, as a result, the right to meet their ongoing obligations to class members without judicial supervision.

Rolland Active Treatment Review

The Website of the Court Monitor

Rolland v. Patrick   98-30208-KPN