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Enforcing the Olmstead decision

"No person should have to live in a nursing home or other institution . . . unnecessary institutionalization of individuals with disabilities is discrimination under the Americans with Disabilities Act," said Clinton Sec. of Health and Human Services Donna Shalala. "If I were disabled I would want this choice -- and so would you."

In a Jan. 14, 2000 letter to U. S. governors, HHS Sec. Donna Shalala pointed out that states were responsible for obeying the June 22, 1999 Olmstead Supreme Court decision, mandating "that services be provided to people in the "most integrated setting" in keeping with the Americans with Disabilities Act's integration mandate.

A letter to state Medicaid directors from HCFA outlined a "framework" to get states to comply with the Supreme Court decision. States now must have "a comprehensive, effectively working plan" for people to get services "in less restrictive settings." If the state has a waiting list, it must move "at a reasonable pace not controlled by the State's endeavors to keep its institutions fully populated."

From Donna Shalala's speech to The National Conference of State Legislators, July 28, 1999:
In June, the Supreme Court issued an important decision in a case that's familiar to many of you: the Olmstead case. The Court ruled that when a professional determines that a disabled individual can live in the community -- and can be served there effectively -- the person must be given the choice of doing so. If I were disabled I would want this choice -- and so would you.

In our view, the Court issued a very balanced and thoughtful decision in this case. Yes, the Court said, if community-based alternatives exist, then we are discriminating if a person who can benefit from community care -- and who wants to live in the community -- is institutionalized.

At the same time, the Court said we must acknowledge that states have limited resources. The Court's decision doesn't require any state to incur excessive new costs. it does, however, require states to move at a reasonable pace to provide community-based alternatives. And the Court also said states can meet their obligations by having comprehensive plans.

We support this. The Olmstead decision defines our mission: To build better systems of supports enabling people with disabilities to live life to the fullest. That's the job we need to do -- and I think we ought to welcome it.

As we move to implement the Olmstead decision, there are three basic principles that all of us can agree on, now.

  • We can agree that no American should have to live in a nursing home or state institution if that individual can live in a community with the right mix of affordable supports.
  • We can agree that we all have the right to interact with family and friends in our make a living...and to make a life.
  • And we can agree that it will take time, effort, creativity and commitment from all of us to make this a reality.

    Over the past years, my department has initiated a lot of activities to help transition people out of nursing homes and other institutions. We've focused on expanding and promoting home and community-based services. We've offered support and technical assistance to states. And we've used the flexibility of the Medicaid program to pursue our goals. In just the last year, we've developed legislative proposals and funded state grants to move people out of nursing homes.

    The Olmstead decision proves that we've been moving in the right direction. Now it's up to all of us to work together to implement the ruling as quickly as possible. To that end, we're ready to meet with you and others to discuss ways to work together to carry out the Olmstead decision. And that includes discussing the technical assistance we can provide. . . .

    . . . Keep in mind that Olmstead furthers our ultimate goal: a nation that integrates people with disabilities into the social mainstream, promotes equality of opportunity, and maximizes individual choice."

    Read Shalala's letter.

    Read the HCFA letter






    The following sites contain information that may be of interest. Please bear in mind that the information at these sites is not controlled by the Center for An Accessible society. Links to these sites do not imply that the Center supports either the organizations or the views presented.
    The Independent Living Research Utilization Olmstead project provides disabiliity advocacy training on the Olmstead decision; their website offers resources.

    Freedom Clearinghouse, a grassroots website designed to help disability activists enforce the Olmstead decision in states

    Consumer Choice and Control:
    Personal Attendant Services and Supports in
    Report of the National Blue Ribbon Panel on
    Personal Assistance Services, August, 1999

    Directory of Publicly Funded Personal Assistance Programs from the World Institute on Disability

    "Understanding Medicaid Home and Community-Based Services: A Primer" -- from the U.S. Dept. of Health and Human Services, available at

    Information on Home & Community-Based, Consumer-Directed, and Personal Assistance Services from the Office of Disability, Aging and Long-Term Care Policy at the U.S. Dept of Health and Human Services


    How States' "Nurse Practice" Acts work against consumer direction -- from the January, 1999 Ragged Edge magazine






    Expert sources

    Nursing home data

    Abuse of seniors under-reported, says study

    The Institutional Bias of Public Policy

    Consumer Direction in Personal Assistance

    Study Validates Consumer Control's Superiority

    In-Home Services and Safety

    In-home services: Implementing the Olmstead decision

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