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P&A deinstitutionalization suits 'appropriate,' says GAO

Nov. 25, 2003 -- State agencies which file lawsuits intended to get individuals out of institutions have been operating appropriately and within their legal mandate, says a GAO study released in late October.

Protection and Advocacy agencies in all 50 states are mandated by federal law to provide legal representation, information and referral services, training and technical assistance to individuals with developmental disabilities. The agencies have initiated a number of "de-institutionalization" lawsuits, in wake of the 1999 Olmstead Supreme Court decision, to force states to provide funding for individuals in the community rather than in institutions.

"Deinstitutionalization has refocused delivery of care to this population over the last several decades from large public institutions to community settings," says the GAO report. "Refocusing service delivery resulted from (1) the desire to deliver care in the most integrated setting and to control costs and (2) the outcomes of deinstitutionalization lawsuits brought by P&As and others.

"Some parents have raised concerns that P&As emphasize these suits over other activities, inadequately inform them of family members' inclusion in the suits, and do not adequately monitor individuals after their transfer to the community.

"GAO was asked to review the extent to which P&As engage in lawsuits related to deinstitutionalization of these individuals, how P&As communicate with affected parents and guardians in these suits, and the role P&As have played in monitoring the well-being of individuals transferred to the community."

GAO found that that P&As had "filed, joined, or intervened in" only 24 deinsitutionalization suits nationwide from 1975 through 2002. It reviewed suits in California, Maryland, and Pennsylvania and found the agencies' activities in keeping with the law and their mandate.

"Lawsuits related to deinstitutionalization brought on behalf of persons with developmental disabilities are a small part of P&As' overall activities for this population," said the report.

Read the complete study online at





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.
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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