COCO Background

OLMSTEAD BACKGROUND INFORMATION

What is Olmstead and why should you care?

In 1999, the United States Supreme Court, in a case called "Olmstead v. L.C.," ruled that unnecessary segregation of people with disabilities in institutions is a form of discrimination in violation of the Americans with Disabilities Act (ADA), which requires that people with disabilities receive services in the most integrated setting possible.

What Did the Supreme Court Say?

The Court found that unjustified isolation in institutions is discrimination because institutional placement of persons with disabilities who can handle and benefit from community settings "perpetuates unwarranted assumptions" and "severely diminishes the everyday life activities of individuals." In other words: "no one should have to live in an institution or a nursing home if they can live in the community with the right support." (January 14, 2000 letter from HCFA to the states.)

Whom Does Olmstead Affect?

The ADA and the Olmstead decision apply to people with all disabilities, including seniors, living in, or at risk of being placed in, all kinds of public and private institutions.

What Does Olmstead Require?

The Olmstead decision requires that people with disabilities receive services in community settings rather than institutions when:

the person prefers or does not oppose community services;

professionals determine that community services could be appropriately provided; and

community placement or services could be reasonably accommodated.

How many Californians reside in institutions or are at risk of institutionalization?

California houses more people with disabilities, including seniors, in institutions than any other state. There are 160,000 nursing home beds, with approximately 95,000 occupied daily. Additionally, 10,000 Californians are confined in state hospitals for people with developmental or psychiatric disabilities and other large public or private institutions. Californians at risk of institutionalization may include people receiving in home supportive services whose services are inadequate, people who are homeless and people who do not qualify for existing community-based programs.

What is an Olmstead Plan? Why do we need one?
What the federal government has told the states (January 14, 2000 letter from HCFA):

1. States are obliged to "make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity."

2. "A State can demonstrate compliance with its ADA obligations by showing that it has a comprehensive, effectively working plan for placing qualified persons with disabilities in less restrictive settings, and a waiting list that moves at a reasonable pace not controlled by the State's endeavors to keep its institutions fully populated."

3. "We strongly urge States to increase access to community-based services for individuals with disabilities by developing comprehensive, effectively working plans for ensuring compliance with the ADA."

What the state legislature has told the state (Budget Trailer Bill Language)

"The California Health and Human Services Agency (CHHS Agency) shall develop a comprehensive plan describing the actions which California can take to improve its long term care system so that its residents have available an array of community care options that allow them to avoid unnecessary institutionalization. The plan shall respond to the decision of the United State Supreme Court in Olmstead v. L.C., 527 U.S. 581 (1999) and shall embody the six principles for an "Olmstead Plan" as articulated by the federal Center for Medicaid and Medicare Services (the Health Care Financing Administration at the time the principles were first articulated).

These principles include

a comprehensive, effectively working plan;
a plan development and implementation process that provides for the involvement of consumers and other stakeholders;
the development of assessment procedures and practices that prevent or correct current and future unjustified institutionalization of persons with disabilities;
an assessment of the current availability of community-integrated services, the identification of gaps in service availability, and the evaluation of changes that could be made to enable consumers to be served in the most integrated setting possible;
inclusion in the plan of practices by which consumers are afforded the opportunity to make informed choices among the services available to them; and
elements in the plan that provide for oversight of the assessment and placement process in order to help ensure that services are provided in the most integrated setting appropriate, and to help ensure that the quality of the services meets the needs of the consumers. The plan is due to the Legislature by no later than April 1, 2003."

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