Serving People with Disabilities in the Most Integrated Setting: Community Living and Olmstead

Serving People with Disabilities in the Most Integrated Setting: Community Living and Olmstead

The U.S. Supreme Court’s 1999 landmark decision in Olmstead v. L.C. (Olmstead) found the unjustified segregation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act (ADA).  The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) plays a pivotal role in supporting the Olmstead decision and promoting community living through our vigorous enforcement of the Americans with Disabilities Act and other key civil rights laws.

OCR investigates complaints alleging a violation of the ADA's "integration mandate," which requires that individuals with disabilities receive services in the most integrated setting appropriate to their needs.  This principle is central to the Supreme Court's Olmstead decision. The Court held that states are required to provide community-based services for people with disabilities who would otherwise be entitled to institutional services when: (a) such placement is appropriate; (b) the affected person does not oppose such treatment; and (c) the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of other individuals with disabilities.

OCR's response to Olmstead complaints has had a significant impact in facilitating the community integration of individuals with disabilities. OCR has received complaints filed by or on behalf of a wide range of individuals, including individuals with different types of disabilities, and people of all ages. As a result of OCR's efforts, many individuals have transitioned from an institution to the community, and many individuals have avoided unnecessary institutionalization.  For example:

• Individuals who had been institutionalized for decades are now receiving services in their community.
• Individuals who lost their housing and/or community-based supportive services when they were forced to enter institutions due to an acute health care problem have had the needed services provided or restored.
• Individuals with disabilities are able to access home and community-based services through Medicaid "Waiver" programs.
• Increased hours of personal care and assistance are being provided to individuals who require additional services to remain in the community.
• Individuals with disabilities now have greater control over their community-based care and services.
• Individuals’ needs are met by providing reasonable accommodations in their communities, and not by moving to a more restrictive setting.

Recent OCR Olmstead Enforcement Success Stories

• OCR has conducted enforcement activities resulting in positive change for individuals needing community services to live in the least restrictive environment. Notably, the October 19, 2010 settlement agreement signed by the Department of Justice, OCR and the State of Georgia will ensure that thousands of people with developmental disabilities and individuals with mental illness receive community services instead of institutional care. Read about this Settlement Agreement and other Olmstead Enforcement Success Stories.

Key OCR Olmstead Efforts

• In December 2014, the Office for Civil Rights in the U.S. Department of Health and Human Services and the Civil Rights Division in the U.S. Department of Justice have issued a joint Dear Colleague letter about compliance with the integration mandate of Title II of the Americans with Disabilities Act (ADA) and the 1999 Supreme Court decision in Olmstead v. L.C when states implement the 2013 Home Care Rule under the Fair Labor Standards Act.  Because home care workers, such as personal care assistants and home health aides, often provide essential services that enable people with disabilities to live in their own homes and communities instead of in institutions, the letter encourages states to conduct a thorough analysis of all their home care programs to determine whether any changes must be made to comply with the ADA integration mandate once the Home Care Rule becomes effective on January 1, 2015. Use the link to read the letter.
• President Obama launched the "Year of Community Living," on June 22, 2009, in commemoration of the 10th Anniversary of the Supreme Court’s landmark decision in Olmstead.  “The Year of Community Living” reaffirms the Administration’s commitment to “vigorous enforcement of the civil rights for Americans with Disabilities and to ensuring the fullest inclusion of all people in the life of our nation.” HHS plays a key role in carrying out the President’s directive.  Among other activities, HHS works in collaboration with the Department of Housing and Urban Development to identify ways to improve access to housing, community supports and independent living arrangements.
• The HHS Coordinating Council was created, led by the Office on Disability.  The Office for Civil Rights is a member of the Coordinating Council, along with the Administration for Children and Families, Administration on Aging, the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, the Office of the Assistant Secretary for Planning and Evaluation, the Office of Public Health and Science, and the Substance Abuse and Mental Health Services Administration. These agencies are tasked with aggressively addressing the barriers that prevent some individuals with disabilities from enjoying a meaningful life in their community. 
• The Office for Civil Rights partners with the Department of Justice to promote “vigorous enforcement of the Americans with Disabilities Act and the Olmstead decision and to maximize the effectiveness of federal leadership in promoting civil rights and setting forth the Administration’s position in the federal courts.”
   

(Revised on 6/19/2014)