Olmstead Ppt


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This is from a presentation by Mark Mark Matulef Trial Attorney U.S. Department of Housing and Urban Development 415 7th Street, SW, Room 10264 Washington, DC 20410 in New Orleans in the summer 2010

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Olmstead Ppt

  1. 1. <ul><li>“ [W]e confront the question whether the proscription of discrimination may require placement of persons with mental disabilities in community settings rather than in institutions.” </li></ul><ul><li>“ The answer … is a qualified yes.” </li></ul>
  2. 2. <ul><li>“ A public entity shall administer services, programs and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” </li></ul>
  3. 3. <ul><li>“ A public entity shall make reasonable accommodations in policies, practices and procedures … </li></ul><ul><li>unless … making the modifications would fundamentally alter the service, program or activity.” </li></ul>
  4. 4. <ul><li>Two women, Lois Curtis and Elaine Wilson , who were institutionalized at Georgia Regional Hospital … </li></ul><ul><li>sued Tommy Olmstead , the Commissioner of the Georgia Department of Human Resources </li></ul>
  5. 5. <ul><li>Ruled for Ms. Wilson & Ms. Curtis </li></ul><ul><li>Found that Georgia “could provide services to [Ms. Wilson & Ms. Curtis] in the community at considerably less cost than is required to institutionalize them.” </li></ul>
  6. 6. <ul><li>Sent the case back to the trial judge on cost of community care </li></ul><ul><li>Asked “whether the additional expenditures … would be unreasonable given the demands of the State’s mental health budget. ” </li></ul>
  7. 7. <ul><li>“ First, institutional placement of persons who can handle or benefit from community settings … perpetuates unwarranted assumptions … that persons so isolated are incapable or unworthy of participating in community life.” </li></ul>
  8. 8. <ul><li>“ Second, confinement in an institution severely diminishes the everyday life activities of individuals, including: </li></ul><ul><ul><ul><li>Family relations, </li></ul></ul></ul><ul><ul><ul><li>Social contacts, </li></ul></ul></ul><ul><ul><ul><li>Work options, </li></ul></ul></ul><ul><ul><ul><li>Economic independence, </li></ul></ul></ul><ul><ul><ul><li>Educational advancement, and </li></ul></ul></ul><ul><ul><ul><li>Cultural enrichment.” </li></ul></ul></ul>
  9. 9. <ul><li>When “the State’s treatment professionals have determined that community placement is appropriate, </li></ul><ul><li>the transfer from the institution to a less restrictive setting is not opposed by the affected individual, </li></ul>
  10. 10. <ul><li>and the placement can be reasonably accommodated, taking into account </li></ul><ul><ul><li>the resources available to the State </li></ul></ul><ul><ul><li>and the needs of others with disabilities.” </li></ul></ul>
  11. 11. <ul><li>When the State, “generally rely[ing] on the reasonable assessments of its own professionals,” determines that habilitation needs can only be met in an institution. </li></ul>
  12. 12. <ul><li>When “in the allocation of available resources, immediate relief … would be inequitable , given the responsibility the state has undertaken for the care and treatment of a large and diverse population of persons with disabilities. </li></ul>
  13. 13. <ul><li>“ If the State were to demonstrate that it had </li></ul><ul><li>a comprehensive, effectively working plan for placing qualified individuals with disabilities in less restrictive settings, </li></ul><ul><li>and a waiting list that moved at a reasonable pace , not controlled by the State’s endeavors to keep its institutions fully populated, </li></ul><ul><li>the reasonable-modifications standard would be met.” </li></ul>
  14. 14. <ul><li>“ [T]he range of facilities the State maintains for the care and treatment of persons with diverse mental disabilities, </li></ul><ul><li>and its obligation to administer services with an even hand .” </li></ul>
  15. 15. <ul><li>“ Nor is it the ADA’s mission to drive State’s to move institutionalized patients into an inappropriate setting, such as a homeless shelter .” </li></ul>
  16. 16. <ul><li>“ We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings.” </li></ul>
  17. 17. <ul><li>“ Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it.” </li></ul>
  18. 18. Source: Centers for Medicare and Medicaid Services
  19. 19. <ul><li>Total Nursing Home Population in the United States: </li></ul><ul><li>~1.35 Million </li></ul><ul><li>SOURCE: CMS Minimum Data Set 2.0 (1 st Q 2010) </li></ul>
  20. 20. <ul><li>Medicaid: 54% (729,000) </li></ul><ul><li>Medicare: 25% (337,500) </li></ul><ul><li>VA: 1% (13,500) </li></ul><ul><li>Self/family: 13% (175,500) </li></ul><ul><li>Private insurance: 9% (121,500) </li></ul><ul><li>SOURCE: CMS MDS 2.0 </li></ul>
  21. 21. <ul><li>Total: $61 Billion </li></ul><ul><li>Total: $45 Billion </li></ul><ul><li>Institutional Spending: </li></ul><ul><li>Nursing Homes: </li></ul><ul><li>$49 Billion </li></ul><ul><li>ICF/MR (for persons with developmental disabilities): </li></ul><ul><li>$12 Billion </li></ul><ul><li>Community Spending: </li></ul><ul><li>Home and Community services (waivers, all disabilities): $30 Billion </li></ul><ul><li>Personal Care option: $11 Billion </li></ul><ul><li>Home Health: $4 Billion </li></ul>
  22. 22. <ul><li>Under 30: .5% (6,750) </li></ul><ul><li>31 to 64: 14% (189,000) </li></ul><ul><li>65 to 74: 14% (189,000) </li></ul><ul><li>75 to 84: 28% (378,000) </li></ul><ul><li>Over 85: 50% (675,000) </li></ul>
  23. 23. <ul><li>An acute care hospital: 61% </li></ul><ul><li>Another nursing home: 13% </li></ul><ul><li>A private home with no home health services: 10% </li></ul><ul><li>SOURCE: CMS MDS 2.0 (1 st Q 2010) </li></ul>
  24. 24. <ul><li>United States: 23% (310,500) </li></ul><ul><li>California: 27% (26,460) </li></ul><ul><li>Illinois: 25% (18,250) </li></ul><ul><li>Louisiana: 16% (4,000) </li></ul><ul><li>Michigan: 30% (11,700) </li></ul><ul><li>New York: 21% (22,260) </li></ul><ul><li>Oregon: 35% (2,555) </li></ul><ul><li>Texas: 20% (18,600) </li></ul><ul><li>Utah: 37% (1,872) </li></ul><ul><li>SOURCE: CMS MDS 2.0 (1 st Q 2010) </li></ul>
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