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Speaker's Notes - Real Choices for Iowa
Presentation for General Audiences

[Plain text file]

Slide 1: [Graphic: Image of river at dawn
Text from Ezekial, "Let justice roll down like waters, and righteousness like a mighty stream

What is Olmstead really about? It's about FREEDOM.

Slide 2: [Graphic: Universally-designed house]

Freedom to choose where you live.

Slide 3: [Graphic: Elderly mother walking and talking with son]

Freedom to be near your family and friends.

Slide 4: [Graphic: Man and woman working with printing press]

Freedom to have a job.

Slide 5: [Graphic: Young man and woman in conversation at table]

Freedom to participate in the life of your community.

Slide 6: [Graphic: Judge's gavel]

Talking Point 1: What is the Olmstead Decision?

The Olmstead Decision was handed down by the U.S. Supreme Court in June 1999 to answer this question:

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Does the Americans with Disabilities Act (ADA) require states to provide treatment in the community for people with disabilities?

NOTES: The Olmstead case began with two women who have mental retardation and mental health conditions.

Both were living in a Georgia state psychiatric hospital, and wanted to move into the community.

Their treatment teams agreed they could be served in the community, but no placements were available. A lawsuit was filed on their behalf against Georgia's Department of Human Resources.

It went all the way to the Supreme Court, and resulted in the ruling now known as the Olmstead Decision.

This ruling made it clear that the unnecessary segregation of individuals with disabilities violates a federal law, the Americans with Disabilities Act.

The ADA protects individuals from discrimination on the basis of a disability. It requires states to administer their programs, services, and activities "in the most integrated setting appropriate to the needs of qualified individuals with disabilities."

Discrimination can occur when:

* People with disabilities can't get needed services unless they live in an institution

* A state's disability services don't offer real choices to consumers In other words, people with disabilities have the right to services provided in the most integrated setting appropriate to their needs. Community placement must be an option when:

* Treatment professionals determine it is appropriate * The person wants to leave the institution * The placement can be accommodated, considering state resources and the needs of other people with disabilities

Slide 8: [Graphic: Photo collage of older woman and son, man with lead dog, and father with daughter in hammock]

Talking Point 2: In Olmstead, the Supreme Court answered: No one should have to live in an institution or a nursing home if they can live in their own community with the right supports.

NOTES: It is the responsibility of each state to take steps to make community living options available.

The key question they must consider is: What is the most integrated setting appropriate to the needs of each individual?

Olmstead protects the rights of people with physical and mental disabilities, as well as the rights of people who are elderly.

It mandates that states must make reasonable accommodations in programs and services, taking into consideration:

* Cost

* Available resources

* How the needs of all people with disabilities will be met

Olmstead does not:

* Allow a state to keep institutions at full capacity by denying community placements

* Require the complete redesign of a state's service system

* Mandate the downsizing or closing of institutions

* Require a state to invest unlimited resources to make community living an option

* Require people with disabilities to move from institutions to community settings:

- If they don't want to

- Before services and supports are in place in the community

Slide 9: [Graphic: Photo of President Bush at podium]

Talking Point 3: In 2001, President George Bush issued Executive Order 1327: Community-based Alternatives for Individuals with Disabilities.

NOTES: In this executive order, the President says: "The United States is committed to community-based alternatives for individuals with disabilities, and recognizes that such services advance the best interests of the United States."

The President directs key federal agencies to ensure compliance with the Olmstead Decision by evaluating and revising their policies, programs, statutes, and regulations.

In 2002, the federal Centers for Medicare and Medicaid Services (CMS) called upon all states, including Iowa, to:

* To develop "effectively working plans" to move people from institutions to community-based services

* To ensure that people on waiting lists to leave institutions for community-based services move to these services at a reasonable pace.

To help states implement Olmstead, Medicaid has given them more flexibility in:

* Determining benefits

* Adjusting income guidelines CMS also awarded millions of dollars in new grants to states to be used to:

- Move individuals from nursing homes into the community

- Improve personal assistance services (PAS)

- Create ongoing support systems to promote community participation for people with disabilities

Slide 10: [Graphic: Photo of Governor Vilsack]

Talking Point 4: In Iowa, Governor Vilsack named the Department of Human services as Iowa's lead agency to respond to Olmstead. The governor called on DHS to:

* Report on Iowa's current service system

* Develop an "effectively working plan" for implementing Olmstead in Iowa NOTES: DHS responded by:

- Providing a report on Iowa's current disability-related service system

- Holding 20 statewide public meetings to gather input to use in creating an "effectively working plan" for Iowa

- Convening a steering committee to draft the plan * Opening the draft plan to statewide comment

In 2001, the Iowa Plan for Community Development was presented to Governor Vilsack, who approved it.

DHS received a federal Real Choices Systems Change grant to fund the activities of that plan, and contracted with the Center for Disabilities and Development for help with implementing the grant.

The steering committee became Iowa's Olmstead Real Choices Consumer Task Force. Its members include:

* People with disabilities

* Family members

* Advocates

* State agency representatives

* Service providers

* Other stakeholders

The mission of the task force is to:

* Remove institutional biases and barriers in Iowa's service system

* Prevent institutionalization

* Provide Iowans who have disabilities with real choices about:

-Where they will live

-What services they will use

Slide 11: [Graphic: Map of Iowa]

Talking Point 5: In 2003, Governor Vilsack issued Executive Order 27. It calls on Iowa's state agencies to:

* Move purposefully to swiftly implement the Olmstead Decision

* Coordinate a comprehensive effort to "reshape the structure and nature of community-based services" to reshape the structure and nature of community-based services."

NOTES: The governor's executive order also calls on Iowa agencies to:

* Develop plans for effective, efficient use of agency resources to support ADA goals

* Identify agency-specific institutional biases and barriers to community living in Iowa, and prioritize how they will be addressed Institutional biases and related barriers are identified in:

- Delivering on the Promise, the federal report to the President

- The Iowa Plan for Community Development, the DHS report to the Governor

- The evolving systems redesign recommendations of the Mental Health/ Mental Retardation/Developmental Disabilities/Brain Injury (MH/MR/DD/BI) Commission, for both the children's and the adult service systems.

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Talking Point 6: Implementing Olmstead in Iowa will involve removing BIASES and BARRIERS, such as:

* Policies and programs that have an institutional bias

* Regulations that prevent the use of natural supports

* Funding of programs, rather than people

* Eligibility criteria that keep people dependent

* Iowa's complex and confusing service system

NOTES

Example - Policies and programs that have an institutional bias: Funding from programs like Medicaid, Medicare, and Social Security usually supports institutions rather than community-based services.

* In Iowa, 76% of Medicaid long-term care funding goes to institutions and nursing home, and only 24% goes to community-based programs.

* Current federal Medicaid law makes availability of nursing home services mandatory for people who are eligible; community-based services are optional. E

Example - Natural supports:

* 64% of direct care is currently provided by families, friends, neighbors, and other informal caregivers.

* 95% of elderly persons who need help with daily living have family members involved in their care.

Example - Funding programs, not people:

* People are "slotted into" existing programs. They often cannot choose services to help them accomplish their own goals.

Example - Eligibility criteria that keep people dependent by restricting people from:

* Saving money for such things as a rental deposit, furniture, the purchase of a home

* Earning enough to be self-supporting without jeopardizing health care or other essential benefits

Example - Iowa's complex and confusing service system:

* No core services available in every county

* No coordinated service system: 99 counties, 99 systems

* Poor communication among local, state, and federal service programs

*Lack of personal assistance, transportation, housing

* Lack of personal assistance services

* Lack of transportation services, which prevents people from having access to services

* Lack of affordable, accessible housing.

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Talking Point 7: Olmstead Real Choices Consumer Task Force priorities for Iowa

* Reduction of institutional bias

* Self-directed, person-centered services

* Federal funding for accessible housing

* Funding of personal assistance services

* Availability of clear, accurate service information

NOTES: What is the "Olmstead Real Choices Consumer Task Force"?

The task force grew out of the steering committee convened by DHS to gather input and then draft a plan to guide the implementation of Olmstead in Iowa.

In 2001, this steering committee presented its Iowa Plan for Community Development to the Governor.

When Iowa received a federal grant implement this plan, the steering committee became the Olmstead Real Choices Consumer Task Force.

It includes people with disabilities, family members, advocates, and representatives of:

* Conner Center for Independent Living

* Iowa Association for Home Care

* Iowa Association of Community Providers

* Iowa Department of Corrections

* Iowa Department of Elder Affairs

* Iowa Department of Human Rights

* Iowa Department of Human Services

* Iowa Department of Public Health

* Iowa Governor's DD Council

* Iowa Protection & Advocacy, Inc.

* Iowa Statewide Independent Living Council

* National Association for the Mentally Ill, Iowa Chapter

* South Central Iowa Center for Independent Living

* Woodward Resource Center

Task force members are currently working closely with state agencies and other key stakeholders to implement Olmstead in Iowa.

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Talking Point 8: It's up to us to make Olmstead a reality in Iowa.

Here's how: Learn about the Olmstead Decision and the Americans with Disabilities Act.

An "Olmstead Resources" sheet and other handouts are available upon request.

Explain how Olmstead upholds basic American freedoms when you talk with your friends, neighbors, community members, legislators.

Work with them to implement Olmstead in your neighborhood, community, and state.

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Olmstead in a nutshell?

No one should have to live in an institution or a nursing home if they can live in their own community with the right supports.

Not you.

Not your friend with disabilities.

Not your elderly parent.

Not your medically fragile child.

No one.

Slide 16: [Graphic: River at dawn with verse from Ezekial]

Talking Point 9: Together, we can use Olmstead to make Iowa a better place - for all of us.

NOTES: You will find more information about the Olmstead in Iowa on the handouts you have received.

If you have questions, please ask them now, or talk with me after the presentation!

Slide 17: [Graphic: River at dawn]

To learn more, Visit our web site:

Olmstead - Real Choices for Iowa olmsteadrealchoicesia. org