PowerPoint Presentation: Introducing Olmstead to Agency Audiences Slide 1 [Graphic: Older mother walking and talking with son] Introducing Olmstead What is the Olmstead Decision about? It's about freedom. Slide 2 [Graphic: Universally designed home] Freedom to choose where you live. Slide 3 [Graphic: Father with toddler in hammock] Freedom to be near your family and friends. Slide 4 [Graphic: Man and woman working together] Freedom to have a job. Slide 5 [Graphic: Young man and young woman socializing] Freedom to take part in the life of your community. Slide 6 What is the "Olmstead Decision"? Slide 7 It is a US Supreme Court Decision that says the unnecessary segregation of people with disabilities is illegal discrimination. NOTES [The extra information in these "notes" is optional - use as appropriate.] "Olmstead" is a legal decision, handed down by the US Supreme Court in 1999. It takes its name from the lead defendant, Commissioner Olmstead of the Georgia Department of Human Resources. Two women who have developmental and mental health disabilities filed the case after spending years in a Georgia state psychiatric hospital, even though treatment professionals said they could be better served in the community. The Atlanta Legal Aid Society filed the lawsuit in their names in 1995. It argued that federal law - the Americans With Disabilities Act (ADA) - makes it illegal to require people with disabilities to get services in an institution if they can be appropriately served in a more integrated, community-based setting. Information on where to find the Olmstead Decision and related materials is available on the "Olmstead Resources" sheet. Slide 8 It is discrimination when: * You can only get services in an institution. * You don't have real choices about services. * You can't get services in the most integrated setting that meets your needs. NOTES How would you feel if you were told that after you retire, you could only get your Social Security check if you lived in a nursing home? If you were told what you could spend it on, whom you could hire, when and how you would get services you need? Sorry, but: * You can't live in the same town as your family * You can't do your laundry until a week from tomorrow * You can't choose where you will get health care, or what it will be * You can only hire certain people to mow your grass, and mowing is only available as part of a total landscaping package, so it will cost you $95 an hour... (never mind that your nephew would do it for $10 and a ride to the mall). Slide 9 What do they mean? Discrimination? Institutional bias? Unnecessary segregation? We don't do any of that! Slide 10 Discrimination? Our baby with hemophilia needs medicine that costs $9,000 a month. How can we pay for that? To get help, we'd have to quit our jobs and meet poverty guidelines, or give custody of him to the state. Then the state would pay for the medicine our baby needs to survive. NOTES The Disability Rights Commission of the US Department of Justice defines discrimination as unjustified, less favorable treatment for a reason relating to disability, or a failure to make reasonable adjustments. In this example from real life, the parents are both employed, and have insurance. Their co-pay, however, is 20%, or $1,800 a month. They simply can't afford the $21,600 each year -- their yearly copay -- for the medication their child has to have to survive. Children may not be eligible for financial assistance unless they meet the disability criteria for the Mental Retardation, Ill and Handicapped, or Brain Injury waiver. A child with a chronic medical condition (like hemophilia, asthma, or a heart condition) that does not result in developmental delay often will not qualify for Medicaid waiver services. Then Medicaid eligibility would be dependent on parental income; parents would have to quit their jobs and meet 150% of federal poverty guidelines to get Medicaid assistance. Or the family's inability to provide essential medical care could be declared "denial of critical care"; that is, child neglect or abuse. The state or county would become the child's guardian, the child can be institutionalized, and thus eligible for financial assistance through Medicaid. Slide 11 Institutional bias? After my pneumonia, I wanted to go home... but I need help with bathing and with my medicines, and I can only get it in a nursing home. NOTES Institutional bias - Policy and practices that result in the placement of people, voluntarily or involuntarily, in institutions. The definition of " institution" varies; one commonly accepted meaning, from the US Centers for Medicare and Medicaid Services, is "an establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor." Iowa institutions include: * State Resource Centers at Glenwood and Woodward * Mental Health Institutes at Clarinda, Cherokee, Independence, and Mount Pleasant * Other facilities, such as County care facilities Halfway houses Group homes Intermediate care facilities Juvenile reform schools Nursing homes Psychiatric hospitals Residential care facilities Skilled care facilities Slide 12 Unnecessary segregation? I want to be in my hometown near my family, but I can't get the services I need unless I move into a group home 30 miles from here. NOTES Unnecessary segregation occurs when you require an older person or a person with disabilities to be institutionalized in order to get essential services when service needs and requirements could be met in a less restrictive, more appropriate setting. Slide 13 [Graphic: Man with lead dog] The Supreme Court ruled that you have a right to services in the community when: Slide 14 1. Treatment professionals say it's appropriate. 2. You want to be served in the community. 3. You can be served in the community without overburdening state resources or keeping others from getting the services they need. NOTES If professionals say community services can meet your needs, and if you want (or don't object to) getting services in the community, you should have this choice. The US District Court that has jurisdiction over Iowa has ruled that tight budgets do not justify delayed Olmstead implementation. Slide 15 [Graphic: Hand of an elderly person grasping the curving head of a cane] 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 supports. NOTES The Olmstead Decision, as interpreted by the courts, protects the rights of people of all ages who have mental or physical disabilities, including people who are elderly. Home and community-based services are provided in a person's own home or community. People who are elderly or have disabilities use these services to be as independent as possible. Some examples: * Adult day care * Children at Home services * Community Mental Health Center services * Community Supervised Apartment Living Arrangement (CSALA) services * Education services provided by Area Education Agencies * Elder Family Homes services for assisted living * Homemaker/home health aides * In-Home Health Program care * Mayor's Youth Corps services * Meals on Wheels * Personal assistance services (PAS) * Services provided by Area Agencies on Aging Slide 16 [Graphic: Photographs of President Bush and Governor Vilsack] Olmstead implementation has bipartisan support, through the New Freedom Initiative of President Bush and, in Iowa, through Governor Vilsack's Executive Order 27. NOTES You will find information on the New Freedom Initiative and Executive Order 27 on the "Olmstead Resources" handout. Slide 17 [Graphic: Map of Iowa] Iowa's Executive Order 27 directs 19 key state agencies to implement Olmstead in their services and programs: Slide 18 * Administrative Services * Department for the Blind * Civil Rights Commission * Corrections * Economic Development * Education * Elder Affairs * Finance Authority * Human Rights * Human Services * Inspections and Appeals * Management * Public Health * Public Safety * Regents * Transportation * Veterans Affairs * Veterans Homes * Workforce Development Slide 19 The Olmstead plans of our state agencies address: * Communications * Policies * Training * Services and programs * Funding NOTES Updates on agency Olmstead activities are available on the Olmstead Real Choices web site. I'll give you that URL at the end of this presentation. Slide 20 [Graphic: Group of young men and women in business suits walking down hallway] Communications Our agency is reviewing how it communicates internally, among agency staff, divisions, and departments. Slide 21 [Graphic: Computer screen and keyboard] ... and externally, among: * staff from other agencies and organizations * consumers * family members * community members NOTES Does our agency offer information in accessible formats, such as: Audiotape Braille Closed-captioned video Large print, Braille On disk ... and share information, internally and externally, via accessible: E-mail Sign language TTY/TDD Web pages Slide 22 [Graphic: Capitol Dome in Washington] Policy Our agency is reviewing its policies to be sure they comply with federal laws: * Americans with Disabilities Act, and the Olmstead Decision that interprets it * Section 508, Rehabilitation Act NOTES Information resources on these key federal laws are included on the "Olmstead Resources" handout. Slide 23 [Graphic: Capitol Dome in Washington] ...and federal policies: * New Freedom Initiative * US Centers for Medicare and Medicaid Services (CMS) letters to state Medicaid directors NOTES More information about these federal policies is also included in the "Olmstead Resources" handout. Slide 24 [Graphic: Map of Iowa] Closer to home, our policies need to respond to * Governor Vilsack's Executive Order 27 * Iowa's Olmstead Plan for Community Development * The evolving system redesign recommendations being developed by the MH/MR/DD/BI Commission NOTES Executive Order 27 - In early 2003, Governor Vilsack issued Executive Order 27, which calls for key state agencies to "...swiftly implement the Olmstead decision" by coordinating a "comprehensive effort to reshape community-based services." The Iowa Plan for Community Development - The Iowa Department of Human Services (DHS) was named by the governor as the lead agency in developing this plan, which: * Describes Iowa's existing disabilities service system * Identifies issues surrounding the development of community services * Provides information about current initiatives, service gaps, and unserved/underserved populations MH/MR/DD/BI [Mental Health/Mental Retardation/Developmental Disabilities/Brain Injury] Commission System Redesign Recommendations - Recommendations for the improvement of Iowa's disability service systems for children's and for adults, to: * Improve access to services * Fund core services to more people statewide * Equalize county funding obligations * Increase community capacity for home and community-based services The "Olmstead Resources" handout includes information on these three Iowa initiatives. Slide 25 Policies, procedures, and administrative rules should: * Eliminate institutional bias * Commit equal resources to community services * Focus on self-direction, using person-centered planning and individualized budgeting NOTES Institutional bias exists when policy and practices result in the placement of people, voluntarily or involuntarily, in institutions because funding is only, or primarily, available to services provided in institutional settings. Self-direction operates when planning is person-centered, rather than program-centered. The person who has disabilities or is elderly provides information, sets his or her own goals, and decides: * What services to use to reach these goals * Whether to spend funding on services or other items, such as home modifications * When and where to get services * Who to hire to provide these services * Whether to pay their workers themselves or to have a "fiscal intermediary" Slide 26 [Graphic: Man and woman in business suits sitting and talking] Training Our agency needs to look at how we: * Orient new staff to Olmstead * Keep current staff up to date on Olmstead NOTES You can find many Olmstead Decision resources on the Olmstead Real Choices web site. I'll give you that URL at the end of this presentation. Slide 27 [Graphic: Man and woman working together] Do agency and community-based staff know how to: * ...work with people with disabilities? * ...support self-direction and person-centered planning? Slide 28 [Graphic: Young parents with toddler] Olmstead says people must have real choices about services: What services they use; who they get services from; when, where, and how they access them. That is, they practice self-direction. Slide 29 [Graphic: Hand holding several dollar bills] Funding Iowa Executive Order 27 calls on state agencies to "make optimal use of federal funding opportunities." This will often require us to make Olmstead-related changes in Iowa policies, procedures, and rules. Slide 30 Do our agency's policies, procedures, rules, and regulations reduce federal funding opportunities by: * Requiring unnecessary segregation? * Creating or fostering institutional bias? * Restricting home and community-based services? Unnecessary segregation - Requiring older people or people with disabilities to be institutionalized in order to get essential services. Institutional bias in funding practices is common in Iowa. For example, more than 3 of every 4 dollars (76%) of Medicaid long-term care funding goes to institutions. Fewer than 1 of every 4 dollars (24%) goes to home and community-based services. Slide 31 Are you thinking: This is somebody else's problem... I don't have the time to tackle this... I'm too busy to deal with Olmstead... Slide 32 The ADA, which the Olmstead Decision interprets, has been called the "most important civil rights law since the Civil Rights Act of 1964." It's not going to go away. NOTES In the Olmstead Decision, the US Supreme Court ruled that discrimination on the basis of disability is illegal. A state must make services in the community available when: * A person wants (or is not opposed) to this * Professionals say community-based services can meet the person's needs * Providing such services can be done in light of state resources and meeting the needs of others who have disabilities. Slide 33 What can you do? 1. View issues from an Olmstead perspective. 2. Target problem areas. 3. Talk with your colleagues and supervisors; become an agent for change. NOTES The Olmstead perspective: No one should have to live in an institution when they can live in the community with the right supports. Problem areas: These often exist because policy, rules, or regulations: * Require specific types of authorized providers * Limit the number of hours or units per service * Use specific lists of supports and don't fund or support any that are not on the list For example: A client of yours, who currently gets services in an institution, wants to be at home. Regulations say a specific agency must provide home nursing care. That agency charges $95 an hour. This costs more than care in the institution. It is more than the county can afford. But your client's sister is an RN. She would gladly provide this health care for much less. What regulations need to change so your client can tap this natural support? How can you advocate for this change? Natural supports are friends, neighbors, relatives, coworkers, and others who help someone who is elderly or has a disability to live more independently in the community. Slide 34 Olmstead in a nutshell? No one should have to live in an institution or a nursing home when they can live in the community with the right supports. Slide 35 [Graphic: Photos of man with lead dog, elderly hand with cane, and man and daughter in hammock] No one. Not your client. Not your aging parent. Not your medically fragile child. No one. Slide 36 For more information visit our web site Olmstead - Real Choices for Iowa olmsteadrealchoicesia.org NOTES You can find this web address on the "Olmstead Resources" sheet, along with links to other resources related to Olmstead in Iowa. If you have questions, please talk to me today, or contact me at [Your phone number] [Your e-mail address]