| Olmstead
-- Real Choices for Iowa
Talking Points, text only
Talking Point #1In
1999, the U. S. Supreme Court handed down the Olmstead Decision to answer
this question:
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
Talking Point #2
The Olmstead Decision
says:
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 mandates that states must make reasonable accommodations
in programs and services, taking into consideration:
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
Talking Point
#3
In 2001, President
George Bush issued Executive Order 1327:
Community-Based Alternatives for Individuals with Disabilities.
It 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.
NOTES
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 states:
- 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
Talking Point #4
In 2000, Governor
Vilsack named the Iowa Department of Human Services (DHS) as Iowa’s
lead agency for responding to Olmstead. He called upon 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:
- Address
institutional biases and barriers that shape our service
system
- Prevent institutionalization
- Provide
Iowans with disabilities real choices about:
- Where they will live
- What services they
will use
Talking Point #5
In 2003,
Governor Vilsack issued Executive Order 27, calling upon 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”
Develop plans for effective,
efficient use of their resources in support of ADA goals
- Identify and prioritize institutional biases and barriers
to community living in Iowa
NOTES
These 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
Talking Point #6
Implementing Olmstead by removing BARRIERS and BIASES in Iowa
Iowa biases and barriers
- Policies and programs that
have an institutional bias
- Regulations that prevent
the use of natural supports
- Funding goes to programs,
not people
- Eligibility rules that limit
income and assets in ways that keeps people dependent
NOTES and examples
- 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 homes
- Only 24% goes to
community-based programs.
- Regulations that prevent
the use of natural supports
Even though:
- 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
- Funding goes to programs,
not people
People are “slotted into” existing programs. They often cannot choose
services to help them accomplish their own goals.
- Eligibility rules that
limit income and assets in ways that keeps people dependent
People cannot:
- Save money for such
things as a rental deposit, the purchase of a home
- Earn enough to be self-supporting
without jeopardizing health care or other key benefits
BARRIERS to implementing
Olmstead in Iowa:
- No core services
available in every county
- No coordinated service
system: 99 counties, 99 systems
- Poor communication
about services
- No personal assistance
services in Iowa Medicaid Plan
- Little accessible transportation
- Lack of transition and
job training services
- Fragmented, confusing, segregated
employment services
- Lack of accessible housing
Talking Point #7
Olmstead Real
Choices Consumer Task Force priorities for Iowa:
- Funding follows the person
- Federal funding for accessible
housing
- Reduction of institutional
bias
- Funding of personal assistance
services (PAS)
- Transition services for
students
- Statewide crisis and intervention
services
- Availability of clear,
accurate information about services and supports
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.
- Explain how Olmstead
upholds basic American freedoms when you talk with your:
- Family
- Neighbors
- Community
- Legislators
Work with them
to implement Olmstead
- In your neighborhood
- In your community
- In your state
Talking Point #9
Olmstead means real choices
for Iowa.
Together, we can use Olmstead
to make Iowa a better place – for all of us.
[Graphic of river at dawn,
with text: Let justice flow down like waters, and righteousness like a
mighty stream. (Amos 5:24)] |
