People with disabilities did not always live in institutions. In the mid 1800's, some of the first services for people with disabilities were in school settings. But in the late 19th century, the medical model view of the time forced institutionalized care. Little changed for almost 100 years and only recently have we come full circle in our view of how best to serve and support our citizens with disabilities.
In the 1990's, supporters of people with disabilities helped to create a movement to relocate people with disabilities and the elderly, out of institutionalized care and into residences in the community. Hawai`i led the way in making these changes. The state officially closed its institutions for people with developmental disabilities in the year 2000.
"Deinstitutionalization" means to remove from an institution or to enable someone to live away from an institution. Although transferring people from institutions into community settings has created new opportunities for people with disabilities, it has also become clear that a change of address is not enough for someone to become part of a community. Fortunately, communities have adapted quickly and have responded to the needs of their new neighbors.
There are more services in the community for those with disabilities and the elderly. More and more community businesses are reaching out to meet their needs and they are now able to participate more fully in everyday life activities.
Community-based living services support individuals by encouraging them to interact with their community. Services range from offering neighborhood classes to providing personal shopping or driving assistance. More intensive services are also offered. These may include providing a personal attendant or finding a special daytime program.
Executive Order Community-based Alternatives for Individuals with Disabilities
The White House issued an Executive Order on June 19, 2001. It stated that whenever appropriate, communities must place qualified individuals in community settings.
CMS and Related Laws and Regulations
The Centers on Medicare & Medicaid Services (CMS) lists rules on serving persons with disabilities. Medicaid provides states with billions of dollars to help people with disabilities obtain long-term care services.
Medicaid Reform Information Page
The Association of University Centers on Disabilities (AUCD) sponsors this website to help its members and the public learn about new proposals to change (reform) Medicaid.
Deinstitutionalization of Persons with Developmental Disabilities: A Technical Assistance Report for Legislators
The National Conference on State Legislatures (NCSL) provides this report on the effort to move people out of institutions and into the community.
The Freedom Clearinghouse is a nonprofit organization dedicated to recruiting and organizing advocates willing to work towards eliminating institutionalized living. Their website includes stories and resources focused on keeping people out of institutional facilities.
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In 1999, the U.S. Supreme Court concluded that under Title II of the American Disabilities Act (ADA), all states are required to place persons with mental disabilities in community settings rather than in institutions when:
The state's treatment professionals have determined that community placement is appropriate.
The affected individual does not oppose transfer from institutional care to a less restrictive setting.
Placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others with mental disabilities.
The implications of this decision are far reaching and states have been encouraged to develop plans for implementing this decision. They must also report on how this will impact their unique needs and circumstances.
On this site you will find the complete text of the Olmstead decision.
Assuring Access to Community Living for the Disabled
The Centers for Medicare & Medicaid Services (CMS) address how the Olmstead decision affects Medicaid funding and services.
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