As we wait for one historic Supreme Court decision, it’s right to remember another. Thirteen years ago today, the Supreme Court announced its decision in Olmstead v. L.C and E.W. Aside from the Department of Health and Human Services, the blogosphere didn’t lavish much love on Olmstead today. That’s too bad, because this was among the most important cases for persons living with disabilities in American history.
At stake in Olmstead was whether the Americans with Disabilities Act required states to provide services in the most integrated setting appropriate to the needs of disabled individuals. A lower court ruled that ADA required this. Georgia appealed to the Supreme Court, arguing that such a requirement would lead to the closing of state hospitals and would otherwise prove disruptive. Writing for a 6-3 majority, Justice Ruth Bader Ginsberg concluded:
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 transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.
In affirming the right to community services, Olmstead spurred both state and federal provision of home- and community-based services for children and adults living with diverse disabilities. The decision clearly stated that unjustified institutionalization of people with disabilities constitutes discrimination and violates the ADA. It thus ratified and accelerated the welcome shift to care provided on a human scale—in the family home, or in small-group settings. Without cases such as Olmstead, I’m convinced that my own brother-in-law would be stuck in the back ward of a forbidding institution someplace.
The number of people with intellectual and developmental disabilities living in large state institutions declined by almost 85 percent between 1965 and 2009. Of course it wasn’t only Olmstead, but the decision rendered the shift irreversible. More important, it required state Medicaid and social service programs to provide the resources needed to make community-based care actually work.
The number of children and youth in residing in large public institutions has declined by about 98 percent over the past 30 years. In 1977, the average number of persons per residential setting was 22.5. The average today is about 2.5.
Many people regard deinstitutionalization as a disaster. It sometimes was, when institutions for severely mentally ill patients were closed without the provision of required supports and services. Deinstitutionalization of the intellectually and physically disabled has proceeded more effectively and humanely.
Olmstead was essential in this process. I shudder to consider how the current court would have ruled in the same case.
[Cross-posted at The Incidental Economist]