Nov 18, 2010

Olmstead Decision (1999)

Harvard JCHS article on Aging in Place (2001) mentions an Olmstead Supreme Court ruling in 1999 that applies the ADA to mental illness. According to wikipedia:
  • The case rose to the level of the Supreme Court which decided the case in 1999. A major aspect of the Americans with Disabilities Act (ADA) in determining that mental illness is a form of disability and therefore covered under the ADA. Title II of the ADA applies to 'public entities' and include 'state and local governments' and 'any department, agency or special purpose district' and protects any 'qualified person with a disability' from exclusion from participation in or denied the benefits of services, programs, or activities of a public entity.
  • The Supreme Court decided mental illness is a form of disability and that institutional isolation of a person with a disability is a form of discrimination under Title II of the ADA. Institutionalization perpetuates unwarranted assumptions about people with disabilities and their ability to participate in community life. Institutionalization can also severely diminish the quality of life of persons with mental illness by severing connections to family and other social contacts as well as limiting economic independence. In addition the court decided that the state must transfer the plaintiffs to a community based treatment center. Title II requires that public entities make 'reasonable accommodations' to avoid discrimination on the basis of disability unless those modifications would entail a 'fundamental alteration' of the entities services, program or activity. However, there was an integration mandate that states must develop comprehensive plans to end unnecessary institutionalization at a 'reasonable pace' with the goal of integrating individuals with disabilities into mainstream society to the fullest extent possible.
Status of state of Georgia - as of 2009, still has not complied with ruling. 
  • http://www.ajc.com/opinion/georgia-stalls-as-disabled-158253.html
  • Interestingly, this article points out that institutionalized care is costing Georgia more money than community based care and that community support services are more flexible and have much better outcomes.
  • Considering increasing rates of dementia and alzheimer's, i wonder if the Olmstead Ruling will mandate federal and state funding of community based care for seniors (ie. federal funds to support retrofits to homes to support aging-in-place)
  • More importantly, will the effort be proactive and preventative (ie Fall Prevention programs implemented at home can reduce long-term costs)
  • This reinforces JCHS Aging in Place article's main point of integrating Housing and Health care to do more with less resources.