According to Separate But Equal, the Olmstead decision envisioned that “states will provide appropriate Long Term Services and Supports (LTSS) to individuals with disabilities through Home and Community Based Services (HCBS) and end forced segregation in institutions.”
Some key findings in the report include the following:
Providing services for people with disabilities outside an institutional setting is more cost-effective than providing care in an institution. Thirty-eight studies published from 2005 to 2012 found that providing HCBS is less costly than providing institutional care.
Although a number of states reported a substantial increase in the number of people receiving HCBS, this did not produce a significant decline in the number of people in the state living in institutions. For example, one state enrolled more than 5,000 people in HCBS between 2008-2012, but the number of people living in institutions declined by less than 100.
Nationwide, the proportion of nursing home residents younger than 65 increased from 12.9 percent in 2005 to 14.2 percent in 2009. According to federal data, people under 65 now make up 16 percent of the nursing home population.
Many states Olmstead implementation efforts have not included meeting specific benchmarks designed to transition people with all types of disabilities out of institutions and into the most integrated setting in the community in a manner that is cost effective.
The report contains eleven recommendations calling for amendments to both the ADA and the Medicaid statutes, increased ADA enforcement by the U.S. Department of Justice, federal Olmstead reporting requirements, and increased collaboration across federal agencies, including the U.S. Department of Health and Human Services, the U.S. Department of Housing and Urban Development, and the U.S. Department of Justice.