Slide 1:
WebEd: Professional Development &
ADA National Network Legal Webinar Series
March 21, 2012
2:00pm ET/1:00pmCT/12:00pmMT/11:00amPT
The content and materials of this session are the property of RESNA, Great Lakes and Southwest ADA Centers and the presenters and cannot be used and/or distributed without permission.  For permission to use training content or obtain copies of materials used as part of this program please contact adaconferences@adagreatlakes.org 
Telephone Option:  712-432-3066 Access Code: 148937 (not a toll free #)     

Slide 2:
Review of the Webinar Platform Features
Closed captioning – click CC icon (menu bar at the top of your screen) and adjust the captioning box as needed (keyboard – Ctrl F8 to open/Ctrl W to close)
Customize your view – choose “View” from the menu bar at the top of the screen and choose the layout you prefer from the dropdown menu.
Submitting questions via webinar platform –Type comments and questions in the Chat Area.  (keyboard – Ctrl M)
Emotions/hand-raising:  Please do not use these features during this session unless directed to do so.

Slide 3: 
Olmstead Planning:
 Litigation, Collaboration, and Improving Community Services
C. Talley Wells
770-817-7527
ctwells@atlantalegalaid.org 

Slide 4:
Learning Outcomes:
1.  The participant will state when an individual receiving state funded disability services has a right to receive such services in the most integrated setting.
2.  The participant will briefly describe what an Olmstead Plan is.
3.  The participant will identify three examples of quality community supports that resulted from the Olmstead decision.
4.  The participant will identify three examples of assistive technology that could be used to provide quality community supports for people returning to an integrated community setting.

Slide 5:
Olmstead v. L.C. (1999)
2 women (Lois and Elaine) in and out of Georgia Regional Hospital (psychiatric institution) over 30 time each.
Most important civil rights court decision for people with disabilities.  Often called the Brown v. Board for people with disabilities
Qualified Right to Live in Community

Slide 6:
Olmstead based on Americans with Disabilities Act
(1990)
Congressional Findings of Historical Discrimination and Segregation of People with Disabilities
Applies to Qualified Individuals with a Disabilities 
Broadly, it prohibits discrimination and requires reasonable accommodations and reasonable modifications in many situations

Slide 7: 
Title II of ADA
Covers Public Entities (state and local governments, agencies of government)
No Refusal to Provide Services Due to Disability
Must provide services in most integrated setting appropriate to needs 
Requires Reasonable Accommodation but not a Fundamental Alteration

Slide 8:
What is the ADA 'Integration Regulation?' 
(a)	A federal regulation from the United States Justice Department that requires public entities to administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.
(b)	A federal regulation that requires schools to teach students in the least restrictive environment.
(c)  	It is another term for the Olmstead decision.
(d)	A requirement in the Americans with Disabilities Act that no children should receive disability services in an institution.
(e)	All of the above

Slide 9:
Answer
A federal regulation from the United States Justice Department that requires public entities to administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.  28 CFR 35.130(d) (2011).  

Slide 10:
Supreme Court’s Olmstead test
1.	When Treatment Professionals determine that Community Placement is Appropriate.
2.	When individual does not oppose move to community.
3.           When placement is reasonable accommodation when balanced with the needs of others with similar disabilities.

Slide 11:
Olmstead:  Fundamental Alteration
“Sensibly construed, the fundamental-alteration [defense]. . . would allow the State to show that, in the allocation of available resources, immediate relief for the plaintiffs would be inequitable . . .”
“If, for example, the State were to demonstrate that it had a comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings, and a waiting list that moved at a reasonable pace …. 
Slide 12:
 Fundamental Alteration Defense
Budgetary constraints alone do not create a fundamental alteration defense. Pennsylvania P&A (3rd Cir. 2005)
Or put another way…
Bad economic times for a state alone does not create a fundamental alteration defense.  Fisher (10th Cir. 2003).
Also. ..  Burden of fundamental alteration on state.  Benjamin (M.D.Pa. 2010).

Slide 13:
Olmstead Plan
Term comes from fundamental alteration discussion in Olmstead
No universal meaning
At a minimum, (1) comprehensive, (2) effective, (3) working plan (4) with waiting lists moving at a reasonable pace for all of its individuals with disabilities 

Slide 14:
Olmstead Plan
Frederick  I  (3rd Cir. 2004)  plan must be communicated in some manner and a “commitment to action in a manner for which [state] can be held accountable by the courts.”
Frederick  II  (3rd Cir. 2005)
A “vague assurance” not enough.
at a bare minimum should specify the time-frame for discharge, # to be discharged, and general description of community coordination/services necessary.

Slide 15:
To Whom Does Olmstead Apply?
Individuals in institutions and nursing facilities.
Those at risk of institutionalization (don’t have to be in institution)   Fisher (10th Cir. 2003)
Individuals in state funded large institution-like group homes DAI (S.D.N.Y. Sept. 2009) (currently on appeal)

Slide 16: 
To Whom Does Olmstead Apply?
State may have obligation to assess individuals in institutions to see who is eligible for community supports.  Messier (D. Conn. 2008).

Slide 17:
 An Example:  
Georgia’s Olmstead Planning
Multiple attempts at plans, but still no state adopted Olmstead Plan.
Planning process from 2009 through 2012 has brought all interested parties to the table (including advocates, self-advocates, state department for mental health/developmental disabilities, Governor’s office, budget planners, and providers).
Parts of Georgia’s draft (unadopted) plan were used in Georgia/Department of Justice Olmstead Settlement in October 2010.

Slide 18:
Talley’s Essential Elements of a Good Olmstead Plan
Strong Leadership of Planning Committee.
Quality data and comprehensive understanding of need.
Commitment from state leaders, providers, advocacy community.
Everyone at the table (including housing departments/authorities, providers, advocates/self-advocates, Medicaid agency, other departments).
Expert knowledge of supports needed for population.

Slide 19:
Talley’s Essential Elements of a Good Olmstead Plan
Budget expertise to create budgets/costs.
Specialists on maximizing funding from HUD, Medicaid/Medicare, and state funds.
Commitment to Integration.
Ambitious/realistic plan with attainable goals, measurable outcomes, a quality improvement mechanism, and real consequences if goals not achieved.

Slide 20:
Concrete Tools for Implementing Olmstead 
Increased Housing (Section 8, state funded housing, Section 811 etc.)
Medicaid Waivers
Quality Mental Health Supports through Medicaid and State Funded.
Peer Support
Money Follows the Person and Other Bridge Funding
Supported employment/customizable employment
Assistive Technology

Slide 21:
Examples of Assistive Technology to Support Olmstead Integration
Environmental controls
Home modifications
Health sensors for medical conditions
Any assistive technology necessary to ensure or to support an individual to be able to live in the community rather than in an institution

Slide 22:
Question:  Select the three assistive technologies that would be most appropriate to assist someone to return to an integrated community setting funded directly by the MFP. 
A. 	Home modifications to increase accessibility
B.	Personal emergency response device
C.	Communication devices for use in a skilled facility or hospital
D.	Home video monitoring support system
E.	Bladder catheter supplies

Slide 23:
Answer (A, B, D)
A. 	Home modifications to increase accessibility
B.	Personal emergency response device
C.	Communication devices for use in a skilled facility or hospital – (Not in the community)
D.	Home video monitoring support system
E.	Bladder catheter supplies (not assistive technology)

Slide 24:
Future of Olmstead
Department of Justice is requiring states to implement.
More and more tools from federal government, including Money Follows the Person, Balancing the Incentives, HUD/HHS collaborations.
Continue to need to change perspectives/biases.
We must celebrate successes/stories to ensure continued buy in.
Increased Peer Support and Involvement.

Slide 25:
Challenges Going Forward
Managed Care: While financial incentives sometimes encourage community, there is also incentive to not serve or not adequately serve highest needs.
Medicaid Waivers still allowed to have waiting lists under federal law, but this may contradict Olmstead.
Not consensus on what certain populations need/want.

Slide 26:
Challenges Going Forward
Systems lack funds.
Lack of Quality Providers.
Lack of Sufficient Professional Training.
Lack of inclusion of people with disabilities in decision making, planning, providing.

Slide 27:
Final Thought
Olmstead is a modern civil rights movement that is transforming America for people with disabilities.  It is giving thousands of Americans new opportunities to live meaningful lives in our community.  While it is a difficult journey forward, it is one of the most important transformations happening in our country and in our local communities today.

Slide 28:
Questions/Discussion

Slide 29:
Thank you for participating in today’s session
This session was recorded and the archived recording will be made available.  A follow up email will be sent to you with additional information to access the archive