Good day, ladies and gentlemen, and welcome to the Implementing Olmstead Conference Call. At this time, participants are in a listen-only mode. Later we will conduct a question-and-answer session, and instructions will follow at that time. If anyone should require assistance, please press star then zero on your touchtone telephone. As a reminder, this conference call is being recorded. I would now like to introduce your host for this conference, Mr. Peter Berg. You may begin.
Thank you very much and welcome to eveybody joining us for the November Americans with Disabilities Act (ADA) Audio Conference session. The ADA Audio Conference is a project of the ADA National Network, which is funded by the U.S. Department of Education, National Institute on Disability and Rehabilitation Research. The ADA National Network is a leader in providing information and educational training programs, such as the ADA Audio Conference on the Americans with Disabilities Act. You can reach your regional ADA Center by visiting www.ADATA.org or by calling 800-949-4232. I want to welcome again everyone to the ADA Audio Conference. I just want to go through a few items before we turn it over to today''s speaker. We have slide 2, we have participants joining us via telephone and also participants joining us through the Blackboard webinar platform. For those of you using the webinar platform, you are able to modify your audio settings through the Audio Setup Wizard. If you are having any problems with your audio, you can adjust those. And of course, make sure that your volume is turned up. Next slide, slide 3, it is now possible to participate using the Blackboard app to connect with the ADA Audio Conference. Those are downloadable through your manufacturer''s store where you can download applications. There are limited accessibility features available at this time through the plaque Board app, so captioning is not supported through the app, as well as some limited accessibility for screen reader users, voiceover for the iPhone users if using the Blackboard app. The next slide, captioning is being provided in the webinar room for those needing captioning in order to access today''s webinar session. You can click on the captioning icon located in the webinar room. The captioning icon -- the captioning window can be moved, it can be made larger, font can be adjusted, as well as the transcript within the captioning area can be saved. Next slide, for submitting questions, when we get to the question-and-answer portion of today''s session for those of you on the telephone, we with will have Tamera, our operator come back and give instructions for you. For those in the webinar room, questions can be submitted in the chat area. You can click on the chat area or keystroke function control-M, and you can submit questions in there. While you will not be able to see your questions once they are submitted, they are viewable by the moderators of today''s session, so even though you can''t see your question, it has been submitted. Again, for -- next slide, for our users in the webinar room, you can adjust the view, so the white screen can be adjusted to fit your particular needs. And that could be resized, and you can choose the drop-down menu that''s located to the white -- I''m sorry -- to the left of the whiteboard. Next slide, slide 7. The other panels within the webinar room can also be adjusted. The three panels can be made larger, made smaller, they can be moved around to fit your particular needs. And finally, slide 8, for anyone needing any technical assistance during this session, for those in the webinar room, you can click on the participant list, and the participant list, you can see Great Lakes, double-click on that, and you can send a private message as well. Emails can also be sent to firstname.lastname@example.org, or you can give us a call at 877-232-1990 if you are having any technical difficulties with today''s session. Alright on to slide 9 and the introduction of today''s session and our speaker; We are pleased to be joined by Anne Raish, who is with the -- Deputy Chief with the Office of Civil Rights, Disability Rights Section, within the U.S. Department of Justice. Anne has a presentation today looking at the Olmstead enforcement by the Department of Justice, and following Anne''s presentation, there will be an opportunity for questions. So at this point, I will turn it over to you, Anne. Welcome.
Thank you, Peter. As Peter mentioned, I am one of the Deputy Chiefs in the Disability Rights Section here in the Civil Rights Division at the Justice Department, and most of my work substantively is spent on Olmstead enforcement. That''s the vast majority of what I work on here. And I am going to talk today about the Department''s Olmstead enforcement work over the last few years. I''m sort of going to break this into sections, starting with our enforcement work generally, and then go into talking about specific cases and matters that we''ve been working on. And within that, I''m going to split that into two parts. The first part will be about matters involving segregated residential services, so people who have been unnecessarily segregated in institutional settings; and then I am going to turn to segregated day programs, which has been a more recent part of our focus, and that addresses people who have been receiving segregated services in shelter workshops and other day programs. So Peter, I am going to start with the slide that starts Olmstead is a top priority. And the Olmstead decision, the Supreme Court decision in Olmstead came down in 1999, as many of you probably know. But for several years after that, there were still many people unnecessarily institutionalized. And so in 2009, the Department launched an aggressive effort to enforce the Olmstead decision and the integration mandate of Title II of the ADA which is what Olmstead was based on. As part of that, in June of 2009, President Obama issued a proclamation launching the Year of Community Living. And in that, he stated the Olmstead ruling articulated one of the most fundamental rights of Americans with disabilities: Having the choice to live independently. This initiative reaffirms my administration''s commitment to vigorous enforcement of civil rights for Americans with disabilities and to ensuring the fullest inclusion of all people in the life of our nation. So over the past several years, we have been involved in roughly 40 matters in 25 states, and I''ll go into some of that work in more detail in this presentation. If you could go to the next slide, Peter, that would be great. I am going to talk about the range of Department of Justice (DOJ) tools. There are a variety of ways in which we can become involved in Olmstead enforcement work. The first is through conducting our own investigations. Typically in response to a complaint filed with the Department, and then we typically issue findings letters, which are our conclusions at the end of the investigation that notify public entities, usually states, what our findings were and what we concluded with respect to the facts under the Americans with Disabilities Act. And those findings letters can lead to negotiations and settlement agreements or litigation if we''re unable to resolve the problems that we found in our investigation. And the second way that we can become involved in Olmstead litigation is through intervention in ongoing cases that were brought by individual plaintiffs or class plaintiffs or advocacy organizations. And we, as a Department, can intervene -- seek to intervene just like any other entity with an interest in ongoing litigation. The third way we''ve gotten involved in Olmstead enforcement is through our statement of interest work, which is similar to what''s called Amicus work in other contexts, so statements of interest are legal briefs that we can file in cases -- the Department can file it in any case in which it has an interest in any area of law. And we''ve been using that tool in Olmstead to weigh in on issues involving, you know, dispute over the interpretation of Olmstead or Title II of the ADA, and so we will oftentimes provide the Department''s view on how the legal issues should be viewed. And because we are the agency that promulgates the regulations under the Americans with Disabilities Act, we are often given some deference in our view on how to interpret those principles. Then the fourth way we have done work in this area is through issuing some technical assistance. We put together a technical assistance piece on addressing the legal requirements of Olmstead to inform public entities of their responsibilities under the integration mandate and to inform individuals of their rights under Olmstead and the integration mandate. And then finally, everything -- everything I talk about today and everything I just talked about is available on our website, ADA.gov, and on there, that website has a huge amount of the disability rights work of the Disability Rights Section, but within that is a page devoted to -- pages devoted to our Olmstead work. And on there are all our findings letters, settlement agreements, complaints, and all our statements of interest that we''ve filed. And beyond that, there are also -- for cases where we reached a settlement agreement and now we''re implementing the settlement agreement, there are -- the monitor''s ongoing reports are typically posted there. And then also just some personal stories of people who have been affected by the work, so people who have moved from segregated settings to the community. Some of them agreed to be featured on our website, so please, hopefully you will use that as a resource, and it''s a -- we work hard to keep it updated, so I''m hoping it''s a good source of information. Before I go on to the next slide, I wanted to talk a little bit about who does this work in the Civil Rights Division. There are two primary sections here in the Civil Rights Division that do this Olmstead enforcement work, and one is disability rights, where I am, and the other is a special litigation section, which traditionally did a lot of work around conditions in state-operated institutional settings. And that work was done, you know, and continued to be done -- continues to be done very active under the Civil Rights of Institutionalized Persons Act. And so they look not only at those issues, but also whether -- whether, you know, people in those institutions actually need to be there in the first place. So when I go through this presentation today, I am going to mention cases that the Disability Rights Section has worked on and others that the Special Litigation Section has worked on. Their work tends to be more linked to state-operated facilities, but that''s not always the case. We both do systemic and individual, DRS does systemic and individual cases, but we work very closely with Special Litigation. And then, of course, we have a separate appellate section in the Civil Rights Division that would handle any appellate work that comes through the components work. So there''s a lot of us here in the Civil Rights Division doing this work and working closely together, and you know, a lot of the work also overlaps with what CMS is doing and Housing and Urban Development (HUD) and so there''s been a good amount of interagency collaboration on issues relating to Olmstead and how to implement Olmstead enforcement. So now I am going to turn to segregated residential service settings and Peter, if you could go to the slide that has the title U.S. v. New York. That''s where I''m going to start off. I am going to talk about settlement agreements first. We have reached a number of settlement agreements in the last few years in our Olmstead work. The U.S. v. New York case is a recent one, although it''s a very old litigation that was started in 2003. In July of this year, we reached a global settlement with the State of New York and private individuals who initially filed the case in 2003. And the case was initially brought by the New York Protection and Advocacy entity alleging that New York violates the ADA and Olmstead by relying on institutional what are called adult homes to provide services to adults with mental illness. And this was -- this is one where, you know, I mentioned state-operated facilities and private facilities, and you know, the Olmstead case itself dealt with two individuals in a state-operated facility, but Olmstead equally applies to situations where a state or public entity administers their services in a manner that segregates people in private facilities and the U.S. v. New York case is an example of that. So the initial case went all the way through to trial in 2009, and the plaintiff prevailed at trial. It was tried in the federal court in Brooklyn, New York, and that court after trial ordered the state to transition everybody with mental illness in the adult homes at issue who wanted -- who were not opposed to moving to the community and who could move to the community. And the State appealed, so the case went up to the 2nd Circuit Court of Appeals, who ultimately vacated the decision based on standing. So it didn''t alter the substantive findings, the merit findings by the trial court, but it vacated the decision because the Court found the P&A did not have legal standing to bring the suit on behalf of the residents in the adult homes. And so the Department of Justice got involved in that case after the trial and before the appeal, and everybody went back to the table after the second circuit opinion and ultimately reached a global settlement this summer. The agreement will have to be approved by the court, and so there will be a fairness hearing, and that''s been scheduled for January 9 in Brooklyn. And you know, during that process, residents will have an opportunity to come and speak about the agreement. And the question for the Court there will be whether the settlement agreement is fair and reasonable. But if approved, the agreement provides and will provide relief to roughly 4,000 individuals who mental illness in 23 large adult homes in New York City. So these facilities were -- had at least 120 beds and what the state calls a mental health census of 25% or more with disabilities. Many of these facilities were 100% persons with psychiatric disabilities. And that was because for years, the state was using them as a place to discharge people from psychiatric hospitals. If you go to the next slide, Peter, actually, it''s the next U.S. v. New York slide --
Can I get you just to pause for one second. I want to bring the operator, if you could -- we are not having any troubles on the telephone, but Tamara, if you could increase the volume or work on Anne''s volume on her phone, they are having some problems with our webinar connection, so if you could adjust that, I would appreciate that. And Anne, I will let you then go ahead and continue.
Should I wait a second?
No, we can continue on.
Okay. And some people tell me I talk too fast, so let me know. I did live in New York for a while, so -- (Laughter) -- just let me know if I should slow down.
And then just go ahead. So you are on which slide again?
It''s the second U.S. v. New York slide.
Okay. That''s going to be slide 16, then, to orient folks. That''s slide 16.
Yes. So the State, under this agreement, will provide at least 2,000 supported housing units, and supported housing is an integrated setting. They are scattered apartments throughout New York City, where people will live and have all the rights of a tenant, like anybody would. And get the supports they need, not as a condition of tenancy, but supports provided for them so they can be successful in the community. So at least 2,000 and potentially more than 4,000 individuals will transition to supported housing in New York. Then if you go to the next slide, Peter. This is the last U.S. v. New York slide. The agreement will also ensure that individuals receive the services they need to support them in supported housing, and those services include assertive community treatment, mental health clinic services, personal care services if needed, home health services, care coordination, and crisis services. And the agreement also provides a very robust person-centered planning process to make sure persons get a lot of information about their housing choices, and you know all the supports they need for a successful transition. The agreement is going to be monitored by an independent reviewer. The reviewer in that case is an expert in this area. His name is Clarence Sundrom, and he has a lot of experience implementing Olmstead agreements. Even though that case, the fairness hearing has not yet occurred, the parties are doing outreach to the residents and working with the State to lay the groundwork. So now I am going to move on to the U.S. v. Virginia settlement agreement. That''s on the next slide. And this is actually a case that was done by our special litigation section. And this case involves the unnecessary institutionalization of adults and some children with intellectual disabilities and developmental disabilities in facilities in Virginia, and that agreement was reached in early 2012 and then approved by the Court in August of 2012. So that agreement reforms almost the entire system for people with intellectual disabilities and developmental disabilities in Virginia and provides relief to more than 5,000 people. Under the agreement, the State is going to be creating home and community services waivers for people transitioning out of intermediate care facilities and people transitioning from nursing homes and people with urgent needs on the wait list. So I think in total there will be 4200 waivers. The reason the agreement and several of our other agreements apply to people who may already be in the community is that, as many of you may know, Olmstead applies to persons who are at risk of unnecessary institutionalization, and there, there were folks in the community who were having a very hard time getting by and were going to have to turn to institutional care to get the services they need. The agreement also created a family support program for people on the wait list, a full range of community-based crisis services, including a crisis hotline, mobile crisis teams, and crisis stabilization programs, expanded case management. There are also provisions around supported employment. So the State''s going to be developing an employment-first policy and expanding supported employment and integrated day opportunities. And then the agreement also provides for subsidies for integrated housing; and finally, also, expanding the quality management system to ensure that community-based services are compliant with the agreement and of good quality to ensure people''s success in the community. Both in New York and Virginia, settlement agreements are on our website that I mentioned. I believe under the U.S.-Virginia agreement, there''s already a report by the reviewer in that case who has been reporting on the state''s progress, but basically, to date, more than 200 people have transitioned successfully from institutional placements to the community. More than -- I am trying to just do the math here, roughly 455 waiver slots have been created to date. More than a hundred individuals are being served in the family support program, and the State''s been continuing to implement its newly developed crisis system. The State Has also enhanced its peer support program, and more than 20 peer mentors have been trained. And the State has also developed a housing subsidy program that I mentioned. So that''s a pilot program that''s going to use $800,000 in one-time funds to support up to 20 individuals in northern Virginia in independent apartments for up to a three-year period. So I am going to move on to the North Carolina agreement, which is the next slide. And this case is very similar to the New York case in that it addresses North Carolina''s use of privately owned and operated adult care homes to provide services to adults with serious mental illness, and this case came about through an investigation that the Disability Rights Section did in response to a complaint that was filed with our office in 2011 and -- I apologize -- 2010. And the Department did an investigation and issued a findings letter, concluding that the State was violating the ADA and Olmstead by unnecessarily institutionalizing people with mental illness in adult homes who wanted to and could be served in their own housing. So we spent about a year negotiating with the state and ultimately reached a settlement agreement in the summer of 2012. And that settlement will provide community-based housing and services to at least 3,000 people with mental illness in or at risk of entry to an adult care home. The services under that agreement will include supported housing, assertive community treatment, supported employment, transition supports, and enhanced quality management system, and enhanced crisis service system. So we are entering the second year of implementation. The State has moved, under the agreement, over 100 people have moved to supported housing. And more than 30 ACT teams are operating according to fidelity models and surveying more than 3,000 individuals. The department has regular meetings and calls with the state and also the reviewer who is overseeing compliance with the agreement, and the reviewer in that case is Mary Lou Sutters, who is a former mental health commissioner in Massachusetts and so that is an eight-year agreement. So it''s relatively early on, but the State is making good progress and the Department is regularly monitoring the agreement. When we enter into agreements, we don''t just go away after the agreement is signed. We spend a lot of time working with the states and consumers and providers to work together to ensure that implementation is successful. So it''s typically a several-year process. I am going to move on to the, the Steward v. Perry case, which is a case based in Texas. That''s on the next slide, and it''s another case out of our special litigation section, and that case addresses persons with intellectual and developmental disabilities in nursing homes in Texas, so we reached an interim agreement with the State, while a more comprehensive agreement is being negotiated. In the meantime, there is an interim agreement, and under that, Texas is expanding its community-based alternatives for persons with intellectual disabilities and developmental disabilities in nursing homes in Texas. So as part of that, there''s going to be a new PASRR program, which is a screening program reviewing all Texas nursing facilities to identify which of them have a developmental disability and should be diverted from nursing home placement; So all those individuals will have Service Planning Teams and Service Coordinators. All people who are diverted from nursing facilities. And the state has agreed to provide community support, 635 waivers in this current legislative biennium, and then an array of medical nursing and nutritional management supports and services, as well as integrated day employment, recreational and other activities. I apologize, Peter, I just jumped to the next slide, the second slide on the Steward v. Perry case. In addition to community supports, there''s going to be diverging efforts which entail identifying individuals at risk of entering nursing facilities, educating people about community alternatives, and coordinators who will identify and arrange community services for individuals diverted. I am going to move on to the next slide and just touch briefly on two other cases in the special litigation section that are being implemented. The first one is the U.S. v. Georgia, which was settled in 2010. So that''s been under way for a few years, and that is actually a larger case than some other because it deals with both the State''s mental health service system and its service system for people with intellectual disabilities and developmental disabilities. And so there will be community-based services for at least a thousand people in the state-operated developmental disability facilities and on the wait list for services, and at least 9,000 people in or at risk of entering the state psychiatric hospital. So the relief under the developmental disability system part includes waivers and family supports, crisis services, and case management, and then under the mental health system side it includes crisis services, assertive community treatment, case management, including intensive case management teams, and supported employment services. So under that agreement, over a thousand individuals are being served by assertive community treatment teams. Many people have moved to the community. The crisis, there is -- the crisis system is in development. There are several case management teams, and there''s been supported housing vouchers provided to more than a thousand individuals. Separately, the Delaware agreement, which is another agreement entered into by our special litigation section, that case addressed the state''s use of overreliance on psychiatric hospitals to provide services to people with mental illness, and that agreement will provide community services for at least 3,000 people in or at risk of entering a state psychiatric hospital and provides an array of community-based services, including supported community treatment, crisis services, supported housing, and supported employment. And similar to the other agreements, you know, the State -- Delaware is in substantial compliance with the benchmarks of the agreement. Many people are now living successfully in the community. Some of these people you can -- are among those I mentioned are on our website and have told their personal stories. So you know, all these agreements I''ve mentioned are several-year agreements, so we have seen a lot of progress and hopefully more progress to come. So you know, if you''d like more detail, there''s a lot more detail on our website, including the monitor''s reports, which if you have a lot of time on your hand, those reports tend to have a lot of detail about the progress of implementation, so they''re great sources of information. So I am going to turn to the next section and the next slide, so Peter, I think if you skip two slides ahead to the slide that has the title U.S. v. Florida. I''m going to talk a little bit about -- I''ve been talking about settlement agreements, and I am going to turn to our ongoing litigation addressing segregated service settings. We don''t always reach agreement. The United States v. Florida is a case the Disability Rights Section filed this past summer, and it addresses the unnecessary institutionalization of children with significant medical needs in nursing facilities in Florida. This case arose out of an investigation, a complaint that our office received and an investigation that we did into Florida''s service system for children with significant medical needs. And the Department issued a findings letter in September of 2012 concluding that the State violates the ADA and Olmstead by relying on nursing homes to provide services to children with significant medical needs. It was filed as a related case to a pending proposed class action that has many similar allegations. That''s Florida is violating the ADA by failing to provide medically necessary services to children with significant medical needs in the most integrated setting appropriate. And just to summarize some of the allegations there, there are almost 200 children in nursing homes in Florida, and many others in the community are unnecessarily -- are at risk of institutionalization as a result of several issues, including unreasonably denying medically necessary home-based services and failing to ensure sufficient capacity in waiver programs that can meet their needs in the community. And that complaint is also on our website, and there''s much more detail than I''ve just gone through. But that case, as I mentioned, was filed in July and is currently ongoing. So the parties are currently in discovery, and you know, one of the down sides of litigation is it can take some time so that, I think, will be ongoing for several months to come. 41:52 - The next slide is another ongoing case that was filed by the special litigation section, U.S. v. New Hampshire, and that case addresses the State''s reliance on the state psychiatric hospital and state-run nursing facility for people with serious mental illness. And so that case also seeks relief for people with -- adults with mental illness who are unnecessarily institutionalized, and that case is also ongoing. 42:34 - If you go to the next slide, Peter, I am going to talk a little bit about our statements of interest work. And as I mentioned earlier, you know, we do active work in looking at cases around the country and looking to see whether it makes sense for us to weigh in on an issue, a legal issue, involving Olmstead. And so to date we''ve -- since 2009, we''ve filed more than 35 statements of interest in Olmstead cases. These can -- have covered a variety of issues, including state policies that have put people at risk of unnecessary institutionalization. We''ve weighed in on issues relating to Olmstead plans. We''ve weighed in on issues relating to class certification in the Olmstead context. And we''ve filed in support of both plaintiffs and states, and an example of where we''ve weighed in where there''s an issue involving the state is more recently there''s been litigation around institutional closures. So states that are intending to or in the process of closing state-operated institutions and have been sued by families of people in those institutions, claiming that the ADA and Olmstead create a right to remain in the institution and prevent its closure. So we have filed a few statements of interest stating that it''s a mandate, that it creates a right to integration, not segregation, and courts have tended to disagree. That''s sort of a -- sort of an overview of our statements of interest practice, and those briefs are all on our website. So now I am going to go to the next slide and talk about our recent enforcement efforts around sheltered workshops and segregated day programs. So I am on the slide that says ADA and Olmstead not limited to where people live. I don''t know if I skipped ahead on you.
We are all right.
Good. So a lot of the Olmstead litigation has been around institutions and where people in institutions are living, in many cases spending most of their lives because it''s the only place you can go to get the services you need. Of course, Title II doesn''t just apply to residential services and programs; it applies broadly to all services and programs of a public entity. So it also applies to day programs, not just where people live. And so we recently became involved in a case in Oregon, Lane v. Kitzhaber, addressing that state''s employment services programs. And they are a proposed class of individuals with intellectual disabilities and developmental disabilities brought an ADA case alleging that the state was violating Olmstead by providing services to individuals in sheltered workshops when they could and wanted to be served in integrated work settings. So in that case, the state moved to dismiss, arguing that Olmstead applies, and the integration mandate to this residential settings, and the court rejected that argument, finding it applies to all government services programs and activities, including employment. And although the court issued that finding, it did dismiss the complaint but allowed the plaintiffs to refile it, so they did that, and then the Department of Justice intervened in that case, and it is ongoing. I will go into it in more detail. I just wanted to go to the next slide and just mention the importance of, you know, ensuring that persons are -- people with disabilities are getting day program services and integrated settings has been a big part of our work throughout and has been included in not just the litigation I''m going to talking about in Oregon. Also in Rhode Island it''s been part of our settlement agreement. In North Carolina, the state is agreeing to provide supported employment to 2500 persons with psychiatric disabilities over the course of the agreement. There''s provisions in the Delaware agreement as well, also in the Virginia agreement, as I mentioned. So it''s been a large part of our work. We more recently have become involved in ongoing litigation on those matters. So Peter, if you go to the next slide, I am going to talk in more detail about the Lane v. Kitzhaber case. And so as I mentioned, the Department moved to intervene in that case, and our motion was granted. So the case is ongoing. And the complaint, which can be found on our website, and if you are interested, I encourage you to read it. But essentially, it includes allegations that the vast majority of -- the state administers its employment rehabilitation, vocational, and education services, such as people with disabilities are denied the benefits of the vocational and employment services in the most integrated setting. And it includes -- those allegations include the allegation that relying on state data that showed that as of March 2012, of the individuals with intellectual and developmental disabilities receiving employment services in the state system, at least 61% of them were receiving them in segregated sheltered workshops, while only 16% received any services in individual supported employment. And also, of the total number of hours expended in various employment settings, 57% were in segregated sheltered workshops, while only 10% were spent receiving services in integrated settings. The vast majority of individuals in sheltered workshops are paid far below minimum wage, and according to the state, the average hourly wage for sheltered workshop participants is $3.72. And over 52% of the participants earn less than $3 per hour, and some earn only a few cents per hour. And you know, we tried to make clear in the complaint that beyond the segregation, the low wages perpetuates a stereotype that individuals with intellectual and developmental disabilities are not capable of performing at the same level of their non-disabled peers. The case, as I mentioned, includes an at-risk component, which is comprised of students with intellectual and developmental disabilities who are not being prepared for work in integrated settings and are, instead, referred to sheltered workshops instead of receiving transition services to ensure they move on to competitive work or integrated employment after school. And so that''s another sort of stay-tuned subject area because that case is ongoing, and as more information becomes available in public I think major developments will be included in our updates on our website. I''m going to skip two slides to U.S. v. Rhode Island and the City of Providence. This is another case addressing segregated day services, and this is one where the Department reached an interim agreement with the State of Rhode Island and the city of Providence, and that agreement''s being implemented. But that case, the Department initiated investigation in that case, and that matter was brought to our attention by an investigation of the labor department''s wage and hour division regarding improper sub-minimum wages being paid to people with disabilities at the state''s largest sheltered workshop called Training through Placement or TTP. And it also came to light that a school day sheltered workshop at a Rhode Island, Providence, high school was a point of origin for many people entering that adult sheltered workshop. So following our investigation, we issued a findings letter to the City and State finding that TTP, the largest sheltered workshop, does not provide persons with disabilities the opportunity to interact with non-disabled persons to the fullest extent possible. And the vast majority of people in sheltered workshops could and want to be served in more integrated settings, like supported employment and other integrated day settings. And then separately, we found that students with intellectual disabilities and developmental disabilities were at risk of unnecessary segregation in sheltered workshops because the in-school sheltered workshop served as a pipeline to the adult workshop, and there was really a lack of transition to prepare students for more integrated options, such as internships or part-time jobs or other work-based learning. And so there the TTP, the sheltered workshop, was the typical -- the typical tenure in that program was 15 to 30 years, and workers had little or no interaction with persons without disabilities. They earned an average hourly wage of $1.57 with some as low as 14 cents an hour. And if you go to the next slide, Peter, the State and City cooperated with us in that matter, and after we issued the findings letter, we reached an interim settlement agreement, and the reason I call it an interim agreement is because it addresses -- it provides relief to the individuals in that largest sheltered workshop I mentioned, TTP. And then also, youth preparing to leave the in-school sheltered workshop, which is called Birch, or who left Birch within the last two years. And then separately, youth participating in the Birch programs. So if you go to the next slide, the -- under the agreement, the State and City are going to work together to provide a career development plans, vocational assessments, and benefits counseling for all individuals at TTP and all youth leaving or who recently left the in-school programs. And the state and city will also provide supported employment services and placements to all individuals at the sheltered workshops and provide integrated transition services to the students through a youth transition planning process beginning at age 14. If you go to the next slide, there''s some more detail about that agreement. But the State and City agreed to adopt an appropriate employment-first policy. So the State has already adopted one, but the City of Providence will do so as well. They will increase supported employment and integrated day service provider capacity. And so the agreement covers both supported employment and other integrated day activities because TTP, the provider, both -- offered both sheltered workshop and other day program activities. And so the State and City are also agreeing to implement a quality improvement program additionally for supported employment day activity and transition services. And I don''t think I mentioned the number of people involved, but it will provide relief to roughly 200 people with intellectual and developmental disabilities who were at issue in our findings. And so beyond the interim agreement, the matter as it relates to the State''s whole system, entire system, for day activities remains ongoing. And there''s a lot of information about that matter as well on our website. And I see I''ve almost gone up to an hour, and I want to refer you to the next slide, which is just a description of some of our resources I touched on earlier, but the statement of the Department of Justice on enforcement of the integration mandate is the technical assistance I referenced earlier. It was issued by us in 2011. And it''s posted on our website and is a good resource. And then separately, ADA.gov/Olmstead is where you can find, you know, all of the work I talked about and more work than that, including all our agreements, findings letters, briefs, and some pieces of testimony and speeches. Finally, on the last slide is my contact information. We do a lot of outreach. I talk to people frequently about Olmstead enforcement and issues related to Olmstead, so there is my contact information. And you know, this work continues to be a priority for the Department, and so Peter, I''ll turn it over to you. I''m sure -- or maybe people have some questions.
All right. Thank you very much, Anne, for all of that information. For those of you in the webinar room, again, you can submit questions in the chat area. So simply clicking on that or control-M to submit your question through the webinar platform. While you will not see your question, once it has been submitted, it is viewable by the moderators. And Tamara, if you could come on and give the participants connected by phone instructions on how they could ask questions at this point, please.
Sure. Ladies and gentlemen, if you have a question at this time, please press star and then the 1 key on your touchtone telephone. If your question has been answered or you wish to remove yourself from the queue, please press the pound key.
And while we are waiting for questions to come in, I have one here regarding the sheltered workshops and the Department''s viewpoint on the sheltered workshops. And when you talk about the litigation and the settlements, or the work with the Rhode Island case, you''re addressing it from the standpoint that -- or I should say is the Department of Justice viewing it from the standpoint that sheltered workshops as part of an employment program doesn''t meet the integrated requirements of Title II versus the -- you know, the overall issue of whether or not there should be, you know, sheltered workshops?
Sure. So if I am understanding correctly, I will make two -- I will try to distinguish the points. So what we found is that the sheltered workshop was not the most integrated setting for individuals with intellectual and developmental disabilities in there because it was a large, segregated facility that really -- you know, in which persons had very little or no contact with persons without disabilities besides the paid staff. And so we did find that that''s not the most integrated setting under the -- under Olmstead and the ADA. However, you know, under that agreement, if a person decides to remain in that service setting, then that is a choice that person can make, and that''s actually -- I am glad this question was raised, actually, because I didn''t -- I don''t think I clarified that during my presentation, but that''s actually consistent across our agreement, so that they provide relief to people who are qualified for community-based services and don''t oppose them. So there''s -- in all of our agreements -- provisions around transition planning and informed choice to ensure that people get all the information they need to make an informed decision about where to receive services. So if at the conclusion of that process they ultimately decide to stay, that is a -- an option that''s preserved under the agreement.
All right. Great. And then the other issue of sheltered workshops in general is something that I would image would take action from Congress outside of the scope of what the Department of Justice is doing.
Right. I''m not sure I follow that question. We look at any case based on the facts in the case, and we don''t only -- we look at a state''s, you know, service system and what it''s offering and how it''s set up and whether it''s segregated individuals, whether it be in a workshop setting or, you know, residential setting. And so it''s really -- our work -- our enforcement work is really addressed on a, you know -- based on the facts of each case that comes to us.
Okay. Excellent. Tamara, do we have a question on the telephone at this time?
I am not showing any questions.
All right. Questions -- and again, you can continue to submit your questions in the webinar room. Someone in the webinar room had asked about -- wanted more information about the adult homes in the New York case, where there''s nursing homes, assisted living, or what types of facilities?
They are not nursing homes. Nursing homes in the State are more, you know -- provide probably more -- higher level of care, I might say. That might be an overgeneralization. I know each state''s licensing system may be a bit different, but they''re not exactly assisted living either. Some of them are -- can be licensed as assisted living, but most of them are what are traditionally considered board and care homes. So there are state regulations for who can be admitted. And really what they provide are shelter obviously, because it''s a facility; three meals a day; and then some support. So it may be medications, and not a hugely intensive array of services. It''s really what you would traditionally think of as boarding care.
All right. Great. Another question from the webinar room. If you had -- the questioner asks what is the citation used in the U.S. v. Florida case?
Good question, and I should know that by heart at this point. Bear with me for one second. I assume they want the case citation, but it''s pending in -- it''s U.S. v. State of Florida, and it''s pending in the Southern District of Florida, so that''s the -- and that''s the Ft. Lauderdale division, not the Miami division. And it''s case No. 13-CIV, and the number is 61576.
All right. Great. And Tamera, do we have any questions on the phone at this time?
We do have a question. Our first question comes from (Inaudible). Your line is now open.
Hello, go ahead with your question. If you are using a speakerphone, if you could pick up the handset so we can hear you clearly. Go ahead.
Thank you. This is from Indiana. One of the -- we have an over reliance on the use of nursing homes for people with physical disabilities.
Could you speak to how that applies, given your examples of addressing cases with people with developmental disabilities and those with mental illness?
Yes, definitely, and I''m really glad you asked that question because I think by my presentation, you might think that that''s the only -- those are the only populations, but that''s not the case at all. We have done -- a lot of our statement of interest work has actually involved individuals with physical disabilities. So some of them -- and physical -- people with physical disabilities in nursing facilities specifically. So we have weighed in in cases where there may have been plaintiffs who were individuals with quadriplegia, for example, who were in the community and then, because of various budget cuts or other policies or state actions started to really not be able to make it in the community. So their only option was going to have to go to a nursing facility. And we weighed in to say that it''s -- you know, it''s a violation of the ADA to put people at risk of unnecessary institutionalization. And you know, I talked a lot about our nursing facility work. I think that will continue to be a priority. There''s another case -- the case that I just mentioned that we weighed in on was actually another one in Florida, where actually, the state was saying to people who were at risk and they had physical disabilities and were at risk of going in a nursing facility, they were saying, well, if you go in a nursing facility for 90 days, then we will be able to put you on the waiver. And these individuals were trying to get on the spinal cord injury waiver. And so we came in and alleged that that was a violation of Olmstead to require people to go into a nursing facility to then get the services they need in the community. And these were all people who were living in their own homes at the time. And so probably would have also been at risk of losing their homes. And then separately, we''ve more recently weighed in on a case in the District of Columbia involving people with a range of disabilities, actually, in DC nursing facilities. And so that case, we actually weighed in on a rather technical issue. We weighed in on the class "Certs" requirements because that''s an area where, you know, there was a recent Supreme Court case addressing the requirements for plaintiffs to satisfy class certification, and that has been coming up a lot in Olmstead cases. So we weighed in there, and that case is also ongoing.
Thank you very much.
All right. Thank you, Anne. And then let''s see. Another question from the webinar room. This questioner wants to know how the Department of Justice determines which states they are going to file lawsuits in. And they have the example that the state where they reside has a very similar situation to the Oregon sheltered workshop situation, and they want to know how they can get some movement.
Okay. We -- there''s a range of factors we look at. I can''t -- you know, I can''t talk about our internal process for deciding what enforcement action to take. That''s not something that''s -- you know, that I can talk about really publicly. But you know, we -- we have -- we have a complaint intake process here at DRS, and that''s something I didn''t talk about. But you know, to the extent you seek to file a complaint for us to look at, you know, you can look -- on the website, there are detailed instructions for how to file a complaint. You can do it through the Internet -- sorry -- through our -- yeah, through our Internet or by fax. I am always happy to talk offline with you, and we can do that too, and you have my contact information at the end of presentation. But I''d be happy to do that as well. If you are not in a position to send something into our office.
Great. So for that questioner, Anne''s contact information is in the PowerPoint presentation there. Just as a follow-up from that question and the the previous question from Indiana, this is my own question. But does the department have, you know, a formal plan in place in terms of outreach? Obviously, you know, the audio conference is a great way to reach people and let folks know about what the Department is doing, but are you also actively working with, you know, protection and advocacy services and other advocacy groups? Obviously, the Department of Justice can''t file suits, take on all cases. It needs the disability community, you know, those -- the P&As, you know, obviously can do work. So are you working with those and educating them on the work that you are doing?
Yeah, that''s a great question, and we work very closely with the P&As. We have been attending their annual conference in the last few years, and you know, many of the cases I just talked about, North Carolina was a case that was filed by the North Carolina protection and advocacy organization with our office. In several of the other cases, the P&A was either another plaintiff or, you know, involved in the case, and you know, frankly, you know, we are here in Washington. So we do as much outreach as we can because we are not on the ground in certain states, knowing the service system inside and out, knowing what''s going on on the ground. So when we do our investigations, we do reach out to the P&As, and we do reach out to as many stakeholders as we can because it''s a great source of information for how the system''s working and, really, what people want in that state. So yeah, we do try to do a lot of outreach.
Great. Tamera, do we have another question on the telephone at this time?
Again, ladies and gentlemen, if you would like to queue for a question, please press star and then the number 1 key on your touchtone telephone. We have a follow-up question. Your line is now open. Hi, Anne. Can you hear me okay?
I can. Hello. I have an individual that is blind and has a -- (Inaudible) -- reassessment to try to qualify for waiver services.
Uh-huh. And because he''s not able to -- they denied him all three times saying he doesn''t meet the actual classification for someone that, you know, can gain access to a waiver because he''s able to bathe himself, dress himself, you know, sometimes take his medicines appropriately, those types of checks that he has to meet, they are saying he doesn''t meet the criteria for the waiver. So he is now at risk of losing his housing and being institutionalized because of this.
I am sorry. Can you get the phone closer to you, please? Having some trouble hearing you.
I am sorry.
Okay. Go ahead. Continue with your question.
So he is now at risk of losing his housing because he is not able to get those waiver services and at risk of being institutionalized. Would you consider that to be an Olmstead violation?
Well, I would have to look at more facts than that, unfortunately. One thing I would ask is whether -- you know, whether there are other services that the state could use to support him in his home. Because you know, he may be applying for the waiver, but there may be other services, either in their Medicaid program or in another program, that they could use to support him there so he doesn''t have to be institutionalized. We see this, you know, similar issues sometimes where, you know, the state or the entity may be looking at things from a purely Medicaid perspective, like what Medicaid services exist, but you know, the requirement to avoid unnecessary institutionalization doesn''t, you know, end with what''s available in Medicaid. So it''s all state programs, including Medicaid and maybe others, and you know, oftentimes it''s beneficial for the states to look at those other options because typically, it''s usually the highest-cost option to have -- you know, let the person end up in the -- is it a nursing facility for him? Is that what --
Actually, we were told that the best chance of receiving waiver services would be go to an institution for 90 days and then get qualified for "Money follows the person". That was their recommendation.
Okay, well, yeah, I would definitely -- and I am happy to talk with you offline as well about this situation. But in the meantime, also take a look at -- it was this similar situation, the one I talked about in Florida, involving the applicants to the spinal cord injury waiver. The case was called Haddad. And the court there found that, you know, telling someone, well, if you go in for 90 days then we''ll get you out was not -- violated the ADA. So take a look at that because that may be helpful to you in this. And then I''m happy to talk offline about this specific situation.
Thank you. I have another really quick question, if that''s okay.
Just real quick, in U.S. v. Virginia settlement agreement, you indicated that there were subsidies for independent living as part of the settlement. What type of subsidies were those?
I believe that''s a voucher type subsidy, so state monies. But I would want to verify that. I''m not as intimately involved in the implementation there as I am with the other ones, so I don''t want to misstate anything, obviously. And so --
Yeah, and Anne, if you get us that information, we can share that with the participants in follow-up information. We''ll get that out to folks.
Okay. Thank you.
All right. Thank you for the question. This question regarding the letters of interest slide, if you could just talk a little bit more, clarify the comment that you made about courts have been disagreeing with the Department of Justice related to lawsuits being filed by families attempting to use Olmstead to keep institutions open.
Oh, no, sorry. If I said that, I misspoke. The courts have been agreeing, actually, that at least as it relates to an Olmstead cause of action, that Olmstead ensures the most integrated setting. It doesn''t create a right to remain in a particular segregated facility.
All right. Excellent. Thank you for that clarification. Tamara, do we have another question on the telephone at this time?
I am not showing any more questions.
Okay. Anne, can you talk about what is the department''s plan regarding follow-up with some settlement agreements that you''ve entered into at this point? I know that sometimes we get some feedback regarding, you know, the very active, you know, Project Civic Access program that the Department of Justice is involved in and follow up with some of those, you know, settlement agreements and how the department handles that. What are any plans regarding, you know, follow-up and enforcement of those settlement agreements that have been reached?
Sure. So we remain actively involved, and that includes going on the ground, you know, going back to the state and talking to individuals getting services under the agreements, talking to providers, talking to the state, and any other stakeholders that might have an interest. And then we get regular reporting from the states. We regularly talk to the monitors, the reviewers, the experts who are overseeing compliance. And then for those who have more active -- so all of the settlement agreements I talked about today are court enforceable, which means that if there''s a breach of the agreement, that we can go into court and address it with the court. So that is -- so some of the courts have status reports or maybe a status conference from time to time. There has not been any major court action in any of the agreements where we''ve gone in and said there''s a major breach. So our ongoing -- you know, our efforts remain very active on an ongoing basis. I mean, you know, we remain involved to ensure that the agreement is being complied with and that it''s going as well as it can. And you know, there''s always going to be glitches in system reform, and so you know, we try to get as much data as we can, you know, to address, you know, any and all concerns and work with states to do this successfully.
And do all the agreements at this point include the requirement for a monitor? Is that the plan going forward to have that inclusion? Is that the case?
They do. I mean, the ones -- all the ones I''ve talked about today either have what we call a reviewer or a monitor. And you know, we think it''s important. I mean, these are people who are experts in these areas, either in transitioning people from institutional settings in the community or they''re expert in the kinds of services provided under the agreement. And so are I think the states have come to view them as helpful to them in implementing these agreements. But you know, they''re not only technical experts, they''re also helpful in if issues come up and we need someone to help us resolve them, that person can serve that role short of going to court. It''s been an important aspect to these agreements, ensuring that they are not only compliant, but that people are doing well as they are transitioning.
Okay. Excellent. Another question that was submitted. I know that you can''t give specifics, but are there any emerging areas related to the efforts in regard to the Oregon case? The viewpoint that Olmstead doesn''t only include housing, that it involves all programs and services. Are there other emerging areas out there where you -- where the Department potentially sees using Olmstead as -- you know, as a tool in enforcing the Title II of the ADA?
You know, that is a good question. I mean, as I mentioned and as the courts have held, you know, the integration mandate applies broadly to services, activities, and programs. So it''s a wide array of -- of programs under the ADA. And so you know, there has to be a sufficient nexus. There has to be, you know, a state service or program at issue. But you know, I think we do look to places that, you know, issues that may remain unaddressed, and so you know, that''s -- that''s something, you know, we hear -- you know, if we hear from stakeholders about a certain issue that hasn''t been addressed, that''s definitely something we would think about.
Right. Excellent. Let''s go -- let''s check one last time, see if, Tamara, do we have any last questions on the phone at this time?
Yes, we have a follow-up question from Ms. (Inaudible).
All right. If you make sure if you are on the speakerphone still to have that in front of you so we can hear you. Go ahead with your question.
Can you hear me okay?
Okay. I heard you talk about you filed statements of interest and weighed in on state Olmstead plans. Is it a requirement for a state to have an Olmstead plan in place?
It is a -- so the state has a defense that it would be a fundamental alteration of a service system to -- you know, to undertake the relief that a plaintiff or we are seeking in an Olmstead case and in other Title II cases. So some courts have held, and we have also taken the position, that in order to assert that you have -- that the relief would be a fundamental alteration, you have to show that you have a comprehensive, effectively working plan to address unnecessarily institutionalization. So that is the position we have taken in the context of litigation. And that''s -- that''s in the statement, the technical assistance I talked about a little bit.
And to that end, Anne, are there any thoughts of additional technical assistance materials, such as, I don''t know, a draft policy, something along the lines that the Department did with the -- with the ADA, the Title II online, you know, best practices technical assistance material they developed?
Yeah, we have -- just even beyond the Olmstead context, we have a technical assistance group here in the Section, and so I''m not sure, you know, what''s in the pipeline now. You know, nothing that I can share. But that is work that will continue to be ongoing.
But if a state -- if someone was looking to model something, they could certainly look at the settlement agreements that the Department has already reached and, you know, the cases that you''ve talked about and could probably model a -- you know, their policy based on some of those settlement agreements?
Oh, sure, sure, yeah, and you know, that''s part of the reason we make -- you know, we publicize the work is hoping that people can use them as a resource for that. And you know, people give us ideas for technical assistance and guidance, so people can always make suggestions.
All right. Excellent. Well, thank you very much, Anne, for your expertise and your time today in presenting this information. As a reminder, today''s session is being recorded, and the audio archive of today''s session will be posted to the ADA-audio website, www.ADA-audio.org, within 24 hours following the session. An edited transcript of today''s session will be made available within seven business days, again, on the ADA audio website. Once you get to ADA-audio.org, selecting the audio conference tab, and once on that homepage, selecting archives to access all of the archives in this ongoing educational program. As a reminder, we will be back here in December with a session, "Ask the Equal Employment Opportunity Commission (EEOC)," where we will have representatives from the U.S. Equal Employment Opportunity Commission join us, and that will be on Tuesday, December 17. Registration for that session will be opening shortly, so continue to visit the audio conference website to find information on registration for that session. If you have questions going forward regarding the ADA Audio Conference, you can reach us at 877-232-1990. If you had any questions that were not answered today, we would encourage you to follow up with your regional ADA Center, which you can visit -- which you can locate by visiting www.ADATA.org. Or you can reach your regional ADA Center by calling 800-949-4232. And once again, want to thank Anne again for your participation today and want to thank the Department of Justice for your continued work with the ADA National Network. It certainly helps in the work that we do, and hopefully vice versa. So thank you very much. Thank you to all of our participants. That''s why we are here. That''s why we provide the information, for you folks out there. So for those of you in the webinar room, you can exit by simply closing your Web browser. And thanks again, and good day.
Ladies and gentlemen, thank you for participating in today''s conference. This concludes today''s program. You may all disconnect. Everyone have a great day.