June 22, 2024 marks the 25th anniversary of the U.S. Supreme Court’s affirmation that people with disabilities have the right to live, work, and learn in integrated settings. Over the past 25 years, progress has been made toward meeting this mandate — but we have a long way to go.
Olmstead is not “just another task” alongside everything else. Rather, Title II of the Americans with Disabilities Act (ADA) is the law — and should be an essential guide in both the design and the implementation of systems that serve people with disabilities. Leaders and policymakers must address this core civil rights issue in all publicly funded systems, from integrated housing and employment settings to crisis services to law enforcement. The fact that many people with disabilities end up in correctional facilities due to insufficient community-based services is an illustration of how, in the absence of adequate commitment the principles of Olmstead, these systems intersect to deny people the opportunity to be successful neighbors and members of their communities.
In these past 25 years, we’ve made great strides toward learning what works. Permanent supportive housing, Assertive Community Treatment, integrated employment, peer supports, and supported education are among the many practices and tools that have been proven to help people with disabilities live in integrated settings. Public funding, including the use of new innovations in Medicaid, is increasing to meet the specific needs of people in community-based settings. Yet even as such models gain traction, it remains clear that our public systems — and, crucially, our local, state, and national budgets — are not yet fully aligned with the goal of community integration. Solutions to Olmstead require an all-of-government approach, and must be woven into the everyday fabric of government if we are to succeed in meeting the intent of the ADA.
Assessment is Key
Why, if we know the types of services that have an evidence base, do we continue to experience so many challenges in supporting people in integrated settings? Despite progress, we still have too many people with disabilities living unnecessarily in hospitals, large board-and-care settings, nursing homes, and correctional settings. Each system has its own unique challenges and there is no single solution. However, one of the biggest barriers to orienting public systems toward community integration is the lack of system review and performance improvement processes. What works? What does not work? What changes are necessary to comply with the law?
When programs with transformative potential are poorly designed, inconsistently implemented, or inadequately funded, public bias is reinforced that people with disabilities cannot succeed in integrated settings. Many observers fear that in spite of all our successes, the pendulum is swinging back toward putting people in long-term restrictive settings. The movement for disability rights and community-based services has been further hampered by a historic workforce shortage and a nearly universal affordable housing crisis, creating major setbacks to states striving to meet their obligations under Olmstead.
Building on Success to Achieve Our Shared Vision
The case that resulted in the Olmstead decision was initially propelled by the determination of two women with disabilities to leave the restrictive institutions where they were living. In this spirit, one of the lessons from the past 25 years has been that leadership by people with lived experience of mental illness, substance use disorders, and other disabilities is vital in every effort to transform the programs and systems that exist to support them. Leaders and policymakers are also recognizing the necessity of incorporating a racial justice and equity lens into these initiatives, unlocking knowledge and creativity that have historically been sidelined in the search for solutions.
In spite of important gains, the adage “The definition of insanity is doing the same thing over and over again and expecting different results” still applies all too accurately to our public systems. Only with a renewed and sustained commitment to a more inclusive process and to meaningful system review and performance improvement — pushing all stakeholders to substantively drive away from what does not work, and toward what does — can we fulfill the ADA’s full vision of diverse, integrated communities in which all people with disabilities can thrive.
