Olmstead: Implementing the Integration Mandate

 The Olmstead case and the integration mandate of the Americans with Disabilities Act (ADA) apply more broadly than state hospitals. Many individuals with mental disabilities are unnecessarily segregated in institutions such as nursing homes, board and care homes, and residential treatment centers that are physically located in the community. Others are segregated in various types of smaller group facilities that may have the physical appearance of a home but, in fact, are quite isolated from mainstream community life. All of these settings are part of the public systems that Olmstead addresses when they are publicly planned and financed, regardless of whether they are government operated or privately run.

The physical location of a living setting in the community, its private ownership, or the absence of characteristics generally associated with a hospital do not guarantee that residents with mental disabilities are free of the discrimination and segregation prohibited by the ADA. The Bazelon Center has joined with local partners throughout the country to litigate the ADA rights of individuals consigned to nursing homes, board and care homes, and other segregated community settings.

In addition to the ADA, the Nursing Home Reform Act (OBRA ’87) protects people with mental illnesses (or intellectual disabilities) in referred for admission to nursing homes that accept public insurance (Medicaid or Medicare). OBRA ’87 incorporated a package of nursing home reforms, including provisions known as PASRR (Preadmission Screening and Resident Review). OBRA ’87 requires that people with a mental illness (as may be indicated, for instance, by a prescription for psychiatric medication), are required to have a comprehensive screen by an entity other than the state or the nursing facility to determine if admission to a nursing home is appropriate, based on the individual’s needs. PASRR should work in concert with the ADA to ensure that nursing homes do not unnecessarily segregate individuals with mental disabilities—many of whom are older adults—and that these individuals are afforded the services and supports that allow them to live with maximum independence in their communities.