Serving People with Disabilities in the Most Integrated Setting: Community Living and Olmstead

A special education child works on a laptop.The U.S. Supreme Court’s 1999 landmark decision in Olmstead v. L.C. (Olmstead) found the unjustified segregation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act (ADA).  The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) plays a pivotal role in supporting the Olmstead decision and promoting community living through our vigorous enforcement of the ADA and other key civil rights laws.

OCR investigates complaints alleging a violation of the ADA's "integration mandate," which requires that individuals with disabilities receive services in the most integrated setting appropriate to their needs.  This principle is central to the Supreme Court's Olmstead decision. The Court held that states are required to provide community-based services for people with disabilities who would otherwise be entitled to institutional services when: (a) such placement is appropriate; (b) the affected person does not oppose such treatment; and (c) the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of other individuals with disabilities.

A woman in a wheelchair works on a laptopOCR's investigations of Olmstead complaints have had a significant impact in facilitating the community integration of individuals with disabilities. As a result of OCR's efforts, many individuals have transitioned from an institution to the community, and many individuals have avoided unnecessary institutionalization.  For example, OCR's investigation have led to:

  • Individuals who had been institutionalized for decades are now receiving services in their community

  • Individuals who lost their housing and/or community-based supportive services when they were forced to enter institutions due to an acute health care problem have had the needed services provided or restored

  • Individuals with disabilities are able to access home and community-based services through Medicaid "Waiver" programs.

  • Increased hours of personal care and assistance are being provided to individuals who require additional services to remain in the community.

  • Individuals with disabilities now have greater control over their community-based care and services.

  • Individuals’ needs are met by providing reasonable accommodations in their communities, and not by moving to a more restrictive setting.

Recent OCR Olmstead Enforcement Success Stories

OCR has conducted enforcement activities resulting in positive change for individuals needing community services to live in the least restrictive environment. Notably, the October 19, 2010 settlement agreement signed by the Department of Justice, OCR and the State of Georgia will ensure that thousands of people with developmental disabilities and individuals with mental illness receive community services instead of institutional care. Read about this Settlement Agreement and other Olmstead Enforcement Success Stories.

Ensuring Beneficiary Health and Safety in Group Homes Through State Implementation of Comprehensive Compliance Oversight

OCR has joined with our partners in the U.S. Department of Health and Human Services Office of Inspector General (OIG) and Administration for Community Living (ACL) to publish a joint report, entitled “Ensuring Beneficiary Health and Safety in Group Homes Through State Implementation of Comprehensive Compliance Oversight,” focused on preserving the health, safety and well-being of individuals with disabilities who live in group homes.  The joint report, issued on January 17, 2018, is a resource to help ensure that group homes are safe and healthy places for people with disabilities, as part of a spectrum of integrated options.

Read the CMCS Informational Bulletin:  Health and Welfare of Home and Community Based Services (HCBS) Waiver Recipients  - PDF

Content created by Office for Civil Rights (OCR)
Content last reviewed on June 28, 2018