Delivering on the Promise: OCR's Compliance Activities Promote Community Integration

September, 2006

Introduction

The HHS Office for Civil Rights (OCR) is responsible for investigating complaints alleging a violation of the Americans with Disabilities Act (ADA) "integration regulation," which requires that individuals with disabilities receive public services in the most integrated setting appropriate to their needs. Typically, these "most integrated setting" complaints filed with OCR allege a violation of ADA rights as set out in the Supreme Court 1999 decision, Olmstead v. L.C., which interpreted the integration regulation. (Note 1)

OCR's response to Olmstead complaints has had a significant impact in facilitating the community integration of individuals with disabilities. OCR has received complaints filed by or on behalf of a wide range of individuals, including individuals with physical, psychiatric, developmental and cognitive impairments, and individuals of all ages, including children, young and middle-aged adults, and elderly persons. As a result of OCR's efforts, many individuals have been able to move from an institution to the community, and many individuals have avoided unnecessary institutionalization. For example:

OCR's intervention and assistance have helped secure community services for individuals who had been institutionalized for decades.
OCR's efforts have resulted in the provision or restoration of community services for individuals who lost their housing and/or community-based supportive services when they entered institutions due to an acute health care problem.
OCR's work with complainants, states and other parties have resulted in providing community services to individuals with disabilities through "waiver" programs.
OCR's efforts have resulted in individuals receiving increased hours of personal care and assistance.
OCR's work has resulted in individuals with disabilities having greater control over their community-based care and services.
OCR has helped ensure that individuals are provided reasonable accommodations where they resided, rather than having to move to a more restrictive setting.

In March 2002, in response to President Bush's Executive Order 13217, Community-Based Alternatives for People with Disabilities, HHS committed to broadly disseminate individual accounts of how its civil rights compliance activities have facilitated community integration. (See Delivering on the Promise, HHS' Report to the President on Executive Order 13217, available at www.hhs.gov/newfreedom/final/hhs.html.) Accordingly, OCR is providing the following accounts of satisfactorily resolved complaints affecting approximately 250 individuals.

More than 160 individuals involved in these cases moved from institutional to community settings, and more than 80 individuals who resided in the community avoided institutionalization as a result of OCR's work. As can be seen from these accounts, the resolution of these matters varied according to each set of facts and circumstances, and was tailored to appropriately and practically address the interests of the parties involved. Complainants, government entities and other parties worked cooperatively with OCR, often devising creative solutions to the issues involved in the complaints.

Some of OCR's activities resulted in systemic change. In Kentucky, OCR obtained a Voluntary Resolution Agreement in which the State agreed to undertake a variety of actions to identify, assess and transition to the community individuals residing in State-owned and -contracted psychiatric hospitals. In Virginia, following OCR's intervention and assistance, the State provided community services to OCR complainants with developmental disabilities and established a Task Force for the development of an Olmstead Plan. Virginia also issued an Executive Order which, among other things, increased the State's Medicaid waiver slots for individuals with mental retardation. In Oklahoma, OCR was already working with the State on its Olmstead planning and identification of barriers to community living when OCR began investigating complaints alleging that eligibility criteria for one of the State's Medicaid waiver programs put complainants at risk of unnecessary institutionalization. Following OCR's intervention, the State requested and received approval from the HHS Centers for Medicare and Medicaid Services (CMS) to amend the waiver program's eligibility criteria in a manner that addressed the complainants' concerns. In Delaware, OCR's investigative and case resolution strategies resulted in the community placement of more than 50 individuals who had resided in a State psychiatric facility. In addition, as some of these examples reflect, OCR continued its efforts to serve as a catalyst for the development of State "comprehensive, effectively working plans" for services to people with disabilities discussed in the Olmstead decision. (A detailed report about state planning efforts is available from the website of the National Conference of State Legislators, at http://www.ncsl.org/Portals/1/documents/health/forum/olmsreport2001.pdf)

Descriptions of these cases follow. The summaries are grouped by state, and identified by the governmental or other entity against whom the complaint was filed. Some personal details about the complaints have been omitted to protect the complainants' privacy. For more information about these cases, please contact OCR, using the OCR docket number or numbers provided at the conclusion of each description.

Finally, OCR continues to be an integral part of HHS' response to Executive Order 13217 and the President's New Freedom Initiative for individuals with disabilities. (The text of Executive Order 13217, more information about the New Freedom Initiative and HHS' role in carrying out the initiative can be found at www.hhs.gov/newfreedom.) OCR works with the HHS Office on Disability (www.hhs.gov/od), the Centers for Medicare and Medicaid Services (www.cms.hhs.gov) and other HHS and other federal agency offices in joint ventures to promote the community integration of people with disabilities. OCR will continue both the investigation and resolution of complaints, and broad-based systemic activities as part of its continuing work in this important civil rights area.

Case Descriptions

Colorado

Adams County, Colorado Department of Social Services
Allegation:
This complaint was filed on behalf of an individual with a brain injury who resided in the community. The complainant, who received services under a Medicaid waiver for persons with brain injury, alleged that a County jeopardized his ability to remain in the most integrated setting by making it unnecessarily difficult for him to apply for a Medicaid waiver for individuals who are elderly, blind and disabled (EBD). The complainant alleged that he would require the EBD waiver upon the expected expiration of his brain injury waiver services.

Disposition:
OCR and the county negotiated an agreement that satisfactorily resolved the complaint. The complainant never experienced a break in services provided under the brain injury waiver. As part of the resolution, the OCR provided civil rights training for the county's home and community based services waiver staff.

Colorado Department of Health Care Policy and Financing and Adams County, Colorado Department of Social Services
Allegation:
This complaint was filed on behalf of a 30-year-old man with a brain injury who resides in the community with his family. The complaint alleged that the complainant is at risk of institutionalization because the State and a County denied him appropriate services and supports to enable him to live in the community.

Disposition:
Through OCR's intervention and assistance, a number of issues involved in this complaint were resolved. The State arranged for the complainant to have a week of in-home services so that the complainant's mother could have respite from her care-giving responsibilities. The State replaced rehabilitation equipment used by the complainant. The State reimbursed the complainant's family for specialized glasses. The State investigated the complainant's assertion that a mechanical device used to lift the complainant was not working properly, and identified and paid for a replacement device.

Colorado Department of Health Care Policy and Financing
Allegation:
This complaint was filed on behalf of a woman with Multiple Sclerosis. The complainant, who lives at home, alleged that the State's policies put her at risk of unnecessary institutionalization because she could not obtain the daily and overnight care she needed to continue living in her home when the complainant's husband was carrying out responsibilities related to his National Guard service.

Disposition:
OCR worked with the State and the complainant to resolve the issues in this matter. The complainant began receiving two additional Certified Nursing Assistant (CNA) visits a day when her husband is away for National Guard duty. The complainant found this level of care adequate for her needs. The State also provided information as to the complainant's options should she believe that the level of home health care services she receives is inadequate. The complainant continues to receive Medicaid waiver services, including cleaning, meal preparation, and the use of certain medical equipment.

Health Care Quality Improvement Organization, Denver, Colorado
Allegation:
The complainant, a person diagnosed with Parkinson's disease and lupus, alleged that the State discriminated against him of the basis of disability and national origin when he was determined ineligible for Home and Community-Based Services for the Elderly, Blind and Disabled (HCBS-EBD) waiver program. The complainant contended that without the HCBS-EBD waiver services he was at risk for unnecessary nursing home placement.

Disposition:
As a result of OCR intervention and assistance, the complainant's HCBS-EBD services were restored. With his services restored, the complainant, after a short nursing home stay, was able to return to his own home.

Assisted Living Facility, Durango, Colorado
Allegation:
This complaint was filed on behalf of a person diagnosed with Parkinson's disease. The complainant alleged that the State failed to make reasonable accommodations for her disability that would ensure her continued residency in an assisted living facility. The complainant feared that without reasonable accommodation she would be evicted from the assisted living facility and risked being unnecessarily institutionalized.

Disposition:
OCR proposed that the parties enter into mediation to resolve their dispute. An initial mediation session was held in person with all the parties and numerous teleconferences followed. As a result of OCR's mediation efforts, the parties executed a Settlement Agreement that prevented the complainant's eviction from the assisted living facility and resolved the issue of reasonable accommodation.

Colorado Department of Human Services
Allegation:
This complaint was filed on behalf of a person diagnosed with Down syndrome, vision and speech impairments, neck fusion, and a bladder disease requiring daily catheterization. The complaint alleged that the State failed to provide him with residential services even though he had been approved for these services more than two years earlier. The complainant alleged that he was at risk of unnecessary institutionalization because his caretaker was unable to continue caring for him.

Disposition:
As a result of OCR intervention and assistance, a settlement was reached that 1) enrolled the complainant in the home and community-based services waiver program for individuals with developmentally disabilities, 2) placed him in an apartment, and 3) met his catheterization needs, including training of staff on methods of catheterization. The settlement also ensured development of an individual plan to provide appropriate services and supports to ensure his successful placement in the community.

Connecticut

Connecticut Department of Mental Health and Addiction Services
Allegation:
This complaint was filed on behalf of a 22 year old woman with cerebral palsy and other health impairments. The complainant had lived in the community previously and was placed in a nursing home because of changes in her living situation and health care status. She wanted to move back into the community.

Disposition:
Through the intervention and assistance of OCR, the complainant leased an apartment and enrolled in an Outreach and Engagement Program for counseling and case management services. OCR was directly involved with ensuring that services were in place for the complainant to leave the nursing home and move to a community-based setting. The complainant received a variety of community-based services, including counseling and intensive case management.

Connecticut Department of Mental Retardation/Connecticut Department of Children and Families
Allegation:
The complainant alleged that the State failed to provide her son, who has numerous mental and physical disabilities including mental retardation and a seizure disorder, with services in the most integrated setting appropriate to his needs. The complainant sought corrective action with the desired end of receiving personal and home health care for her son.

Disposition:
As a result of OCR's investigation, both State agencies took actions to support the individual's return to community living. Through the collaborative actions of OCR, the State, and the complainant, it was agreed that the following services would be provided: home health, nursing, respite care, repairs to the family van, money for clothing, and modifications (for physical accessibility) to the family's home.

Connecticut Department of Mental Retardation
Allegation:
This complaint was filed by a mother on behalf of her son, a young man who has a variety of disabilities including severe mental retardation, obsessive compulsive disorder, and seizure disorder. He received respite care in a State-run intermediate care facility for individuals with mental retardation, but sought community placement.

Disposition:
The State agency agreed that the young man should be placed in the community with supportive services. The process was delayed due to the cost submitted by one of the contractors. Through OCR's intervention and assistance, all parties agreed on the plan and timetable for finding a suitable roommate and a provider to deliver the supportive services. OCR will monitor this case until all elements of the plan are implemented.

Nursing Home, New Haven, Connecticut
Allegation:
The Connecticut chapter of a nationwide advocacy group filed complaints with OCR on behalf of individuals who were then residents in a number of long-term care facilities. When OCR conducted an on-site visit to one of these facilities, a facility resident told OCR that like his roommate, he would like to be discharged to a less restrictive setting with appropriate housing and employment support. He has a variety of disabilities including traumatic brain injury and seizure disorder.

Disposition:
Upon OCR's intervention and assistance, the facility's discharge planning staff worked cooperatively with the pertinent State agency to comply with the complainant's wish. As a result, he was placed on a waiting list with the New Haven Housing Authority and eventually moved into an apartment.

Nursing Home, Avon, Connecticut

Allegation:
The Connecticut chapter of a nationwide advocacy group filed this complaint on behalf of an individual living in a nursing home for more than 4 years. The individual has a variety of disabilities including mobility impairments. The Director of Nursing at the nursing home determined that he should be discharged into a community setting. The complainant alleged that the State agency was uncooperative.

Disposition:
Upon OCR's intervention, the State agency moved more promptly and placed the individual in an apartment using a Medicaid waiver for individuals with acquired brain injury.

Nursing Home, Hartford, Connecticut

Allegation:
The Connecticut chapter of a nationwide advocacy group filed this complaint on behalf of an individual living in a nursing home for more than 7 years. He sought community placement.

Disposition:
At the time the complaint was filed, the State agency was evaluating whether the individual would be eligible for an Acquired Brain Injury (ABI) waiver. He stayed in the nursing home primarily because of the lack of affordable housing, the need for the right roommate, and supportive services. OCR's intervention resulted in the State agency providing the complainant with community services through the ABI waiver.

Delaware

Delaware Department of Health and Social Services and Delaware Psychiatric Center
Allegation:
An advocacy group filed this complaint on its own behalf, and on behalf of nine individuals and a purported class of individuals with mental illness who resided at a State psychiatric hospital. The complaint alleged that hospital residents who sought discharge and whose treating professionals had determined that community placement was appropriate were subjected to inappropriate institutionalization.

Disposition:
Through nearly four years of OCR's intervention and assistance, the State took actions to address the individual and systemic issues involved in this complaint, including placing into the community more than 50 individuals. After OCR made a preliminary finding that six of the nine individuals identified in the complaint were ready for discharge, the State discharged these individuals to community-based settings. The State also agreed to provide OCR with a list of an additional 66 individuals who were ready for discharge, to work toward placing these individuals into the community and to review with OCR the progress in discharging these individuals after one year. The State placed 45 of these 66 individuals into the community within one year.

After OCR asked the State for information about additional individuals ready for discharge, OCR investigated the State's assertion that there were no additional individuals for whom community placement was appropriate. Specifically, OCR reviewed information regarding several individuals identified by complainants as allegedly ready for discharge, and concluded that the State's actions with respect to these individuals did not violate the ADA's integration regulation.

Delaware Department of Health and Social Services
Allegation:
This complaint was filed on behalf of an individual diagnosed with cerebral palsy and osteoarthritis. The complainant uses a wheelchair for ambulation and requires substantial assistance in all aspects of daily living. The complainant, who had lived in an institution for approximately 25 years, expressed a desire to live in the community. Treatment professionals determined that she was eligible and qualified to receive services in the community. However, after more than 12 months of delay in providing a community-based residential placement, a complaint was filed that alleged that the State had failed to provide services in the most integrated setting.

Disposition:
As a result of OCR intervention, the complainant was discharged from the institution to a community-based apartment.

Georgia

State of Georgia
Allegation:
This complaint was filed on behalf of a person with a disability who resided in an institution for more than 27 years. The complainant alleged that the State's policies and practices forced him to live in an unnecessarily segregated institutional setting in order to receive long-tern care services in violation of the ADA's integration regulation.

Disposition:
As a result of OCR's intervention, the complainant was removed from the institution and placed in a less restrictive group home.

State of Georgia
Allegation:
This complainant was filed on behalf of an individual diagnosed with cerebral herpes encephalitis and seizure disorder. He had lived in a transitional care facility for several years and received services under an Independent Care Waiver Program (ICWP). The complainant moved out of the facility but was not satisfied with the care he received. Therefore, he requested transfer back to his previous living arrangement. The complainant was informed that he could not receive services under the ICWP if he returned to the transitional care facility. The complainant alleged that he was being denied services in a setting most appropriate to his needs.

Disposition:
Through OCR's intervention and assistance, the State agreed to move the complainant back to his former living arrangement with ICWP services.

State of Georgia
Allegation:
This complaint was filed on behalf of an individual diagnosed with Traumatic Brain Injury. The complainant received services at an institution under an Independent Care Waiver Program (ICWP). The complainant was informed by the State that his ICWP services would be phased out. The complainant alleged that the State's actions would force him into a living arrangement inappropriate to his needs.

Disposition:
After OCR met with the State to discuss the specifics of the complainant's situation, the State agreed to change its policy and allow complainant's ICWP services to continue.

State of Georgia
Allegation:
This complaint was filed on behalf of an individual with mild mental retardation, impulse control disorder and deafness who has lived in an institution for more than 21 years. The complainant's treatment team recommended community placement with proper supports, including sign language capability. When progress in implementing community placement was delayed for approximately 20 months, a complaint was filed alleging unnecessary institutionalization in violation of the ADA's integration regulation.

Disposition:
Working with the State, OCR secured community placement for the complainant with appropriate support services.

State of Georgia
Allegation:
This complaint was filed on behalf of an individual with severe mental retardation, organic personality syndrome and a seizure disorder. The complainant's treatment team recommended community placement conditioned upon behavior management being available. When progress in implementing this recommendation was delayed for approximately eight months, a complaint was filed alleging inappropriate institutionalization in violation of the ADA's integration regulation.

Disposition:
Through OCR intervention and assistance, the complainant was approved for services and placed in the community.

State of Georgia
Allegation:
The complaint was filed on behalf of a woman with speech and hearing disabilities, a seizure disorder, mild scoliosis, and moderate mental retardation. The complainant had lived in an institution for more than 12 years. The complainant alleged that the State's policies and practices forced her to live in an unnecessarily segregated institutional setting in violation of the ADA's integration regulation.

Disposition:
Working with the State, OCR helped secure approval of services for the complainant and placement in the community.

State of Georgia
Allegation:
This complaint was filed on behalf of an individual diagnosed with moderate mental retardation, psychiatric disorders and a seizure disorder. The complainant resided in an institution. Her treatment team recommended community placement for two successive years. Because of the delay of approximately 20 months in providing community placement, a complaint was filed alleging inappropriate institutionalization in violation of the ADA's integration regulation.

Disposition:
Working with the State, OCR helped secure approval of services for the complainant and placement in the community.

State of Georgia
Allegation:
This complaint was filed on behalf of a woman diagnosed with moderate mental retardation and other disabilities. The complainant was admitted to an institution during her childhood and resided at the institution for more than 38 years. The complainant alleged that the State's polices and practices forced her to live in an unnecessarily segregated setting in violation of the ADA's integration mandate.

Disposition:
Through OCR intervention and assistance, the complainant was approved for services and moved to the community.

State of Georgia
Allegation:
This complaint was filed on behalf of a man with severe mental retardation who had resided for many years in state psychiatric institutions. While at these institutions, the complainant never received habilitation and training that was appropriate for his disability. Because he lacked adequate training, he was never offered the community placement option. The complainant alleged that his continued institutionalization is a violation of the ADA's integration regulation.

Disposition:
As a result of OCR's intervention and assistance, the State took action to provide the complainant with a community placement transition plan and necessary training, and then moved him into the community.

State of Georgia
Allegation:
This complaint was filed on behalf of a woman who has schizophrenia. The complainant had lived in an institution for several years, but wanted to move to a more integrated setting. The complainant alleged that her continued institutionalization and the failure of the State to move her to a setting most appropriate to her needs violated the ADA's integration regulation.

Disposition:
As a result of OCR intervention, the State approved the complainant for services and placed her in the community.

State of Georgia
Allegation:
This complaint was filed on behalf of a man diagnosed with mental retardation who had lived in state institutions since early childhood. The complainant alleged that during his annual reviews the habilitation review committee found that he had no need for 24 hour medical care (which he alleged is a state law requirement for institutional placement.) Further, the complainant alleged that committee found he could have all of his habilitation needs met in a less restrictive community setting. The complainant alleged that the failure of the State to place him in a setting most appropriate to his needs is a violation of the ADA's integration regulation.

Disposition:
Working with State officials, OCR helped secure the necessary support services for the complainant's placement in the community.

Illinois

Illinois Department of Human Services/Eligibility Assessment Agency, Olympia Fields, Illinois
Allegation:
The complaint, a man with a developmental disability, had lived an Intermediate Care Facility for the Developmentally Disabled for approximately 13 years. The complainant alleged that the State failed to provide him with a placement in the least restrictive environment in violation of ADA and the Olmstead decision.

Disposition:
After working closely with the State for six months, OCR secured the placement of the complainant into a Community Integrated Living Arrangement home. The complainant was pleased that OCR was able to resolve the situation when he was unable to do so.

Illinois Department of Human Services/Eligibility Assessment Agency, Northbrook, Illinois
Allegation:
The complainant alleged that the State failed to provide him with a one-to-one assistant he needed to avoid unnecessary institutionalization.

Disposition:
Working closely with various components of the State, OCR secured a reassessment of the complainant, an agreement from the State to increase the one-to-one assistant care funding for the complainant from 11 hours for a 5-day week to 35 hours for a 7-day week, which permitted the complainant to remain in the community.

Illinois Department of Human Services
Allegation:
This complaint was filed to enable a person diagnosed with autism to make an appropriate transition from the state educational system for children to adult community services. The complainant alleged that the State failed to provide funds for adult day care services, and that without those services the complainant was in danger of being unnecessarily institutionalized.

Disposition:
Working with the State for a year, OCR helped secure an agreement that included a State-approved family Community Integrated Living Arrangement (CILA) award in excess of $50,000, something the complainant had been trying to obtain for two years prior to OCR's involvement. The receipt of this award permitted the complainant to obtain ten hours of direct support services and fifteen hours of respite on a weekly basis. In addition, he received forty hours of professional staff service per week. Moreover, the State is providing 208 hours per year in individual support to the complainant.

Illinois Department of Human Services
Allegation:
This complaint was filed on behalf of a woman with quadriplegia who had been placed in a nursing home instead of being referred to community services when she lost her housing. The complainant alleged that the State failed to provide her with the independent living resources which would allow her to leave the institution and live in a less restrictive community setting.

Disposition:
Working with the State for a year, OCR ensured that the complainant received the necessary community integration resources including a Determination of Need assessment, a housing voucher, and a vocational rehabilitation evaluation. The complainant was able to move into the community.

Illinois Department on Aging
Allegation:
The complaint alleged that the State failed to provide the complainant with additional hours of home services based on his disability and age.

Disposition:
As a result of OCR intervention and assistance, the complainant, after a brief hospitalization, was re-enrolled in the Community Care Program and granted 45 hours of service per month. The complainant was satisfied with the number of service hours a month and homemaker services provided by the State.

Illinois Department of Human Services
Allegation:
The complaint alleged that the because the State failed to find an appropriate community placement, a person with a disability was forced to live in a nursing home rather than receive services in a less restrictive setting.

Disposition:
As a result of OCR intervention and assistance, the complainant was able to move from a nursing home to a community residence. The State further changed the complainant's Medicaid status so that he can access Medicaid services in the community.

Illinois Department of Human Services
Allegation:
The complaint alleged that the State failed to find the a community placement for a person with mobility impairments, although the complainant could be appropriately served in the community. As a result, the complaint alleged that the complainant had no choice other than to reside in a nursing home.

Disposition:
Working with the State, OCR helped secure the complainant's removal from the nursing home to a community residence.

Illinois Department of Human Services
Allegation:
The complainant, a woman with multiple sclerosis and quadriplegia, alleged that the State failed to provide her with sufficient service hours to remain in her home. As a result, the complainant alleged, she was forced to move to a nursing home.

Disposition:
As a result of OCR's intervention and assistance, the complainant was discharged from the nursing home to an apartment of her own. The move was made possible from funds made available by the State's Community Reintegration Grant.

Illinois Department of Human Services
Allegation:
The complainant, a woman with mental and neurological impairments, alleged that the State failed to provide community housing options and therefore that she was forced to live in a nursing home.

Disposition:
Working with the State, OCR helped secure the complainant's discharge from the nursing home and move to a community residence. The State changed the complainant's Medicaid status so that she can access Medicaid services in the community.

Illinois Department of Human Services
Allegation:
This complaint was filed on behalf of a person with a developmental disability after her guardian and an advocacy organization had given up trying to move her from a 10-bed facility to a more independent and integrated community-based living arrangement that would foster skills to enable her to live more independently. The complainant alleged that the State failed to provide funds for the more integrated placement, thus making her remain in a more restrictive environment.

Disposition:
Working with the State for close to a year, OCR secured a placement in a more integrated living arrangement approved by the guardian.

Illinois Department on Aging/Laden Township, Illinois Family & Senior Services
Allegation:
The complainant, who is blind, alleged that he needed additional services to remain at home and avoid institutionalization.

Disposition:
As a result of OCR intervention and assistance, the complainant was provided with additional reader/senior companion services and such practical assistance as a taxi cab coupon book, case manager services and assistance in applying for waiver services.

Indiana

Indiana Family and Social Services Administration
Allegation:
This complaint was filed on behalf of a 41-year-old man with moderate mental retardation who had lived with a parent until the parent began experiencing health problems. The complainant's family applied for Medicaid waiver services, but the complainant was placed on a wait list, allegedly as a result of budget shortages. The complaint alleged that the complainant had waited for services for more than two years while living in group homes that the complainant and his family found inappropriate. Shortly before the complaint was filed, the complainant's sister moved the complainant to a subsidized apartment she located, where family members provided the complainant with his only community supports. The complaint alleged that the complainant had been denied a "priority" waiver by the State and thus was at risk of inappropriate institutionalization.

Disposition:
After OCR initiated its investigation, and the complainant's sister continued her advocacy, the State provided the complainant with a Medicaid waiver slot.

Indiana Family & Social Services Administration
Allegation:
Three complaints were filed with OCR alleging that the State-administered Aged and Disabled Medicaid Waiver Program requires that program recipients not leave home in order to receive benefits. The complainants contended that if they left their homes they would lose their benefits, thus being forced into a more restrictive nursing home setting.

Disposition:
Working with the State, OCR ensured that notices of clarification were sent to all providers of services, including home health providers. Specifically, the notices clarified that the Aged and Disabled Medicaid Waiver does not have an rule requiring clients to remain in their homes in order to receive services. In addition, OCR helped ensure that the State sent notices directly to the complainants explaining the rules of the program and confirming that individuals are not required to be confined to their home to receive services under the waiver.

Indiana Family & Social Services Administration
Allegation:
The complaint, a man with physical disabilities, alleged that the State failed to provide the complainant with supportive services that would enable him to live in his own home.

Disposition:
As a result of OCR's intervention and assistance, the State agreed to contact the complainant so that he could make a proper application to receive appropriate services under the State's Aged and Disabled Waiver. In addition, the State agreed to "fast-track" the complainant's application and assessment for the Aged and Disabled Waiver program. The complainant is now living in the community.

Indiana Family & Social Services Administration
Allegation:
The complainant alleged that the State failed to enroll him in the Medicaid Aged and Disabled Waiver program that would enable him to live in his own home. As a result, the complainant believed that he was at risk of unnecessary institutionalization.

Disposition:
OCR determined that the complainant had not applied to the State for the Aged and Disabled waiver and therefore, was not on the waiting list to receive services. Following OCR's intervention, the State "fast tracked" the Complainant's application and assessment for the Aged and Disabled Waiver Program. The complainant was found eligible for the waiver and is living in the community.

Kansas

Kansas Department of Social and Rehabilitation Services
Allegation:
OCR received a number of complaints filed by an advocacy organization on behalf of individuals with a variety of disabilities who resided at home and who alleged that they were at risk of inappropriate institutionalization. Each of the complainants alleged that they had applied for Medicaid waiver services. The complainants alleged that they had not been provided with waiver services, and were instead placed on a waiting list. Some of the complainants alleged that they had been offered nursing home care.

Disposition:
In each of these cases, after OCR initiated its investigation, the State provided the complainants with community-based services, and the complainants withdrew the complaint.

Kentucky

Kentucky Department of Mental Health and Mental Retardation Services

OCR initiated a compliance review of the Kentucky Department of Mental Health and Mental Retardation Services (DMHMRS) and its four state-owned or -contracted psychiatric hospitals to evaluate whether DMHMRS moved psychiatric hospital patients from the institution to the most integrated settings appropriate to their needs. Through the review, OCR identified concerns regarding timely discharge of patients, the adequacy of assessments, the existence of formalized transition plans, the scope of outplacement efforts and the adequacy of community resources to meet the complex needs of some patients. Prior to the conclusion of the review, DMHMRS agreed to work voluntarily with OCR on these issues. Through a Voluntary Resolution Agreement with OCR, DMHMRS agreed to undertake a variety of actions, including: (a) transitioning to more integrated settings institutionalized patients who are identified as appropriate for community placement; (b) developing a formalized procedure for identifying and assessing psychiatric hospital patients who are appropriate for community placement; (c) assessing current resources and providers to identify barriers to their use and the need for any specific new services or providers; and (d) creating a timeline for the transition of psychiatric hospital patients determined appropriate for community placement and a formal transition plan for each of these individuals. DMHMRS also provides OCR with certain information each month, including the names of individuals discharged and the reasons for the continued institutionalization of individuals who have not been discharged.

The steps taken by DMHMRS pursuant to this agreement helped facilitate the community placement of persons residing in psychiatric hospitals, including individuals who filed complaints with OCR. Some OCR complainants alleged that they remained institutionalized despite the recommendations of their treatment teams that community placement was appropriate. After OCR began its investigation, complainants were discharged from the institution and began receiving community services.

State of Kentucky
Allegation:
The complainant, a 23-year-old woman with mild mental retardation, alleged that she was inappropriately institutionalized in a facility for individuals with mental retardation. The complainant, who desired placement in a group home close to her family, alleged that her treatment team agreed that she could benefit from less restrictive placement in the community and she had previously been referred for community placement. The complainant alleged that the State was denying her services in the most integrated setting appropriate to her needs.

Disposition:
After OCR began its investigation, the complainant was discharged from the institution and began receiving community-based services.

State of Kentucky
Allegation:
The complainant, a 47-year-old-man with mental retardation, had been institutionalized for 40 years. He alleged that his treatment team agreed that he could benefit from a less restrictive environment, and that the State had denied him services in the most integrated setting appropriate to his needs.

Disposition:
After OCR began its investigation, the complainant's needs were assessed. The complainant was placed with a community-based provider.

State of Kentucky
Allegation:
The complainant alleged that she was inappropriately institutionalized in a State facility, and thus denied the opportunity to receive services in the most integrated setting appropriate to her needs.

Disposition:
After OCR began its investigation, the complainant was placed in an appropriate community-based setting.

State of Kentucky
Allegation:
This complaint was filed on behalf of a 46-year-old man with severe mental retardation who resided in an institution. The complaint alleged that the complainant wanted to live in a group home and that his treatment team agreed that he could benefit from a community placement in an appropriately structured environment.

Disposition:
After OCR began its investigation, the complainant was discharged from the institution and began receiving community-based services.

State of Kentucky
Allegation:
This complaint was filed on behalf of a 55-year-old-man diagnosed with psychiatric, developmental and physical impairments. The complainant had resided in an institution for more than 35 years. The complainant alleged that, to receive long-term care services, the State's policies and practices forced him to live in an unnecessarily segregated institutional-based setting in violation of the ADA integration regulation.

Disposition:
Working with the State, OCR helped secure the discharge of the complainant from the institution to a group home.

State of Kentucky
Allegation:
This complaint was filed on behalf of a 66-year-old woman with psychiatric, developmental and physical impairments who was admitted to an institution. The complainant alleged that to receive long term care services, the State's policies and practices forced her to live in an unnecessarily segregated institutional-based setting in violation of the ADA's integration regulation.

Disposition:
With OCR's intervention and assistance, the complainant moved from the psychiatric hospital to less restrictive environment of a nursing home. There she is being provided the level of care which has been deemed appropriate by her treatment team and facility administration.

State of Kentucky
Allegation:
This complaint was filed on behalf of a 39-year-old woman diagnosed with mental illness and blindness. She has an extensive history of hospital placement since adolescence and had been residing in an institution for several years at the time the complaint was filed. The complainant alleged that to receive long term care services, the State's policies and practices forced her to live in an unnecessarily segregated institutional setting in violation of the ADA's integration regulation.

Disposition:
Working with the State, OCR was able to effectuate the complainant's removal from the institution and her placement in a less restrictive community-based setting close to her parents' home.

State of Kentucky
Allegation:
This complaint was filed on behalf of a 46-year-old man who was admitted to an institution pursuant to a court order. The complainant was diagnosed with psychiatric and developmental impairments. While at the institution, the complainant's condition improved and various efforts were made to place the complainant in an alternative living arrangement. None of these efforts were successful. As a consequence, the complainant alleged that the State's policies and practices required him to live in an unnecessarily segregated institutional setting in violation of the ADA's integration regulation.

Disposition:
Working with the State and other stakeholders, OCR helped secure a placement for the complainant in a group house with two other individuals. The complainant has his own room and bathroom. He attends a community day program and is learning to administer his own medication. The complainant's advocate reports that his transition and adjustment have gone very well.

Louisiana

Louisiana Department of Health and Hospitals
Allegation:
The complainant, who has quadriplegia, alleged that he was denied community-based services and thus that he was at risk of unnecessary institutionalization.

Disposition:
After OCR initiated its investigation and began communicating with the State about this matter, the complainant began receiving two hours of service per day for bathing, dressing and other needs.

Louisiana Department of Health and Hospitals
Allegation:
The complainant, a 24-year-old man with paraplegia, had been residing in a nursing home for four years and sought community services. He alleged that the State's failure to provide him with community services denied him the opportunity to receive services in the most integrated setting appropriate to his needs.

Disposition:
After OCR initiated its investigation and began communicating with the State about this matter, the complainant was discharged from the nursing home, began receiving services from a personal care attendant, and began receiving training to obtain part-time employment.

Maryland

Department of Health & Mental Hygiene
Allegation:
The complaint, filed by an advocacy organization, alleged that the State failed to provide services in the most integrated setting appropriate. During the course of OCR’s involvement with the State on this issue, 28 individual complaints also were filed against the State.

Disposition:
As a result of OCR’s intervention and the State’s cooperation, 19 of the 28 individuals who had filed complaints were moved from institutional settings to community based services. OCR determined that the State was in compliance with the law with respect to the remaining nine individuals. OCR also recognized that while the State had made significant progress in systemic planning and involving interested parties in the planning process, considerable work remained to be done. OCR committed to continue monitoring the development and implementation of long-range planning in the State.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a woman with mental illness and dementia, who had resided in a psychiatric facility for more than ten years. The complaint alleged that the complainant's treatment team believed that she could be appropriately served in the community, and that the complainant had been ready for discharge for more than one year.

Disposition:
OCR resolved this case through a process utilized for all Olmstead complaints filed by or on behalf of Marylanders. This process included the identification of individuals for whom community services were appropriate, and monthly meetings between OCR and the State to monitor ongoing efforts to move forward plans for community placement. Through this process, after OCR initiated its investigation, the complainant was moved into an assisted living community residential services program and provided with day services.

Maryland Department of Health and Mental Hygiene
Allegation:
The complainant, who had resided in a psychiatric facility for several years, was diagnosed with mental retardation and mood disorder. The complainant alleged that she was denied services in the most integrated setting appropriate for her needs, despite treatment professionals' determination that she could be appropriately served in community based setting.

Disposition:
OCR resolved this case through a process utilized for all Olmstead complaints filed on behalf of Marylanders. This process included the identification of individuals for whom community services were appropriate, and monthly meetings between OCR and the State to monitor ongoing efforts to move forward plans for community placement. Through this process, after OCR initiated its investigation, the complainant was moved into an assisted living community residential services program and provided with day services.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a nine-year-old boy who resided at a chronic care facility. This child had a history of neurological impairment and seizure disorder and utilized a ventilator. The complaint alleged that the child had been ready for discharge for several months, and that a community-based residential provider was willing to serve him. The complaint alleged that the State denied the child the opportunity to receive services in the most integrated setting appropriate to his needs.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint concerned a 47-year-old man with mental illness, deafness and morbid obesity who resided in a psychiatric institution. The complaint alleged that although the complainant was ready for discharge from the institution, the State was unwilling to provide funding for an adequate level of community support services. Thus, the complaint alleged, the complainant was unnecessarily institutionalized and denied services in the most integrated setting appropriate to his needs.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a person with a severe seizure disorder, mental retardation, cerebral palsy and deafness. The complainant was admitted involuntarily to an institution for treatment of episodes of intermittent explosive disorder. The complainant had formerly resided in several different group residential settings. Some months later, the complainant's treatment team recommended that he be placed in a residential facility which could meet his unique needs. However, no community-based residential program existed at that time that could meet his combined residential, social, medical, communication and behavioral needs and the complainant remained institutionalized. The complainant alleged that the State had failed to place him in the most integrated setting appropriate to his needs.

Disposition:
With OCR's intervention and assistance, the complainant was discharged to a community-based service provider which was able to meet his unique needs.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of an 80-year-old woman diagnosed with a depressive disorder and deafness. She had numerous medical problems including ataxia, hepatitis, congestive heart failure, hypertension and cognitive disabilities. Prior to her admission to an institution, she resided in the community in her own apartment. A few months later, the institution recommended that the complainant be discharged to a supervised aftercare facility. However due to various intra agency disputes, her discharge was delayed. The complainant alleged that the State is in violation of ADA and the Olmstead decision because of the failure to place her in the community.

Disposition:
Working with the State, OCR was able to resolve the delayed discharge issues. The complainant was discharged to a community provider for individuals with hearing impairments, which provided her with senior residential housing.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a 78-year-old male who is deaf and has a number of other medical problems. He was diagnosed with adjustment disorder and suicidal ideation at the time of his admission from the community to an institution. The complainant alleged that he was inappropriately confined to an institution in violation of the ADA and the Olmstead decision.

Disposition:
Working with the State, OCR was able to secure the complainant's discharge to a community mental health program for people with deafness.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a 22-year-old man diagnosed with psychiatric and developmental impairments and substance abuse. The complainant was placed in maximum security forensic hospital by the court. Some months later, the court directed that the State provide the complainant with housing and treatment in the community as an alternative to incarceration. However, community placement was delayed, reportedly because of funding issues and the need for an open slot to develop in a residential program. Because of the delay, the complainant alleged that he was not receiving services in the most integrated setting appropriate to his needs.

Disposition:
Working with the State, OCR was able to resolve the delayed placement and the complainant was discharged to a community-based provider.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a 26-year-old man diagnosed with psychiatric and developmental disabilities. The complainant was placed in a psychiatric facility. Several months later, the institution applied for to the State for community placement. The request was denied because the complainant's mental retardation diagnosis was then in question and therefore he did not qualify for certain services. The complainant alleged that he was not receiving services in a setting that is most appropriate to his needs.

Disposition:
With OCR intervention and assistance, the complainant was found eligible for services and he was discharged to a community service provider.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a 36-year-old woman with cerebral palsy, moderate mental retardation and bipolar disorder. The complainant has resided in an institution for more than 20 years. The complainant visited several group homes in preparation for discharge. However, her discharge was delayed. The complainant alleged she is not receiving services in the most integrated setting appropriate to her needs.

Disposition:
OCR was able to help resolve the delay in providing the complainant with community services. The complainant was discharged to a group home where she resides with two housemates.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a 41-year-old woman with visual impairments, cerebral palsy and moderate mental retardation. She has lived in an institution for the past 25 years. The complainant has expressed a desire to move from the institution to a community-based setting.

Disposition:
The OCR investigation found that the State has made reasonable efforts to place the complainant in a community setting. However, the complainant has exercised her choice not to move from the institution at this time. The State has assured OCR of its continuing commitment to pursue community placement with this individual in the event that she changes her mind and finds a placement she likes.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a 20-year-old woman diagnosed with a severe neurological impairment and mental retardation with associated physical impairments. She requires 24-hour-a-day oxygen, turning every 2 hours and assistance with all activities of daily living. The complainant alleged that she was not receiving services in the most integrated setting appropriate to her needs in violation of the ADA and the Olmsteaddecision.

Disposition:
As a result of OCR intervention, the complainant was moved out of the hospital and placed in an alternative living arrangement operated by the county Association of Retarded Citizens.

Maryland Department of Health and Mental Hygiene
Disposition
This complaint was filed on behalf of a 20-year-old woman diagnosed with severe mental retardation, cerebral palsy, and a variety of physical impairments. She requires 24-hour staffing and assistance with all activities of daily living. She is able with difficulty to verbally communicate basic needs. The complainant alleged that she is not receiving services in setting most appropriate to her needs in violation of the ADA and the Olmsteaddecision.

Disposition:
With OCR intervention and assistance, the complainant moved out of the hospital to a community living arrangement more appropriate to her needs.

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of an individual diagnosed with mental retardation and schizo affective disorder. The complainant had resided in an institution for more than five years, but had sought services in the community. The complainant alleged that the failure of the State to place her in the most integrated setting appropriate to her needs was a violation of the ADA and the Olmstead decision.

Disposition:
Working with the State and other stakeholders, OCR helped secure the complainant's move into the community.

Michigan

Michigan Department of Community Health
Allegation:
The complainant alleged that the State reduced her home and community-based waiver hours, thus putting her at risk of institutionalization

Disposition:
As a result of intervention, the State restored the complainant's service hours.

Minnesota

Minnesota Department of Human Resources
Allegation:
This complaint was filed on behalf of a person with a mental disability who had been admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the complainant was eligible for home and community-based services. However, placement was delayed. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the least restrictive setting.

Disposition:
As a result of OCR intervention and assistance, the complainant was provided with a home and community-based services program.

Minnesota Department of Human Resources
Allegation:
This complaint was filed on behalf of a person with mental illness who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the complainant was eligible for home and community-based services. However, placement was delayed, reportedly due to the complainant's history of violence associated with mental illness. After approximately nine months of delay, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the least restrictive setting.

Disposition:
Working with the State, OCR helped secure a new foster care service provider who was willing to serve the complainant in a foster care home.

Minnesota Department of Human Resources
Allegation:
This complaint was filed on behalf of a person with a mental disability who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the complainant was eligible for home and community-based services. However, placement was delayed. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the least restrictive setting.

Disposition:
Through OCR intervention and assistance, the complainant was provided with home and community-based services program.

Minnesota Department of Human Resources
Allegation:
This complaint was filed on behalf of a person with a mental disability who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the complainant was eligible for home and community-based services. However, placement was delayed due to treatment related to diabetes and appendicitis and difficulty finding a community placement to meet the complainant's needs. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the least restrictive setting.

Disposition:
Working with the State, OCR helped secure the complainant's placement in a foster care home.

Disposition:
As a result of OCR's intervention and assistance, the complainant was placed in a community residential mental illness program.

Disposition
Working with the State and the complainant's guardian, OCR helped secure the complainant's placement in a community Intermediate Care Facility/Mental Retardation program.

Disposition:
As a result of OCR intervention and assistance, the complainant was provided with home and community-based services.

Minnesota Department of Human Services
Allegation:
The complaint alleged that the State failed to provide appropriate home and community-based services to enable the complainant, a person with a mental disability, to leave a state institution and live in the community. The complainant had allegedly tried for more than a year to be discharged from the institution.

Disposition:
Working with the State, OCR helped secure the necessary services to permit the complainant's provisional discharge from the institution and placement in community-based apartment operated by the State.

Missouri

Missouri Department of Social Services (MDSS) and the Bureau of Special Health Care Needs
Allegation:
The complaint alleged the State reassessed the number of hours of in-home nursing services provided to the complainant's daughter, who has a number of developmental and physical impairments. The complainant alleged that the hours of care provided as a result of the re-assessment were inadequate, thus placing her daughter at risk of unnecessary institutionalization.

Disposition:
This case was resolved with OCR's intervention and assistance. After OCR initiated its complaint investigation, the complainant's daughter received a feeding tube, and her health improved. Following discussions with OCR about changed circumstances, the complainant expressed the view that she could provide adequate services to her daughter using a reduced number of hours of nursing services. After complainant stated that she was satisfied with the amount of hours her daughter was receiving and no longer wished to continue her complaint, OCR closed the case. (OCR Docket # 03-09058)

Missouri Department of Mental Health
Allegation:
This complaint was filed by the mother of a 12-year-old girl with autism. The complaint alleged that the daughter was at risk of unnecessary institutionalization, because the State failed to provide the daughter with Medicaid waiver services. The complainant's daughter was receiving all of the services available under the Medicaid waiver, but the services were being paid for solely with State funds, not Medicaid funding. The complainant asserted that these non-Medicaid funds could be taken away at any time.

Disposition:
This case was resolved with OCR's intervention and assistance. OCR worked with the parties to improve communication between the complainant and the recipient about the child's needs and available services and funding. Following these efforts, the complainant's daughter received a Medicaid waiver slot.

Missouri Department of Social Services Division on Aging/Missouri Department of Mental Health
Allegation:
This complaint was filed on behalf of a 40-year-old woman with quadriplegia and mild brain damage. The complainant alleged that she was in danger of unnecessary institutionalization because of the failure of the State to provide her with adequate in-home care. The complainant and her mother alleged that she had been without in-home care for many months. The complainant's mother stated that nursing home placement for the complainant had been attempted, but that nursing homes could not adequately meet the complainant's care needs because of her special and complicated condition.

Disposition:
As a result of OCR intervention and assistance, the State developed a service plan that authorizes personal services for the complainant 24-hours a day, seven days a week. The plan assures that the complainant has maximum control over these services by giving her authority to hire, manage and fire her own attendants.

Missouri Department of Social Services Division of Medical Services
Allegation:
The complainant, a 44-year-old woman with paraplegia and multiple health problems, alleged that the State Medicaid program does not pay for diapers to persons unless they are institutionalized. The complainant stated she needed help in paying for this item in order to remain independent and in her own home. The complainant's annual cost of adult diapers was more than 20% of the complainant's annual income.

Disposition:
With the complainant and other stakeholders, OCR explored options to provide diapers for the complainant. An independent agency agreed to provide the complaint with diapers free of charge.

Missouri Department of Mental Health
Allegation:
A complainant with a mental disability alleged that he was in danger of unnecessary institutionalization unless a supported living placement could be arranged for him. The complainant stated that the State had suggested a group home placement, but this would not be the least restrictive setting.

Disposition:
Working with the State and other stakeholders, OCR helped facilitate the complainant's placement into a shared, private apartment , with access to appropriate support services.

Nebraska

Nebraska Department of Health and Human
Allegation:
This complaint, a person with a disability living in an institution, alleged that the State had failed to take action to permit him to live closer to his family in a less restricted setting.

Disposition:
As a result of OCR's intervention and assistance, the complainant was moved from the institution to a private apartment. OCR also helped assure that the complainant received vocational training.

New Jersey

New Jersey Department of Human Services, Division of Disability Services
Allegation:
The complaint was filed by an advocacy organization on behalf of a 42-year old man with mental illness who had been residing at a psychiatric hospital for over three years. The complaint alleged that the New Jersey Department of Human Services (NJDHS) discriminated against the man by keeping him institutionalized at the hospital.

Disposition:
As a result of effective collaboration between OCR and NJDHS, the man was discharged from the hospital and relocated to a boarding home. The boarding home is a less restrictive and more integrated setting as compared to the hospital and the man’s family was satisfied with the new placement.

New Jersey Department of Human Services, Division of Disability Services
Allegation:
The complaint was filed on behalf of a 49-year old man with mental illness who had been residing at a psychiatric hospital for almost 16 years. The complaint alleged that the New Jersey Department of Human Services (NJDHS) discriminated against the man by keeping him institutionalized at the hospital.

Disposition:
As a result of effective collaboration between OCR and NJDHS, the man was discharged from the hospital and relocated to a specialized residence. While supervision exists at the specialized residence, it is a less restrictive and more integrated setting than the hospital and the man expressed satisfaction with the new placement.

New Jersey State Division of Developmental Disabilities
Allegation:
This complaint was filed on behalf of a young woman with neurological impairments who had resided both with her family and in a group home setting, and who had also experienced a number of emergency psychiatric hospitalizations. The complainant was living at home when the complaint was filed. The complaint alleged that the complainant was at risk of inappropriate institutionalization due to the State's denial of appropriate home and community based services and its failure to provide the complainant with a behavior modification evaluation, a traumatic brain injury evaluation, and a vocational assessment.

Disposition:
OCR engaged in substantial fact-finding and other work with the complainant and her family, State officials and health and social services providers to resolve this matter. As a result of OCR's efforts in numerous phone calls and meetings with the State, the complainant and other parties, the complainant was placed in a group home operated by an agency that had previously provided the complainant with services considered by the complainant and her family to be appropriate and successful. The complainant also began working. OCR confirmed that the complainant and her family were satisfied with the group home placement, and closed the case.

New Jersey Department of Human Services, Division of Disability Services
Allegation:
This complaint was filed on behalf of a 62-year-old woman with cerebral palsy. The complainant had lived in her own apartment, but after hospitalization for a fall, she was institutionalized in a nursing home. The complaint alleged that the State discriminated against the complainant by depriving her of the opportunity to live in the most integrated setting appropriate to her needs.

Disposition:
This complaint was resolved through OCR's fact-finding, intervention and assistance. OCR learned that the nursing home did not want to discharge the complainant without additional hours of home care service and a personal emergency call device. The State agreed to approve additional hours of home care services for the complainant, and the complainant's treatment team agreed to obtain an emergency call device for her use. The complainant was then discharged to her apartment with these support services.

Psychiatric Hospital, Hammonton, New Jersey
Allegation:
This complaint was filed on behalf of a 45-year-old man diagnosed with pervasive developmental disorder, autistic disorder, bipolar disorder, Tourette's Disorder and mild mental retardation. The complainant alleged that he is being prevented from moving into the community in violation of the ADA and the Olmstead decision. The complainant had lived with his elderly parents who cared for him for 44 years. When his aged parents were no longer capable to taking care of him, the complainant was admitted to an institution and was placed on a Developmental Disabilities (DD) emergency list for residential placement. Some months later, an independent evaluation was conducted for the complainant and it was again recommended that complainant be transferred as soon as possible to a residential placement. Despite these recommendations, an Individual Habilitation Plan (IHP) was not developed for almost a year after the complainant became eligible for DD services. The IHP stated that complainant wanted to live in the community with 3 or 5 other individuals, find a job and maintain contact with his family.

Disposition:
With OCR intervention and assistance, the long delay in residential placement was resolved and the complainant moved into a group home where he receives day program services appropriate for persons with autism and developmental disabilities.

New Mexico

New Mexico Department of Human Services
Allegation:
This complaint was filed on behalf of a 22-year-old woman with quadriplegia who lived in a nursing home. The complainant has limited mobility, uses a wheelchair, and requires daily assistance with all major life activities. The complainant was put on the State's Central Registry for a Developmental Disabilities (DD) waiver, which would enable the complainant to live in the community. However because of a substantial time lag with no movement on community placement under the DD waiver, a complaint was filed alleging that the State was violating the complainant's rights under the ADA by requiring her to remain in an institution and denying her the opportunity to receive services in the most integrated setting.

Disposition:
Working with the State and the complainant's advocate, OCR helped secure a crisis developmental disability waiver placement. The waiver covered all necessary services and the complainant is living on her own in the community.

New Mexico Human Services Department
Allegation:
The complainant alleged that the State violated his rights under the ADA by requiring that he remain in an institution and failing to provide him with services in the most integrated setting.

Disposition:
OCR determined that complainant wished to move to Utah to be with his family, but the family home needed accessibility modifications. This prompted a collaborative effort between OCR, the complainant's advocate, the State of Utah and the Navajo Tribal Government to secure the home modifications and a Utah waiver, enabling the complainant to live at home.

New York

New York State Department of Health
Allegation:
This complaint, filed on behalf of a man with traumatic brain injury, alleged that the complainant was forced to remain in a hospital, was deprived of appropriate home health care services and thus was denied services in the most integrated setting appropriate to his needs.

Disposition:
OCR made numerous phone calls with the complainant, the State and other parties in order to have the complainant obtain services under the Traumatic Brain Injury (TBI) waiver program. In addition, OCR, with the assistance of the State and other parties for the complainant, was able to secure the provision of occupational therapy, physical and speech therapies for the complainant. Due to OCR's intervention, the State also made certain physical modifications to the complainant's home. The complainant agreed that the issues of the complaint had been resolved, and OCR closed the complaint.

Sullivan County, New York Division of Health and Family Services/New York State Department of Health
Allegation:
This complainant, who has a variety of physical and mental impairments, alleged that State and County agencies had discriminated against her on the basis of disability in denying her home health care services. The complainant alleged that the denial of home care services placed her at risk of unnecessary institutionalization.

Disposition:
This case was resolved as a result of OCR's intervention with the State and assistance to the advocate representing the complainant. OCR made numerous phone calls to the State and to the advocate to secure personal care services for the complainant. The complainant was reassessed for home care services and provided with 8 hours per day of personal care services. This resolution allowed the complainant to remain in her apartment with appropriate supportive services.

New York State Department of Health and Genesee County, New York Department of Social Services
Allegation:
The complaint alleged that a woman with diabetes, mild mental retardation, blindness and mobility impairments was discriminated against when the State and County terminated the complainant's independent living arrangement. The complainant, who then entered an institution, alleged that she had been denied alternative community placement and supportive services, and thus was prevented from receiving services in the most integrated setting appropriate to her needs.

Disposition:
OCR worked extensively with the complainant, the State and the county to resolve the complaint. OCR made numerous phone calls and reviewed data to assist the complainant to be placed in the community. Following OCR's intervention and assistance, the complainant moved to her own apartment and began receiving personal assistance services.

New York State Department of Health, Office of Mental Retardation and Developmental Disabilities
Allegation:
This complaint alleged the inappropriate institutionalization of a 66-year-old woman with visual impairment, renal failure secondary to diabetes, seizure disorder and moderate mental retardation. The complainant, who had been admitted to a hospital after a fall, wanted to return to her home and receive appropriate community-based services. The complainant had been placed on "alternative level of care" status, in which she could be discharged as long as she received appropriate home care services. However, no home health care agency would provide her with services due to a determination that the complainant could not self-direct her care.

Disposition:
OCR interviewed the complainant, reviewed information and made numerous phone calls to the State regarding this complaint. This complaint was resolved due to OCR's continued follow up with the State to provide services to the complainant. Due to OCR's intervention and assistance, the complainant was discharged to her own apartment and provided with 24-hour-per-day supervision, case management services, day program services, medication management, dialysis and diabetes monitoring. In addition, a dispute regarding the appropriate guardian for the complainant was resolved when guardianship was awarded to a local community services agency.

Madison County, New York Department of Social Services & New York State Department of Health
Allegation:
The complainant, a 23-year-old man with paraplegia who resided in an institution, alleged that he had been denied an appropriate amount of personal assistance services. The complainant alleged that his physician had prescribed 24-hour supervision for him to successfully live in the community, but a county social service agency had approved him for only 11 hours of personal assistance services each day. The complainant alleged that he needed 24-hour care due to his medical needs and limited physical abilities, and that the denial of 24-hour care resulted in his inappropriate institutionalization.

Disposition:
OCR made numerous phone calls to two county social service agencies to resolve the number and type of hours of personal care assistance needed by the complainant. Due to OCR's intervention and assistance in working with the complainant, the State and other parties, this complaint was satisfactorily resolved. The complainant's physician's order was amended to prescribe 11 hours daily of direct personal assistance services, supplemented with 13 hours per day of informal supports. The complainant was then discharged to a community placement and confirmed to OCR, through an advocate, that he was receiving appropriate services.

New York State Department of Health (NYSDOH) & Herkimer County, New York Alternatives Program
Allegation:
The complainant, a 44-year-old man with quadriplegia, alleged that he was at risk of inappropriate institutionalization due to his inability to obtain Licensed Practical Nursing (LPN) services. NYSDOH decreased the complainant's nighttime LPN care from two hours per night to one hour per night following a fair hearing decision. The complainant alleged that no area home health care provider would agree to serve him for only one hour per night, and that without nightly LPN care, he would be forced to enter a nursing home.

Disposition:
Following OCR's intervention and assistance, this complaint was resolved. OCR conducted numerous telephone conferences regarding this case with NYSDOH officials, administrative officials, and health care and social services providers. NYSDOH agreed to adjust the schedule and payment rate for the complainant's LPN services. Upon confirming the revised schedule and the complainant's satisfaction with the level of service provided, OCR closed the complaint.

Nursing Home, Staten Island, New York
Allegation:
This complaint was filed on behalf of a mentally retarded individual with mobility impairments. The complainant was admitted into an institution because of its intensive therapy program to improve neuromuscular skeletal dysfunction. The complainant alleged that he was not receiving physical therapy, and was being treated like a psychiatric patient. The complainant wanted to move into a living situation that was more attuned to his disability and service requirements.

Disposition:
With OCR's intervention and assistance, the complainant was moved to a less structured Intermediate Care Facility (ICF) that is in the most integrated setting appropriate to his needs. OCR visited the facility and found that the complainant had adjusted very well to his new surroundings and the facility appeared to be doing a good job meeting his needs for supports and services. OCR was informed by the Project Director during the tour that the complainant had learned the daily routine; has fit in well with the other consumers; received new clothes; received a refitted wheelchair and was participating in a day treatment program at the United Cerebral Palsy Center where he was doing well.

New York State Department of Health
Allegation:
This complaint was filed on behalf of a 29-year-old man with quadriplegia who has a spinal cord injury. The complainant was residing in an institution and wanted to live in the community in his own apartment. Although the institution believed that a discharge to the community with appropriate supports would be safe for the complainant, allegedly no progress was being made in accomplishing this objective.

Disposition:
With OCR intervention and assistance, the complainant secured appropriate housing in the community and moved into his own apartment with appropriate aide services.

New York State Department of Health
Allegation:
This complaint was filed on behalf of an individual who has multiple sclerosis. The complainant had received home health services from the provider for several years. She was hospitalized for surgery and released to an institution a few months later. Although the complainant wished to return to her apartment, she was told by the provider that her case with them had been closed. If it were reopened, the provider would provide her with services for two hours a day, rather than the six to eight hours per day she had previously received. Without adequate supports it was not possible for the complainant to live in the community.

Disposition:
With OCR's intervention and assistance, the complainant was moved to a wheelchair accessible apartment where she receives 24-hour attendant services through the Consumer Directed Personal Assistance Program.

Residential Health Care Facility, Rochester, New York
Allegation:
This complaint was filed on behalf of a 32-year-old man with quadriplegia, who had previously lived in an apartment with the assistance of a home health aide. The complainant lost his apartment and was involuntarily transferred to an institution. The complainant was subsequently offered a wheelchair accessible apartment that was suitable to his needs, but was unable to move to the apartment because of his inability to obtain home health care services. The complainant alleged that he was verbally denied home health care services because he was not able to provide appropriate back-up for these services.

Disposition:
With OCR's intervention, the complainant was accepted into a Consumer Directed Program which allowed him to coordinate and employ his own personal care assistance aides. OCR assisted the complainant in securing an aide and the complainant was discharged from the institution and is now living in his own apartment in the community. (OCR Docket # 02013023)

New York State Department of Health/ Monroe County, N.Y. Department of Social Services
Allegation:
The complainant has multiple sclerosis and had lived in the community with home care for over 20 years. For the last 13 years, she had received 8 to 10 hours of care per day, including a Personal Emergency Response System (PERS), which allowed her to be left alone for a limited period of time. During a hospitalization, the State agency providing the complainant with home care closed her case. Efforts to secure home health services from other sources were unsuccessful and the complainant was allegedly placed in an institution against her will.

Disposition:
Working with the Consumer Directed Personal Assistance program and the State, OCR was able to put in place an arrangement which permitted the complainant to move back into her home and receive an increase to 16 hours per day of attendant services.

New York State Department of Health
Allegation:
The complainant, who has quadriplegia, lives at her home and uses a motorized wheelchair. She requires a great deal of help in bathing, dressing, bowel and bladder assistance, and other activities of daily living. She is in the Consumer Directed Personal Assistance Program where aides are paid $6.00 an hour. She is responsible for locating, hiring, training and scheduling the aides. The complainant believed that discrimination existed because the county in which she lives pays a lower hourly rate in Medicaid funds to medical assistants than other counties in the State. The complainant alleged that this low pay rate puts her at risk of unnecessary institutionalization since it is extremely difficult to find aides because of the low reimbursement rate.

Disposition:
In collaboration with the State and other stakeholders, OCR negotiated an increase in the reimbursement for home health aides in the county where the complainant resided, from $6 to $10 per hour. At this new rate, the complainant was able to secure a home health aide and remain in a community setting.

New York State Department of Health
Allegation:
This complaint was filed on behalf of a 56-year-old woman who has cerebral palsy. The complainant had lived in group homes and a private home where she received home care services. The complainant was hospitalized for treatment of a hiatal hernia and acid reflux disease. When her condition stabilized, the complainant alleged that she was transferred to an institution against her wishes.

Disposition:
With OCR's intervention and assistance, the complainant was able to move into her own apartment and receive community-based services through the Consumer Directed Program. OCR also assisted in her enrollment into a home and community-based service waiver which provided her with residential habilitation, day habilitation and individual supportive services to help her with reintegration into the community.

New York State Department of Health/Home Health Care Agency, Patchogue, New York
Allegation:
This complaint was filed on behalf of an individual who required a wheelchair for ambulation. The complainant was authorized to received Medicaid home care services for assistance. The complainant alleged that Medicaid and the State failed to provide her with the aide services authorized by her care plan. Because she was having difficulty obtaining home care services from the State, the complainant was institutionalized and allegedly could not be discharged.

Disposition:
Working with the State and other stakeholders, OCR helped secure the Medicaid home health aide services authorized under the complainant's care plan. With services in place, the complainant moved from the institution to her own home.

New York State Department of Health/Hospital, Rochester, New York
Allegation:
This complaint was filed on behalf of an individual with brain injury who had lived in the community for several years with home health care services and other supportive services provided through the Traumatic Brain Injury Waiver. The complainant suffered some complications and was admitted to an acute care facility. After her convalescence, the complainant was unable to return to the community because of the loss of her traditional home health care services. The complainant alleged that the State is violating the ADA by forcing her to remain in an acute care hospital setting and refusing to reinstate her home health services.

Disposition:
With OCR's intervention and assistance, the complainant's home health services were restored. She was discharged from the hospital and moved into her own apartment. OCR also assisted in the complainant's acceptance into the Consumer Directed Program where she receives 24-hour attendant services and her attendants are paid a higher wage (enhanced rate) so she can easily recruit replacements as necessary.

New York State Department of Health/Nursing Home, Binghamton, New York
Allegation:
This complaint was filed on behalf of a woman with mobility impairments who uses a wheelchair. The complainant admitted herself to an institution due to a kidney stone and related health issues. She was told her stay at the institution for rehabilitation would not exceed one month during which time she was to receive health care services to recover from her kidney stone. After her recovery, the complainant was prevented from returning to the community because she was not able to secure required attendant care. The complainant alleged that the State and the treating institution violated the ADA by forcing her to remain in a skilled nursing facility and denying her the opportunity to return to the community and receive service in the most integrated setting.

Disposition:
With OCR's assistance, the complainant was able to secure the necessary attendant care support (20 hours per week) under the Consumer Directed Program. OCR also helped ensure that the complainant received residential habilitation services under a Medicaid waiver. The complainant is now living in her own accessible apartment in the community.

New York State Department of Health/Suffolk County, N.Y. Department of Social Services
Allegation:
This complaint was filed on behalf of a person with muscular dystrophy. The complainant alleged that he has not been receiving home health services authorized by his care plan. The complainant believed that without appropriate attendant care, he will face the risk of being forced from his home into an institution.

Disposition:
Working with the State and other stakeholders, OCR secured a change in the complainant's home health care plan and obtained an increase to 5 hours per day of home health care services. This increase allowed the complainant to remain independent.

New York State Department of Health/Home Health Care Agency, Hauppauge, New York
Allegation:
This complaint was filed on behalf of a person who has had a stroke, an aneurysm and back surgery. She uses a cane for assistance in walking. Although the complainant was authorized to receive Medicaid home care services for assistance, care has been inconsistent. Because she was having a problem obtaining adequate home care services, the complainant believed that she was in danger of unnecessary institutionalization.

Disposition:
With OCR's intervention and assistance, the problems associated with the complainant's home health assistance were resolved. The complainant is now receiving all the Medicaid home care services authorized in her care plan, permitting her to remain in the community.

New York State Department of Health/Home Health Care Agency, Watertown, New York
Allegation:
This complaint was filed on behalf of a 14-year-old female who has physical and developmental disabilities. The complainant is authorized 24-hour nursing care services due to her condition. The agency providing services allegedly prohibited the complainant's nurses from accompanying her anywhere outside of her home except to school. The complainant would like her nurses to accompany her outside of her home and school so that she can have full access to the community.

Disposition:
Working with the State and the provider, OCR was able to secure an agreement that permits appropriate nursing coverage outside the school and home, thereby assuring full access to community living.

Finger Lakes Developmental Disabilities Service Office, Rochester, New York
Allegation:
This complaint was filed on behalf of a person with a disability who was in danger of losing a promised apartment that would allow him to live in the most integrated setting. Allegedly, the complainant had been unable to move into the apartment because the State required a "back fill" replacement for the complainant and a "back fill" had not been found to replace complainant in his supportive living arrangement.

Disposition:
With OCR's intervention and assistance, the outstanding back fill problem was resolved. The complainant is currently living in his own apartment and receiving services through the home and community-based waiver program.

New York State Department of Health
Allegation:
This complaint was filed on behalf of an individual diagnosed with a visual impairment and renal failure secondary to diabetes, a seizure disorder, and mild to moderate mental retardation. The complainant alleged that she is required to remain in an acute care hospital against her will. Complainant stated that prior to her hospitalization, she lived in an apartment and received home health aide services as well as residential habilitation and day habilitation under the State waiver program. Complainant could not be safely discharged from the hospital to her own home because home health aide services had been denied.

Disposition:
Working closely with the State and service providers, OCR was able to secure an arrangement for the safe discharge of the complainant to her own home. The complainant is also receiving adequate supportive services to maintain her in the community in her own home.

New York State Department of Health/ Home Health Care Agency, Kings Park, New York
Allegation:
This complaint was filed on behalf of a woman who has arthritis and requires assistance with ambulation. The complainant alleged that the State reduced the number of hours of home health care assistance from 22 hours a week to 152 hours resulting in less time to assist in household chores. Additionally, the complainant alleged that the State is refusing to allow a home health aide to accompany her to medical appointments. The complainant believed that without adequate Medicaid home care services she was at risk of being unnecessarily institutionalized.

Disposition:
With OCR's intervention and assistance, the complainant was accepted into a new State personal aide program and is now receiving adequate personal care services.

New York State Office of Mental Retardation and Developmental Disabilities
Allegation:
This complaint was filed on behalf of a 34-year-old man with an extensive history of psychiatric hospitalizations and treatment. He was admitted to an institution reportedly because he became agitated and aggressive at home. After his psychiatric stabilization, the complainant remained institutionalized. The complainant alleged that he is being denied placement in the community in violation of the ADA and the Olmstead decision.

Disposition:
With OCR's intervention and assistance, the complainant was placed into a permanent transition home consisting of habilitation services, social worker services, registered nurse habilitation specialist services, psychiatric services and other services.

New York State Department of Health/Westchester County N.Y. Department of Social Services/New York State Office of Mental Retardation and Developmental Disabilities
Allegation:
This complaint was filed on behalf of a woman diagnosed with spinal muscular atrophy/quadriplegia. Prior to the complainant's institutionalization, she lived with her elderly mother in a private home. The complainant wants to live in the community and receive services in a more integrated setting.

Disposition:
Working with the State and other stakeholders, OCR was able to secure a private apartment and two twelve hour aides daily making it possible for the complainant to live in the community.

New York State Department of Health/Nursing Home, New Hartford, New York
Allegation:
This complaint was filed on behalf of an individual with multiple sclerosis who lived in an institution. The complainant believed that with proper supports she is fully capable of living in the community. The complainant alleged that because community supports have not been provided she is involuntarily confined to an institution in violation of the ADA and the Olmstead decision.

Disposition:
With OCR's intervention and assistance, the complainant moved into her own apartment and is receiving adequate supportive services.

New York State Department of Health
Allegation:
This complaint was filed on behalf of a 50-year-old woman who has multiple sclerosis. The complainant was hospitalized due to a burn and was subsequently transferred to an institution. Prior to her institutionalization, the complainant had lived in her own home with her two children. The complainant wants to return to the community.

Disposition:
As a result of OCR's intervention, the complainant was discharged from the institution. OCR also helped secure a private apartment for the complainant and 18 hours per day of personal care services provided through the Consumer Directed Personal Assistance Program.

Oklahoma

Oklahoma Department of Human Services
Allegation
Five complainants with quadriplegia filed complaints with OCR regarding a change in eligibility criteria for a Medicaid waiver program to provide community services to individuals who are elderly or have physical disabilities. The complainants alleged that they were at risk of unnecessary institutionalization due to a change to eligibility criteria concerning the age of onset of disability.

Disposition
OCR initiated its efforts to resolve these complaints in the context of work with the State on its Olmsteadplanning process and identification of barriers to community living. After OCR began its investigation, the State requested and received approval from the HHS Centers for Medicare and Medicaid Services (CMS) for an amendment to the waiver program's eligibility criteria. The amendment raised the age of onset of disability for eligible individuals. When this amendment took effect, all of the complainants were once again eligible for the waiver program. OCR documented that the State resumed providing each complainant with appropriate community-based services through the waiver, and closed the complaints.

Oklahoma Department of Human Services (ODHS)
Allegation:
The complainant alleged that Oklahoma's Advantage Waiver program (a Medicaid waiver program for individuals with physical disabilities) failed to provide him a full range of services to allow him to continue living in the most integrated setting in the community. The complainant has quadriplegia and uses a wheelchair. The complainant alleged that ODHS allowed contractors to endanger his well being by providing no back-up services for providers who fail to show for work and by failing to provide enough hours to let him live independently (a minimum of 42 hours a week). The complainant lived on his own in an apartment on his mother's property. His mother provided additional care in the evening. However, his dependency on his mother strained their relationship, and the complainant paid for his own aides for about 15 months. The complainant's aide could not be certified to provide the service through a Medicaid home health agency due to felony convictions. The complainant had his services terminated by several home health agencies due to his reportedly uncooperative and inappropriate behaviors.

Disposition:
OCR and ODHS worked together to resolve the complainant's individual issues. He now lives in his own Section 8 apartment and is receiving 42 hours (AM and PM) of home visits 7 days a week to provide personal care and homemaking chores; skilled nursing visits; medication; and medical supplies and equipment.

Oklahoma Department of Human Services (ODHS)
Allegation:
This complaint was filed on behalf of a 35-year-old woman with quadriplegia. She is a graduate student at a local university. The complaint alleged the university's program for persons with physical disabilities failed to provide her with sufficient services to enable her to live in on-campus housing which was alleged to be the most integrated setting appropriate to the complainant's needs.

Disposition:
OCR and ODHS worked together to resolve the issues raised by this complainant through an informal resolution process. The complainant now receives 45 hours a week of home health services to provide her daily personal care and housekeeping services; skilled nursing visits; medication; medical supplies and equipment; and a mechanical lift. The complainant is able to live in on-campus housing and continue her education.

Oklahoma Department of Human Services (ODHS)
Allegation:
This complaint was filed on behalf of a 47-year-old man who has quadriplegia and who lives in his own apartment. The complainant alleged that ODHS discriminated by failing to provide continuous services, in the least restrictive and most appropriate integrated environment. Also, the complaint alleged that the State is forcing people with disabilities into nursing homes because they cannot receive the necessary services to live independently.

Disposition:
This complaint was resolved through the informal resolution process. The complainant is now receiving the following services through Oklahoma's waiver program for individuals with physical disabilities: 1) AM and PM visits 7 days a week to provide personal care and homemaking chores; 2) total assistance to transfer from bed to wheelchair; 3) skilled nursing visits; and 4) medical supplies and equipment. Additionally, the Veterans Administration provides all medications and wheelchair repairs.

Pennsylvania

Pennsylvania Department of Public Welfare
Allegation:
The Philadelphia chapter of a nationwide advocacy group alleged that the State fails to provide services in the most integrated setting to persons with disabilities.

Disposition:
After OCR initiated its investigation, the State took a number of actions to address issues presented by this complaint. The State developed a long term plan to address the waiting list for mental retardation services in Pennsylvania and created ongoing regional planning groups to address community mental health for adults and a program for reducing beds in State mental institutions and transferring funds to the community. The State also initiated a home and community based services stakeholder planning team to examine services to people with disabilities. OCR concluded that the State had made progress in systemic planning and involving interested parties in the planning process. OCR also stated, however, that the work to achieve the goals outlined in theOlmstead decision is a long-term process and thus continues to monitor the development and implementation of the State's long-range planning to ensure that services are provided to people with disabilities in the most integrated setting appropriate to their needs.

Rhode Island

Rhode Island Department of Mental Health, Retardation and Hospitals
Allegation:
This complaint was filed on behalf of a woman with mental illness, mental retardation and physical impairments who resided with her parents. The complaint alleged that the State denied the complainant services in the most integrated setting appropriate to her needs by attempting to force the complainant to live in a group home setting instead of in her own apartment with a coordinated plan of care.

Disposition:
OCR's intervention and technical assistance to the State resulted in the State agreeing to adopt a comprehensive plan, proposed by the complainant's family, to evaluate and provide services to the complainant so that she could live in her own apartment.

Rhode Island Department of Mental Health, Retardation and Hospitals
Allegation:
This complaint was filed on behalf of a 20-year-old woman with psychiatric and cognitive impairments who lived in a group home with other residents who were more than twice the complainant's age. The complaint alleged that this placement denied her the opportunity to receive services in the most integrated setting appropriate to her needs. The complaint asserted that the complainant wanted to live in her own apartment, pursue education and employment opportunities, and be around individuals her own age.

Disposition:
As a result of OCR's intervention and assistance, the complainant was moved into an apartment and began receiving services from a community health center, including regular medication and caseworker services.

Rhode Island Department of Mental Health, Retardation and Hospitals
Allegation:
This complaint was filed by the State Protection and Advocacy agency on behalf of a young man who has a variety of disabilities including bipolar disorder and Tourette's syndrome. He had been living in a state psychiatric hospital for three years and had multiple hospitalizations. He sought community placement.

Disposition:
Through the intervention and assistance of OCR, the young man left the institution and moved into a supported apartment. He also found a part-time job.

Rhode Island Department of Mental Health, Retardation and Hospitals
Allegation:
This complaint was filed by the State Protection and Advocacy agency on behalf of a young man who has a variety of disabilities including mild mental retardation, attention deficit hyperactivity disorder and a chronic kidney problem. He had been living in a state psychiatric hospital for over a year. Prior to turning age 21, he had been enrolled in several residential schools. He sought community placement.

Disposition:
Through the intervention and assistance of OCR, the young man left the institution and moved into an apartment with a roommate.

Texas

Texas Health & Human Service Commission/Texas Department of Human Services
Allegation:
The complainant, who has a mobility impairment, depression and asthma, alleged that she was unnecessarily confined to a nursing home as a result of the determination by a State contractor that the she did not require Home- and Community-Based Waiver services.

Disposition:
OCR worked with the complainant, an advocacy organization, the State and the State's contractor to resolve this complaint. The complainant agreed to provide the State's contractor with a letter from her doctor that outlined her need for community based services. The contractor then deemed the complainant eligible for community-based services. Shortly thereafter, the complainant moved from the nursing home back into her own home, where she received the necessary supports.

Texas Department of Human Services
Allegation:
The complainant alleged that her daughter, who resided at home, was at risk of unnecessary institutionalization because the skilled nursing care provided the daughter by the State's Comprehensive Care Program (CCP) would be eliminated when the daughter turned 21, and would no longer be eligible for CCP services. The complainant's daughter has cerebral palsy and allegedly requires constant care.

Disposition:
After OCR initiated its investigation, the complainant's daughter began receiving 16 hours a day services from an attendant who is supervised by and consults with a nurse. Following conversations between OCR, the State and the complainant, the complainant determined that she was satisfied with these "nurse-delegated" services, and OCR closed the complaint.

Texas Department of Mental Health and Mental Retardation
Allegation:
This complaint was filed on behalf of a man with mental retardation and mobility impairments. The complainant, a former nursing home resident, lived in his own apartment with supportive services. The complaint alleged that the State and complainant's service provider, a State contractor, intended to terminate the complainant's community services. The complaint alleged that the complainant was at risk of inappropriate institutionalization.

Disposition:
This complaint was resolved as a result of OCR's intervention and assistance. OCR gave the complainant's provider information about the ADA's integration requirement and the Olmstead decision. The provider then decided to continue the complainant's community services.

Texas Department of Human Services
Allegation:
This complaint was filed on behalf of a 10-year-old boy with mental retardation and physical impairments. The complaint alleged that the State failed to provide the child with full home and community-based services when he was found ineligible for Primary Home Care Medicaid Waiver services.

Disposition:
OCR determined that while the child was not eligible for the Primary Home Care Medicaid Waiver, he was qualified for similar services available under the State's Mental Health and Mental Retardation home and community services program. Since application for these services had not been received, the State, at the behest of OCR, is working closely with the complainant to ensure that the child receives all services for which he is eligible. The child continues to live in the community.

Texas Department Mental Health and Mental Retardation
Allegation:
This complaint was filed on behalf of a person with a mobility impairment and mild mental retardation. The complainant alleged that he was in danger of unnecessary institutionalization due to recommendations from his health care provider that he immediately be moved to a nursing home.

Disposition:
As a result of OCR intervention and assistance, institutionalization was averted. OCR also ensured that the complainant received adequate community-based services and assessment for continued community living.

Mental Health and Mental Retardation Services of Tarrant County (MHMRTC), Texas
Allegation:
The complainant alleged that the County discriminated against him based on disability by providing him with inadequate care and services. The complainant has a number of psychiatric and physical impairments. He uses a wheelchair in order to be mobile and requires oxygen 24 hours a day, seven days a week. He alleged that he was not receiving necessary and appropriate mental health services from the County, was unable to access certain services due to his mobility impairment, and feared that the lack of services would result in his becoming institutionalized and/or in drastic and unnecessary deterioration of his physical and mental health. The complainant stated that he was receiving inadequate food and experiencing problems with emergency response, a lack of accessible transportation, and inadequate progress towards community reintegration.

Disposition:
OCR worked with the County and other parties to resolve the issues of this complaint. OCR initiated a meeting among the service providers, the complainant and the complainant's legal advocate to assess the situation. The meeting led to an agreement among the parties, which resolved all of the issues included in the complaint.

Utah

Utah Department Health and Utah Department of Human Services
Allegation
This complaint was filed on behalf of a 27-year-old woman with physical impairments, mental retardation and other medical conditions. The complainant resided with her parents, but wanted to live independently. While residing at home, the complainant received supportive services, including participation in a day training program, respite for her parents, financial assistance for services to assist her in participating in community activities, transportation to the day program and case management. The complaint alleged that the complainant had been on a waiting list to receive residential services in the community for 11 years. Allegedly, the complainant's family was told that she would receive community residential services if her parents died and if no siblings were available to care for her.

Disposition
This case was resolved following OCR's intervention and assistance. After OCR and the complainant's parents attended an annual meeting to assess the complainant's needs, the complainant was removed from the wait list and provided with a residential placement in which she shares an apartment with two other individuals and receives day services and transportation.

Utah Department of Human Services and Utah Department of Health
Allegation:
This complaint was filed on behalf of a 57-year-old woman who was residing in a nursing home and who has a variety of neurological, physical, development and psychiatric impairments. The complaint alleged that the State failed to provide the complainant with appropriate community-based services and instead placed her in a nursing home and on a waiting list for community care. The complaint alleged that the affected party was unnecessarily institutionalized.

Disposition:
OCR worked with the State and the complainant's advocate to address the issues raised by this complaint. OCR learned that resolving this complaint would require finding an appropriate placement both for the complainant and for her husband, a fellow nursing home resident with his own serious impairments. The State demonstrated to OCR that it was actively engaged in efforts to locate an appropriate placement where the complaint and her husband could live together. Ultimately the State completed an assessment process for the complainant and her husband and solicited bids from providers interested in serving the complainant and her husband. The complainant and her husband visited some of these placements. Based on these developments and following discussions with the complainant's advocate, OCR terminated its investigation and monitoring of this complaint.

Utah Department of Health and Utah Department of Human Services
Allegation:
This complaint was filed on behalf of an individual with multiple physical impairments and mental retardation. The complainant alleged that although the State had approved him for residential services, he has remained on a waiting list for such services for more than eleven years. The complainant contends that the State informed him that he would only be able to access residential services if there were a critical need (i.e., death of a parent and the other parent of siblings are unable to care for him).

Disposition:
As a result of OCR intervention, the complainant was removed from the waiting list and placed in an apartment with two other persons. This placement has resulted in the complainant's receipt of increased community-based services, specifically residential services which permit him to live independently in the community.

Virginia

Virginia Department of Medical Assistance Services
Allegation:
Thirty-two individuals with mental retardation who resided in the community complained of inability to obtain services from the State's Mental Retardation (MR) Waiver Program. These individuals alleged that the State's failure to provide them with waiver services put the complainants at risk of inappropriate institutionalization.

Disposition:
OCR urged the State to develop strategies to address the issues presented by these complaints, including through developing and implementing an Olmstead plan that addresses the MR Waiver Program and its waiting list, making a commitment to increase the number of MR Waiver slots and developing a budget plan for submission to the state legislature seeking necessary funds for MR Waiver services. Ultimately, the State took action consistent with OCR's request. The State established a Task Force for the development of an OlmsteadPlan and issued a Final Report of that Task Force. The Governor issued an Executive Order to begin implementing the recommendations contained in that report, which included increasing MR waiver slots by 160 over a two-year period, and specific budget strategies to address ongoing issues of community integration.

In addition, as a result of OCR's intervention and assistance, the State provided community-based services to the majority of the individual complainants, and provided OCR with detailed information about the status of the complainants who had not received services. Thus, OCR closed this complaint but notified the State that OCR will continue to investigate any future individual complaints, and will monitor the development and implementation of the State's long range planning and activities to ensure the provision of services in the most integrated setting.

Washington

Washington Department of Social and Health Services
Allegation:
The complainant, an individual with quadriplegia, alleged that the State violated the Olmstead decision in that Medically Needy Medicaid clients whose income exceeded the Categorically Needy level could receive long-term services only in a nursing home. As a result, because of his income level, the complainant was able to receive the Medicaid long-term personal care services he needed only if he resided in a nursing home.

Disposition:
As a result of OCR intervention and the State’s long-term efforts, the State established two new waiver programs under which the State could provide long-term personal care services to both Categorically Needy and Medically Needy clients in the full-range of settings, from institutional to in-home. The State also agreed to commit State funds to equalize the personal needs allowance provisions available for Medically Needy and Categorically Needy individuals, thus making home-based services equally available to Medically Needy individuals.

Eastern State Hospital
Allegation:
The complainant, a woman with mental illness who had been institutionalized for 12 years in a State psychiatric hospital, alleged that she requested discharge from the facility and that she wanted to leave the facility for years, but to no avail. She alleged that she was not receiving services in the most integrated setting appropriate to her needs.

Disposition
For several months, OCR worked with the parties to resolve this complaint. OCR contacted officials at the hospital, including members of the complainant's treatment team. OCR's information-gathering included discussing with State and hospital officials ongoing efforts to place the complainant in a more integrated setting in the community and obstacles to community placement. Following OCR's intervention and assistance, the complainant was placed in a community facility that was appropriate to her needs.

Washington Department of Social and Health Services
Allegation:
This complaint was filed on behalf of a person diagnosed with mental illness and unspecified physical disabilities who lived in a facility for people with mental illness. The complainant alleged that despite her best efforts, and those of her treatment team, she was unable to move to a more integrated setting because of the difficulty of finding community-based services for persons with mental illness.

Disposition:
At OCR's urging, the State accelerated its efforts to provide the complainant with community placement, and the complainant moved to the community shortly after filing the complaint.

Washington Department of Social and Health Services
Allegation:
OCR received a complaint filed by a patient at one of the public psychiatric hospitals in the State of Washington. The complainant, a person with a mental disability, alleged that she had lived in psychiatric hospitals for more than three years and all her attempts to be moved into a more integrated setting appropriate to her needs had been unsuccessful. The complainant alleged that the State's failure to move her into the community constituted discrimination on the basis of disability.

Disposition:
Working closely with the State, OCR helped establish a new procedure to accelerate the turn-around time for acceptance of an individual into the community resource network. As a result of these efforts, the complainant was moved into a group home. In addition, other similarly situated individuals were helped by the new procedure to remove barriers to the expeditious placement of individuals in particular communities.

West Virginia

West Virginia Department of Health and Human Services
Allegation
A complaint was filed by a mother on behalf of her adult son alleging that he was not receiving services in the most integrated setting appropriate for his needs. The complainant’s son was residing at a psychiatric hospital.

Disposition
Through the Olmstead Mediation Pilot Project coordinated by OCR and the U.S. Department of Justice, this complaint was successfully mediated. As a result of mediation and to the satisfaction of all parties, the complainant’s son relocated to a supervised apartment, which was a more integrated setting as compared to the hospital.

West Virginia Department of Health and Human Resources
Allegation:
This complaint was filed on behalf of an individual with muscular dystrophy who is ventilator dependent and requires 24-hour nursing services. These services, which the complainant has been receiving for several years, allowed him to live in his own apartment. The complainant alleged that these services were scheduled to be discontinued in the near future. He alleged that discontinuation of these services would put him at risk of unnecessary institutionalization.

Disposition:
Working with the State, OCR was able to find another provider who agreed to provide the services the complainant requires through the State's Developmental Disabilities waiver.

Wisconsin

Wi. Department of Health and Family Services
Allegation:
The complaint was filed on behalf of a 55-year-old man with a spinal cord injury who uses a wheelchair and had lived in a nursing home for more than four years. Allegedly, the State had determined that the complainant was eligible for a Medicaid waiver program that would provide him with community-based care, but the complainant expected to remain on the waiver program waiting list for approximately five years. The complainant alleged that he was denied services in the most integrated setting appropriate to his needs.

Disposition:
After OCR initiated its investigation, the State provided the complainant with services in an eight-bed community residential facility. In addition, the complainant's service plan indicated that the eight-bed setting would offer the opportunity to assess the possibility of a more independent living arrangement in the future. The positive result in this complaint was accomplished based on persistent intervention by OCR staff. OCR made continued efforts to seek information about and resolve this case despite a County's initial reluctance to consider community-based placement for the complainant and expressed concerns -- although treating professionals had recommended community-based care -- that placement might not be successful. After repeated inquiries from OCR, the placement was ultimately achieved.

Wisconsin Department of Health and Family Services/Dunn County, Wisconsin Department of Human Services
Allegation:
A woman filed this complaint on behalf of her 25-year-old son, who was diagnosed with the genetic disorder Prader-Willi Syndrome. The complainant's son had been alternating between living at home and in various institutional placements for two years. The complainant alleged that her son wanted community-based services through a Medicaid waiver program, but that the State had failed to provide him with these services due to a very long waiting list for the waiver program.

Disposition:
Following OCR's intervention and assistance, the complainant moved to a supervised apartment with a variety of supportive services, including pre-vocational activities, transportation, case management, and two hours of personal care services each day. Based upon its investigation, OCR found that, because of the County's long waiting list for community placements, the complainant had been moved several times to different institutional placements, several of which his family asserted were not programmatically appropriate. OCR contacted the State and worked with it to devise a unique solution, in which the State approved an enhanced payment rate for the placement, and funding for a waiver slot was "loaned" to the County so that the community placement could be made.

Wisconsin Department of Health and Family Services
Allegation:
OCR received a number of complaints filed on behalf of individuals with mental retardation and in some cases other impairments, who resided in an institution for people with mental retardation. Each of these complainants alleged that they were denied services in the most integrated setting appropriate to their needs. Each complainant wanted to move from the institution to a community-based setting, such as a group home or an apartment.

Disposition:
After OCR began its investigation of these cases and as a result of the closure of an institution, each of these complainants was provided with a community based placement. Some complainants moved to group homes; others were provided with assisted living arrangements. OCR compliance activities in the State of Wisconsin were a factor in the State's decision to assess and provide community services to these complainants. In each case, after confirming that the complainants were satisfied with their placements, OCR closed the complaint.

Wisconsin Department of Health & Family Services
Allegation:
The complainant alleged that the State failed to provide a person with cerebral palsy with an opportunity to live in the most integrated setting appropriate to his needs. The complainant had been living at home with his parents but was not receiving Medicaid waiver services due to lack of funding. The complaint further alleged that continued home placement under those circumstances came at great personal sacrifice by the family and posed the risk of unnecessary institutionalization.

Disposition:
As a result of OCR intervention and assistance, the complainant was approved for Community Integration Program services. Among the services provided to the complainant via this Medicaid waiver program are workshops, day programming and respite care. Transportation was also authorized but was on hold until the provider had an opening.

Wisconsin Department of Health and Family Services
Allegation:
This complaint was filed on behalf of a man with cerebral palsy who lived in a nursing home for 28 years, since the age of 18, and wished to move to a community setting. The complainant alleged that the State failed to provide him with an opportunity to live in the most integrated setting appropriate to his needs in violation of the ADA's integration regulation. He had been on a waiting list for 5 years and was told that his name would not come up to the top of the list for 1 or 2 more years.

Disposition:
With OCR intervention and assistance, the complainant moved from the nursing home to an apartment. The move was facilitated by COP (Community Option Program) Waiver Funding for Nursing Home Relocations for one year. The County will receive funding annually in its COP-Waiver allocation to continue the placement.

Wisconsin Department of Health & Family Services
Allegation:
The complaint alleged that the State failed to provide the complainant, a person with cerebral palsy and cognitive disability, with an opportunity to leave a nursing home and live in a community setting.

Disposition:
Working with the State, OCR helped secure the complainant's move from the nursing home to an adult family group home. Funding for the relocation became available when the complainant, with OCR assistance, was placed in the County's family care management program.

Wisconsin Department of Health & Family Services/Sheboygan County, Wisconsin Department of Human Services
Allegation:
The complaint alleged that the State discriminated against a man with cognitive and physical impairments on the basis of disability by failing to provide him the residential and supported employment services that he had tried to obtain on his own for 5 years. As a result, the complainant alleged he was at risk of unnecessary institutionalization.

Disposition:
Working with the State, OCR helped secure 7 hours per month of Supported Employment job coaching for the complainant; 3 hours of support per week for housekeeping, shopping, and other tasks the complainant cannot perform on his own; and 2 hours of support 2 days per week to help the complainant develop additional self-help skills. In addition, the State bore the cost for the complainant's specialized transportation service.

Wisconsin Department of Health & Family Services/Milwaukee County, Wisconsin Department of Human Services
Allegation:
The complainant, a person with developmental and neurological impairments, alleged that the State discriminated against her on the basis of disability by failing to provide her with appropriate home and community-based services and by placing her on a waiting list, thus failing to place her in the most integrated setting appropriate to her needs.

Disposition:
OCR worked with the State for nearly a year to provide a placement in a group home or an apartment with community services. However, the complainant chose to move out of state to live with her extended family. The State assisted the complainant with moving expenses.

Wisconsin Department of Health & Family Services/Dunn County, Wisconsin Department of Human Services
Allegation:
The complaint alleged that the State failed to find an appropriate community placement for a person with neurological and physical disorders , therefore, the complainant had no choice other than to reside in a nursing home.

Disposition:
As a result of OCR intervention, the complainant was moved from the nursing home to a community-based Adult Family Home. The move was made possible when the State provided the County with COP (Community Option Program)Waiver Funding for Nursing Home Relocations. (OCR Docket # 05013127)

Wisconsin Department of Health and Family Services/Dane County, Wisconsin Department of Human Services
Allegation:
The complainant, a 79-year-old woman who uses a wheelchair and is unable to communicate due to a stroke, had lived in a 20 bed Community-based Residential Facility (CBRF) for more than two years. Her stay at the CBRF was paid for through private funds. When the complainant's funds were exhausted, she contacted the State about Medicaid assistance. She was reportedly told that there was a waiting list for Medicaid waiver services and that it was possible she would have to move to a nursing home, where Medicaid would pay the cost of the placement. As a consequence, a complaint was filed alleging that the State had failed to provide the necessary resources to permit her to live in the least restrictive setting.

Disposition:
Working with the State and other stakeholders, OCR helped secure Community Options Program (COP) funds which allowed the complainant to remain in the community.

Wisconsin Department of Health & Family Services/Dunn County, Wisconsin Department of Human Services
Allegation:
The complaint alleged that the State discriminated against a man who had suffered a stroke on the basis of disability, by denying him participation in the Community Options Program (COP) and the additional home services that would enable him to continue to live at home.

Disposition:
OCR worked with the State for a year to secure the State provided-services sought by the complainant. The State purchased a lift chair and installed a hand railing on the stairs of the complainant's mobile home. In addition, the complainant is currently participating in the Senior Citizen Center's Meals on Wheels program.

Wisconsin Department of Health & Family Services/Milwaukee County, Wisconsin
Allegation:
Seven complaints were filed with OCR by the Wisconsin Coalition for Advocacy (the State Protection and Advocacy agency) alleging that the State discriminated against the complainants on the basis of disability by failing to place them in the most integrated setting appropriate to their needs. All complainants lived in an Intermediate Care Facility for individuals with mental retardation. All had expressed an interest in living in the community, but were on waiting lists with an estimated wait of between 5 and 10 years before waiver funds would be available.

Disposition:
OCR worked with the State to resolve these complaints. Due to financial and programmatic concerns, the State took over receivership of the facility and adopted a plan to move 90% of the residents to community settings and close the facility. All seven complainants moved into the community.

Wisconsin Department of Health & Family Services/Grant County, Wisconsin Department of Human Services/Iowa County, Wisconsin Unified Board
Allegation:
The complainant, a woman with cerebral palsy, alleged that the State failed to provided a community placement that would enable her to leave a nursing home and live in the community.

Disposition:
Working with the State, OCR helped secure community placement for the complainant.

Wisconsin Department of Health and Family Services/Sauk County, Wisconsin Department of Human Services
Allegation:
The complaint alleged that the State failed to provide assistance to enable a man with a neurological and cognitive impairments to remain at home, thus putting him at risk of unnecessary institutionalization.

Disposition:
As a result of OCR intervention and assistance, the State conducted a comprehensive review to determine appropriate services for the complainant. The State assigned a new case manager to ensure that the programs for which the complainant was eligible were made available. In addition, an independent team of stakeholders was put in place to assist the case manager in overseeing service delivery.

----------------------------

Note 1: In Olmstead v. L.C., 527 U.S. 581 (1999), the Supreme Court held that the unnecessary institutionalization of qualified individuals with disabilities in institutions is a form of discrimination prohibited by the ADA. 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) treatment professionals reasonably determine that 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.

Content created by Office for Civil Rights (OCR)
Content last reviewed on November 30, 2013

Civil Rights For Consumers Menu