All Americans, including those who are older or have a disability, are best off when they can live their lives integrated and included in their communities, alongside people of all ages, with and without disabilities. And our communities, and our country, are stronger when we harness everyone’s talents and contributions.
As Prepared for Delivery
Thank you, Roger, for that introduction, and thank you to everyone who’s joined us here in person or over the livestream today. Thank you also to everyone at HHS and elsewhere who helped make today’s gathering possible, because we’re celebrating an important event today.
It’s an honor to help celebrate the twentieth anniversary of the Supreme Court decision in Olmstead v. L.C., which caused a sea change in how our country thinks about supporting people with disabilities.
Today, in part thanks to Olmstead, we recognize that community living should be the default expectation for all people, and we are working to make that vision a reality. As you well know, that wasn’t always the case.
Olmstead wasn’t the first step on the path to where we are today, but Olmstead allowed us to take a significant leap forward and to accelerate the pace of change.
The ruling acknowledged the existence of resource limitations, but it also said states should take “reasonable steps” to provide community-based alternatives to institutions. The decision has significantly increased the availability and quality of services in the community for people with disabilities.
You can see what a dramatic shift this is from looking at trajectories in HHS program spending.
In 1999, Medicaid spent nearly three times more on long-term services and supports provided in institutions like nursing homes than it did on services in the community.
By 2013, a majority of that funding was going toward services and supports in the community.
Olmstead also has helped spark innovation and research. This morning, I visited Gallaudet University to learn about their Rehabilitation Engineering Research Center, or RERC, for Improving the Accessibility, Usability, and Performance of Technology for Individuals who are Deaf or Hard of Hearing.
This RERC is funded by the research institute within HHS’s Administration for Community Living, which is the National Institute on Disability, Independent Living and Rehabilitation Research.
Through advanced research and development work, the RERC at Gallaudet provides people who are deaf or hard or hearing with the knowledge and tools to take control of their communication and hearing technologies, adapt those technologies to their needs in real-world environments, and achieve greater autonomy and satisfaction in their use of technology
That kind of work now happens at universities across the country, and it happens in part because Olmstead has increased our expectations.
Before Olmstead, being born with significant disabilities often meant having no choice but to grow up in an institution.
But because of Olmstead and legislation supporting the rights of people with disabilities, children with disabilities increasingly have the opportunity to attend school alongside peers with and without disabilities.
As those children become young adults, they have many of the same decisions to make as their peers without disabilities: whether to go to college—and important related questions like whether it’s acceptable to come home from college to make your mom do your laundry, how often you’re really supposed to talk to your parents, et cetera—and where to live and what kind of career to pursue.
These benefits extend throughout a person’s life. Before Olmstead, adults who needed help with many physical tasks had few options: They could continue living with family or move to an institution.
Olmstead has greatly increased the availability of these kinds of services and supports in the community, which has greatly increased the opportunities for people with disabilities to live independently.
Around the country, states and communities are adopting an “Employment First” philosophy, which starts with the belief that people of all abilities should have the opportunity to work in integrated workplaces.
Individuals, families, nonprofits, and states are stepping up and working together to provide the supports necessary to make this work, and to change the assumptions people make about the capabilities of people with disabilities.
I also saw this work go on at HHS under President George W. Bush, when we led the New Freedom Initiative to lay out a blueprint for more community integration. Olmstead helped create the environment for that kind of change.
Olmstead has changed the world for older adults, too. Providing some help with getting dressed or assistance with household tasks, or developing new assistive technologies, is often crucial to allowing older adults to continue living in their own homes.
What all of these changes have in common is that they put people with disabilities, as well as older adults, in control of their own lives, with help from their family if they need it.
Despite the great progress of the last two decades, we still have a lot of work to do to make Olmstead’s vision of options and integration a reality for all Americans.
Far too many people who could be—and who want to be—living independently in the community face barriers that lead to them living in institutions.
That’s why we are committed to making home- and community-based services more easily available, to improving access to health care, and to improving quality and coordination of these services.
This is a piece of broader work going on across HHS. We’ve now all recognized that it’s foolish to pay for patients to stay in the hospital, but not pay for the preventive care that would help keep them out of the hospital in the first place.
This change in mindset has been part of a shift toward value-based healthcare, one of Secretary Azar’s top priorities, which requires looking at the continuum of care: prevention, treatment, palliative care, and other services.
But as you know, we need to think even more broadly. The continuum needs to include more than just “care”—we need to think more in terms of a “continuum of support and care.”
That means improving coordination between the health and human services sides of HHS, which is something we are actively working across the department to accomplish.
All Americans, including those who are older or have a disability, are best off when they can live their lives integrated and included in their communities, alongside people of all ages, with and without disabilities. And our communities, and our country, are stronger when we harness everyone’s talents and contributions.
We’ve made a lot of progress on that goal in the 20 years since the Olmstead decision, and it’s my hope the next 20 years will include even more such progress.
So thank you for the work all of you have done to make that progress possible, and thank you for your ongoing commitment to this important cause. Thank you for having me here to join in that celebration and recognize your work today.
