John O'Connor

I first began attending American Health Care Association shows in the 1990s. They tended to be lively events, but not for reasons that had much to do with educational sessions, networking or the goodies being distributed in the expo halls.

Rather, it was because hundreds of protestors would show up each year to get arrested while bull-rushing the convention doors. I can tell you, it was quite a spectacle. Their primary gripe was that Medicaid dollars going toward nursing homes would be better spent on community-based services specifically tailored for people with disabilities.

This annual ritual played for most of that decade. But in 1999, the Supreme Court issued a landmark ruling that would forever reduce security requirements at AHCA events.

In Olmstead v. L.C., the nation’s highest court ruled that the Americans with Disabilities Act gave people with mental disabilities the right to live in communities rather than nursing homes.

More specifically, the justices wrote that a handicapped person’s “confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement and cultural enrichment.”

So you had to figure it would take a few years for states to finally sort things out. How about 14 and counting?

Last week in Texas, state officials finally got around to finalizing an agreement with the Justice Department that lets people with mental handicaps leave nursing homes and instead reside in communal homes.

The official reason is that state regulations and screening-procedure failures caused the delay – as opposed, to say, foot dragging by those in no hurry to revamp the status quo. If you believe the official rationale, you’d better check your watch. Don’t want to show up late to the Flat Earth Society meeting, do you?

But Texas is hardly alone. New York has been similarly slow in responding to a Supreme Court ruling that goes back to the last century.

Just last month, the Justice Department’s Civil Rights Division and the U.S. Attorney’s Office for the Eastern District of New York finally entered into an agreement with the state. The settlement means thousands of people with mental illness unnecessarily segregated in 23 adult homes in New York City will have better living options.


The upshot: during the next half decade, New York will provide scattered-site supported housing to at least 2,000, and potentially more than 4,000, adult home residents. The agreement also will ensure that adult home residents have the information they need to make an informed choice about where to live. An independent reviewer with extensive experience in mental health systems will monitor the state’s compliance.

In pointing out these developments, I suppose I might be accused of biting the hand that feeds me. After all, skilled nursing facilities tend to lose residents as a result, right? That may be true, but so what? Shouldn’t people who need care live in the most appropriate living environment available?

In fact, there really is only one question that should be asked about the glacial pace of Olmstead implementation at this point: What’s the holdup?