The Olmstead Supreme Court Decision in a Nutshell

Olmstead, or Olmstead v. LC, is the name of the most important civil rights decision for people with disabilities in our country's history. This 1999 United States Supreme Court decision was based on the Americans with Disabilities Act.  The Supreme Court held that people with disabilities have a qualified right to receive state funded supports and services in the community rather than institutions when the following three part test is met:

  1. the person's treatment professionals determine that community supports are appropriate;
  2. the person does not object to living in the community; and
  3. the provision of services in the community would be a reasonable accommodation when balanced with other similarly situated individuals with disabilities.

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Brief History of Olmstead

The Olmstead lawsuit started with two women from Georgia named Lois Curtis and Elaine Wilson who both had diagnoses of mental health conditions and intellectual disabilities. Lois and Elaine found themselves going in and out of the state’s mental health hospitals dozens of times. After each stay in the hospital, they would go back home; but then, because they did not have help at home, they would start to struggle again and would have to go back to the hospital to get help again. Lois and Elaine asked the state of Georgia to help them get treatment in the community so that they would not have to go live at the state mental hospital off and on. The doctors who treated Lois and Elaine agreed that they were capable of living in the community with appropriate supports. However, Lois and Elaine ended up waiting for years for their community-based supports to be set up.

Sue Jamieson, who was an attorney at the Atlanta Legal Aid Society, filed a lawsuit on behalf of Lois (and then later added Elaine) for supports to be provided in the community. The lawsuit, which is known as “Olmstead v. L.C.” or “the Olmstead decision,” ended up going to the highest court in the country, the United States Supreme Court.  The name Olmstead comes from the name of the Defendant in the case, Tommy Olmstead, who was the Commissioner of the Georgia Department of Human Resources.

The Supreme Court agreed with Lois and Elaine. The Court found that under the Americans with Disabilities Act, or “the ADA,” it is against the law for the state to discriminate against a person based on his or her disability. The Court said that the state discriminated against Lois and Elaine by requiring them to live in a mental health hospital.  It should have instead provided services for them in the community.  By confining them in the hospital, the state was segregating them by requiring them to live with others with disabilities.  The Court said that people with disabilities like Lois and Elaine have the right to receive the treatment they needed in an integrated setting if that is what they want, if their doctors agree, and if it doesn’t fundamentally change how the state provides services to people with disabilities.

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Before Olmstead

In the 1800s, states throughout America began to build large scale asylums for people with mental health conditions and other disabilities.  By the early 1900s, many of these institutions became overcrowded and residents experienced maltreatment.  Psychiatric institutions continued to grow until public policy began to change toward deinstitutionalization in the 1960s.

In the mid-twentieth century, nursing facilities became the primary institutions for senior citizens and people with physical disabilities.  These facilities grew considerably with the creation of Medicaid and Medicare in the 1960s.  Nursing facility populations grew rapidly throughout the 1970s and 80s.  Unlike the trend with mental health hospitals, the population in nursing facilities grew to 1.4 million Americans in nursing facilities by late 2011.

The Americans with Disabilities Act was passed in 1990 and signed into law by President George H.W. Bush that same year.  At the outset of the ADA, Congress made a number of historical findings.  This included recognition of the history of institutionalization in the United States.  Congress stated, “historically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem.”  42 U.S.C. Section 12101(a)(2).  In signing the law, President George H.W. Bush declared that the ADA “takes a sledgehammer to [a] wall . . . which has for too many generations separated Americans with disabilities from the freedom they could glimpse, but not grasp.”

Title II of the ADA prohibits public entities, including state and local governments, from discriminating against “qualified individuals with disabilities” by excluding them from services and activities due to their disability.  As part of the ADA, federal regulations were created to enforce the Act.  One of the regulations created by the United States Justice Department was called the “integration mandate.”  The integration mandate requires public entities to “administer services, programs, and activities in the most integrated setting appropriate to the needs of the qualified individuals with disabilities.”  This integration mandate would become the basis of the Olmstead decision in 1999.

In 1995, the United States Court of Appeals for the Third Circuit, in the case of Helen L. v. Didario, found that a woman with a disability who was confined in a nursing facility had the right under the ADA to receive attendant care services in the community so she could leave the nursing facility.  The appellate court rejected the state of Pennsylvania’s argument that the woman needed to remain on the waiting list until funds became available.  Pennsylvania appealed to the United States Supreme Court, but the Supreme Court decided not to hear the appeal, which left the Third Circuit’s decision intact.

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The Olmstead Lawsuit

On May 11, 1995, the Atlanta Legal Aid Society filed a lawsuit on behalf of Lois Curtis challenging her confinement at Georgia Regional Hospital Atlanta based on Title II of the ADA. In January 1996, Elaine Wilson was allowed by the trial court to join the case as a plaintiff who was also seeking the right to return to the community from the state hospital.

In March 1997, Judge Marvin Shoob ruled in favor of the plaintiffs declaring that the failure of the Georgia Department of Human Resources and Georgia Regional Hospital to “place plaintiffs in an appropriate community-based treatment program violates Title II of the Americans with Disabilities Act” and that it was required to do so for both plaintiffs.

The Georgia Defendants appealed to the Eleventh Circuit Court of Appeals and then, after losing at the 11th Circuit, to the United States Supreme Court.  On December 14, 1998, the United States Supreme Court granted certiorari in the case, which meant it agreed to hear the appeal.  This was both an exciting and frightening decision because it meant that the decision of the Supreme Court – whether in favor or against the plaintiffs – would set the precedent for the entire country.

Oral arguments were heard on April 21, 1999.

Justice Ruth Bader Ginsburg announced the decision of the Court on June 22, 1999.  She stated that the Supreme Court answered with a “qualified yes” the question of whether the ADA’s prohibition of discrimination by a public entity required “placement of persons with mental disabilities in community settings rather than in institutions.” The Supreme Court created three requirements for when such action is required: (1) when treatment professionals determine that community placement is appropriate; (2) when the individual does not oppose being served in the community; and
(3) when the placement is a reasonable accommodation when balanced with the needs of others with mental disabilities.

In most of the court cases that have applied Olmstead, the first and second requirements have generally not been at issue.  The first requirement is based on the individuals needs and circumstances and not whether or not the services needed actually exist.  Whether such services exist or could exist is determined by the third requirement.  In most court cases, the second requirement would never exist because a person who opposes living in the community would not bring a lawsuit under Olmstead.  However, there are circumstances, such as class actions and cases brought by the United States Justice Department that apply to all individuals who are in a certain category, in these instances the default option is for the person to live in the community and such default is only overcome if the person actively opposes returning to the community.

The third requirement has been the focus of post-Olmstead litigation. In discussing the third factor, a plurality of the Court discussed what would be a reasonable modification under the Americans with Disabilities Act.  The Court acknowledge that a state might be able to resist some modifications if the modifications would fundamentally alter services. “Sensibly construed,” the plurality stated, “the fundamental-alteration component of the reasonable-modifications regulation would allow the State to show that, in the allocation of available resources, immediate relief for the plaintiffs would be inequitable, given the responsibility the State has undertaken for the care and treatment of a large and diverse population of persons with mental disabilities.”

The plurality then gave an example. It said a state could satisfy the reasonable modifications regulation if it demonstrated “that it had a comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings, and a waiting list that moved at a reasonable pace not controlled by the State’s endeavors to keep its institutions fully populated.”  This model of a working plan with reasonably moving waiting lists became a focal point of discussion in later litigation. The more time passes, however, from the Olmstead decision, the issue arises whether states still can defend from immediate Olmstead enforcement by creating plans and waiting lists.

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From Olmstead to the Present

After Olmstead, the lawsuits that followed slowly defined the contours of the decision.  The impact of Olmstead grew steadily but slowly with each court case.  Most of the cases that reached written decisions were resolved in favor of individuals with disabilities but the cases were sporadic and often involved only small groups of individuals or individuals living in specific institutions.  The gradual impact of Olmstead grew faster and more expansive after 2009 when the United States Justice Department made Olmstead a priority of its Civil Rights division and began to enforce the Supreme Court mandate in state after state.  Still, fifteen years after Olmstead, no state could credibly make the case that it is fully in compliance with Olmstead.

Although the Olmstead decision only involved one type of institution, which was a psychiatric hospital.  Courts quickly made clear that Olmstead applied to all state and Medicaid funded institutions, including nursing facilities.

Courts also found that Olmstead applied to individuals living in the community who were at risk of institutionalization.  In an important decision, one federal appellate court (the 10th Circuit) held that the protections in Olmstead would be meaningless if men and women with disabilities “were required to segregate themselves by entering an institution before they could challenge an allegedly discriminatory law or policy that threatens to force them into segregated isolation.”  In that case, the individuals were not in nursing facilities and stated that they would rather die than enter nursing facilities.  The Court held that these men and women, who lived in the community, were still protected by Olmstead.

Some courts have required that states provide additional Medicaid Waivers in order to be in compliance with Olmstead.  A Medicaid Waiver is a package of Medicaid funded services that states can provide to specific types of people with disabilities in the community who qualify for institutional level of care.

Olmstead is starting to be applied in contexts beyond institutions.  In April 2014, Olmstead was part of the foundation of a settlement with the state of Rhode Island relating to sheltered workshops.  Olmstead was also part of a settlement in Georgia that included individuals in forensic hospitals who had been found incompetent to stand trial or not guilty by reason of insanity.

As Olmstead expands, it becomes possible to foresee a time when all Americans will have the supports they need regardless of the extent of any disability or impairment to live in the community and not in institutions and nursing facilities.  After all, it was only in the 1950s and 60s when nursing home expansion took place.

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Olmstead History Links

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