Saturday, July 27, 2019

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From the Interagency Autism Coordinating Committee on Autism Housing Needs, 7/23/19


This is from an account of the Interagency Autism Coordinating Committee meeting on 7/23/19 by Jill Escher: 


Susan Jennings, founder of Keeping Individuals with Intellectual Disability Safe (KIIDS) shared an oral public comment that her son is one of those who kicks down doors and elopes into traffic. He has been discharged from six different group homes, as none could manage his challenging behaviors. She cited systemic shortcomings to community group home, including severe abuse and toxic over-medication. His salvation was an ICF, and she laughed at the idea of “forced institutionalization” since “You can’t force your way” into an ICF since “they are closed or closing.”

She said her son is far from an anomaly. About 40% of the autism population exhibits severe challenging behavior. Because of the lack of options, these adults often languish in psychiatric facilities, hospitals, or jails. The Olmstead Supreme Court decision recognizes that the ADA does not impel states to close institutions, and indeed that some individuals may need these setting for crisis periods or permanently. They must remain available, as they offer a superior form of care for a segment of the population, she said. There are very high costs to keep some adults “in the community” with too little assistance and supervision. “The state center is a bargain compared to the community,” and also provides her son a much greater degree of personal freedom. Also, unlike community settings, ICFs must meet rigorous standards to be certified. She drew attention to the direct service provider (DSP) shortage: “You are asking people to handle life-and-death emergencies at fast-food wages.” Finally she denounced the “cruel movement afoot” to defund out-of-home options. If parents do not have the ability to care for severely affected adults — who does? We must offer a full range of services.

Friday, July 26, 2019

Raise the Wage for some, Lose the Wage for others

This is from the VOR Weekly News Update, 7/19/19 on the recent passage of the Raise the Wage Act by the U.S. House of Representatives:

“On Thursday, July 18, the House of Representatives voted in favor of passing H.R. 582, the Raise the Wage Act. Tucked into this bill are provisions that would end Section 14(c) [of the Fair Labor Standards Act] wage certificates and re-structure wages paid by work centers, forcing tens of thousands of people with intellectual disabilities who are unlikely to participate in competitive employment, out of their existing opportunities to work at facility based employment.

“While some of our members may support raising the minimum wage while others may not, VOR members have come together to oppose this bill as written, in order to protect individuals who benefit from 14(c) and work centers that are designed to accommodate their specific needs and abilities.

“…most coverage of this bill has only mentioned the increase in the minimum wage, with no mention of the effect this would have on people who would be unhireable under competitive integrated employment. Once again, the most vulnerable Americans are suffering discrimination at the hands of agencies that are supposed to protect their interests, and by the work of advocates and self-advocates who focus only on one segment of the community of people with intellectual disabilities.” 

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The controversy over sub-minimum wage certificates comes up again and again as a disability rights issue, framed as blatant discrimination against people with disabilities. The assumption among many advocates is that all people with disabilities are capable of integrated, competitive employment, as long as they have the supports they need to be successful. The fallacy here is that there are, indeed, people whose disabilities prevent them from working in competitive employment, because they are unable to tolerate a competitive work environment or to keep up with other workers.

This is a fact, not a reflection on people with disabilities in general or an assertion that they are somehow less worthy than people without disabilities. To the contrary, the right to appropriate services applies to all, even to those who need a specialized facility-based work program that pays less than minimum wage. For the most part, these workers receive additional government benefits in the form of living supports, Medicaid health insurance, Medicaid waiver services, and often additional social services offered by their employers or other agencies.

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This is from a DD news blogpost from 2014:

"Workers with disabilities who are able to engage in competitive employment, with or without supports, should not be exploited in workplaces that profit off their labor but pay the workers sub minimum wages. The special wage certificates that are now issued, however, allow people with more severe cognitive and other disabilities to work at their own pace in skill development centers (sheltered workshops, usually in community settings) and receive pay adjusted to their abilities and how fast they work. To eliminate the special certificates would  in effect also eliminate this important option for people who can and want to work but would otherwise be unlikely to obtain employment in regular competitive workplaces. In the opinion of many who benefit from these programs, too little consideration has been given to what will happen to these people other than many more of them will sit at home with nothing to do.

"Efforts to increase competitive employment for people with DD in integrated settings should not be expected to offset the need for specialized employment services based on the severity and nature of an individual's disability. 'Robbing Peter to pay Paul' (or in this case, closing sheltered workshops to fund more supported employment), is never a good policy decision when it comes to people with needs as diverse as those with developmental disabilities."

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ACCSES is an organization representing providers of employment services. This is an editorial from their July 22, 2019 newsletter: 

"The Raise the Wage Act (H.R. 582) passed the House last week 231-199. This bill if enacted, would kill jobs for people with disabilities by getting rid of the special wage certificate under Section 14(c) of the Fair Labor Standards Act, which will have a significant impact on opportunities for people with the most significant disabilities. On July 8, 2019, the Congressional Budget Office issued a report on the effects of an increase in the minimum wage on employment and family income, in which it found that the $15.00 federal minimum wage would benefit 17 million workers, and cut at least 1.3 million jobs. (The CBO estimates 125,000 people being served under 14(c) certificates.) Section 14(c) certificates are an important tool in the employment toolbox. Do not let Congress take away jobs for people with disabilities. Your Members of Congress are getting ready to head home for their August recess. Contact them today and invite them to tour your locations to see the devastating effect passing this bill into law would have on people with disabilities. It is vital that Members of Congress have a great understanding of the important role community rehabilitation programs play when setting disability policy. "

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See also:

"House Votes To End Subminimum Wage" by Michelle Diament, July 19, 2019, Disability Scoop
“…many families have opposed such legislation arguing that subminimum wage employment gives people with more severe disabilities who may not be able to succeed in typical jobs a sense of purpose and an opportunity to contribute.”


"Supported Employment : Is it Cost Effective for People with Severe Disabilities?", The DD News Blog, 2/15/16 


"Information on Sub-minimum wages for people with disabilities and appeal rights..." , The DD News Blog, 3/30/16

Thursday, July 25, 2019

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Happy Times!


These were Happy Times fifty years ago, except for the Vietnam War, racial and political strife, drugs, dropouts, cults, and Richard Nixon. Listen to 18 minutes of pure bliss.

Friday, July 19, 2019

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IACC Workshop: Addressing the Housing Needs of People with Autism, 7/23/19



The Interagency Autism Coordinating Committee (IACC) is holding a workshop to address the housing needs of people on the autism spectrum on 7/23/19:

Tuesday, July 23, 2019

Hilton Washington DC/Rockville Hotel and Executive Meeting Center 

1750 Rockville Pike 
Plaza Ballroom 
Rockville, MD 20852 

9:30 to 4:30 pm

“The purpose of the 2019 IACC Workshop, Addressing the Housing Needs of People on the Autism Spectrum, is to convene a working group of the IACC that will focus on housing needs of people on the autism spectrum. The workshop will be open to the public, will include time for public comments, and will be accessible by live webcast and conference call. "

Remote Access:

Conference Call:
Dial: 888-946-9416
Access code: 1391703 (listen only)

Webcast: https://videocast.nih.gov/summary.asp?live=33279&bhcp=1 

It is too late to submit a request to make oral or written comments to the committee during the 7/23 meeting, but truth be told, any member of the public can submit comments in writing to the IACC at any time. You can also listen in by phone or webcast.

Contact information:

Ms. Angelice Mitrakas
Office of Autism Research Coordination
National Institute of Mental Health, NIH
6001 Executive Boulevard, NSC, Room 7218
Rockville, Maryland 20852
Phone: 301-435-9269
E-mail: IACCPublicInquiries@mail.nih.gov



Partial agenda that will include discussion of Intentional Community models:


Overview of Housing Issues

10:00 Status and Trends in Supports and Services from the Residential Information Systems Project
Heidi Eschenbacher, Ph.D.
Researcher, Institute on Community Integration, University of Minnesota

10:15  Trends and Insights from the Autism Housing Network
Desiree Kameka, M.T.S.
Director of Community Education & Advocacy, Madison House Autism Foundation 

10:30  Discussion of Public Comments

Susan Daniels, Ph.D.
Director, Office of Autism Research Coordination, NIMH, and Executive Secretary, IACC

Oni Celestin, Ph.D.
Science Policy Analyst, Office of Autism Research Coordination, NIMH

Intentional Community Models

1:00 Live. Learn. Lead. We’re the place for that…First Place AZ
Denise Resnik
CEO and Co-Founder, DRA Collective, Phoenix, Arizona

1:10 Benjamin’s Hope: a "Live, Learn, Play, Worship" Community Where People with Autism Enjoy Lives of Dignity and Purpose
Krista Mason
Executive Director, Benjamin’s Hope, Holland, Michigan


1:20  From House to Home: Thriving with Autism at The Center for Discovery
Terry Hamlin, Ed.D.
Associate Executive Director, Center for Discovery, Harris, New York


1:30 Organizing for Inclusive Community: Leveraging Partners and Policies to Make More Possible
Lindsay Johnson
Director of Policy and Partnerships, The Kelsey

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"The Interagency Autism Coordinating Committee (IACC) is a Federal advisory committee that coordinates Federal efforts and provides advice to the Secretary of Health and Human Services on issues related to autism spectrum disorder (ASD). Through its inclusion of both Federal and public members, the IACC helps to ensure that a wide range of ideas and perspectives are represented and discussed in a public forum. The committee reconvened in November 2015 to begin a new session under the Autism CARES Act."

Wednesday, July 10, 2019

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Delaware families lead the way for better pay and working conditions for caregivers


 


A Delaware advocacy group, Families Speaking Up , has been renamed A-Team Delaware, joining a national movement for choice in day and residential services.

From the Website:

"If you haven’t heard, Families Speaking Up has rebranded as A-Team Delaware. We are excited to be taking the grass-roots work we’ve been doing for the last several years statewide, with one chapter that meets in New Castle County and one that meets on the border between Kent and Sussex Counties. As one of the newest A-Teams in the United States, we have become a part of the national movement for choice in day and residential services. We would encourage you to visit ATeamUSA.net for more information about the other states that have joined this movement. Although our name has changed, our goals remain the same — to ensure that all voices are heard when policies are being made that affect people with intellectual and developmental disabilities and their families."

Delaware is experiencing the same crisis in caregiving for people with intellectual and developmental disabilities (I/DD) as the rest of the country. Low pay and poor working conditions for Direct Support Professionals (DSPs) have resulted in extreme difficulty in hiring qualified people as caregivers and rapid turnover of workers. Families and other advocates thought they had found a solution when legislation passed last year to fully fund the needs of I/DD adults:



"The McNesby Act passed unanimously in 2018, which promised full funding for adults with I/DD in the next three years. Direct Support Professionals are an endangered workforce in Delaware and often leave the jobs they love for higher paying jobs in other industries. It has reached crisis levels and the Joint Finance Committee only put a Band-Aid on the wound yesterday. 

 "Wearing our green shirts, we held our rally and sat in Legislative Hall during the FY 2020 budget markup for several days. Despite our best efforts, only $2.2 M was added to $1.8 M in the budget for a total of $4 M. Read this press release from the Ability Network of Delaware to learn more."

This disappointing turn of events was followed up by an opinion piece at Delaware Online by Micki Edelsohn, "Be fair to those who care for adults with intellectual disabilities", June 12, 2019: 


Although our son Robert has an intellectual disability due to a difficult birth, our goals for Robert were the same as our older son, Andrew: to get the best education, reach his potential and someday live in his own home, have a job and enjoy his community.

While Robert was still in school, we began our dream of raising the funds to build a group home where he could live with his peers, with staff support. In February 1990 a miracle happened: a chance meeting with Charlie Cawley, former CEO of MBNA America Bank. After learning of our plans, to our amazement and delight, he committed that MBNA fund the first group home and, in addition, hire the residents.

That initial home was the catalyst. We established a non-profit, Homes For Life Foundation and created a partnership. Homes For Life raised the funds and deeded the debt-free homes to the Arc of DE. State government then contracted with provider agencies to hire the direct support professionals (DSP’s) to support the residents.

It was a win-win for the families and for the state, now given affordable housing.

Thirty years later, Homes For Life has built 25 group homes and purchased two condos where 104 adults with intellectual/developmental disabilities (I/DD) live. One thing has become very clear, the home is worthless without the dedicated direct support professionals, whose job it is to provide the appropriate support needed.

But today, the State of Delaware has turned its back on the agencies that provide the workforce to care for the most vulnerable people in our society. DSPs have not been paid a living wage.

The state’s payments to these non-profits only support a wage of $9 an hour. One agency lost 95 percent of their DSPs last year due to low wages; another had a turnover rate of 87 percent, and the turnover rate for most agencies is around 50 percent a year.

Even the most effective business leader could not operate in an environment with a turnover of employees at such high levels.

In 2018, the Michael McNesby Full Funding for Adults with I/DD Act was passed unanimously by both houses of the General Assembly and signed into law with great fanfare by Governor Carney. The Act ensures that funding for services be brought up to levels recommended by the Department of Health and Social Services (DHSS), namely $42 million over the next three years.

Despite the need for $14 million dollars this year and the promise made, only $4 million is in this year’s budget.

Without properly paid direct support professionals, the residents cannot survive. The beautiful neighborhood homes will slowly disappear — homes worth millions of dollars, with contributions by hundreds and hundreds of donors (individuals, corporations and foundations) hoping to give a “home for life” to an adult with I/DD.

How can this happen? Gov. Carney and our legislators must fulfill their promise to fully fund the McNesby Act. The lives of our loved ones with I/DD are at stake.

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Teaming up with a national movement for choice, green T-shirts, rallies, opinion pieces and letters to the editor and legislators, and a great big billboard advertising the cause ... This is a great example for other family advocacy groups to follow.

Micki and Lanny Edelsohn are founders of the Homes for Life Foundation in Wilmington Delaware.

Tuesday, July 2, 2019

VOR: Celebrating the 20th anniversary of Olmstead



VOR acknowledges the 20th Anniversary of the Olmstead Decision and celebrates in its opening doors to community living for people with intellectual and developmental disabilities (I/DD) who are able and wish to take advantage of such opportunities. The Court’s decision in Olmstead was balanced and comprehensive. It presented a road map for how to meet the aspirations of those seeking inclusion while protecting the needs of those with more severe intellectual disabilities. VOR is proud of the role that we played in presenting an amicus to the court, showing the need to include all people with I/DD in their ruling. 

Recently, the Department of Justice (DOJ), and the Administration for Community Living (ACL) issued press releases celebrating the 20th Anniversary of the Olmstead decision. Unfortunately, their ideological focus with one key part of Olmstead, “community integration”, at the expense of the other key part, “choice”, has reduced options for all people with I/DD and especially those with the most severe and profound forms of I/DD. Whether or not this is an innocent misreading of the ruling or a deliberate misrepresentation of the Court’s opinion, this limited interpretation of the plain language of Olmstead has done significant harm to many of our most disabled citizens. 

By insisting that all people with I/DD live in the community, the DOJ and ACL are treating people with I/DD as a monolithic group, not as unique individuals. DOJ and ACL are substituting the wishes of the government for that of the person with I/DD or, where relevant, the parent or legal guardian. While their policies have opened doors for the less severely disabled, they have closed important doors for the more severely disabled. Many of these individuals have lifelong needs that require a very high level of care, the kind often found only in public and private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID). 

DOJ and ACL are pursuing this agenda in the name of the ADA and Olmstead, but that is not what the ADA and Olmstead call for. Both the statute and the Supreme Court case embody the best values of American society —nondiscrimination and choice. All of our civil rights laws contain both elements. Civil rights laws do not tell people where they must live or work. They guarantee individuals are not denied opportunities based on a particular factor, and they expand choices for individuals who have suffered discrimination. In sharp contrast, DOJ and ACL are using federal dollars to bring lawsuits and promote policies that needlessly and dangerous eliminate important options – ICFs/IID, sheltered workshops and facility-based day programs – that many of our most disabled individuals rely on and prefer over small community residences. 

In pursuing a one-size-fits-all ideology, DOJ and ACL are ignoring the vital rights of choice embodied in the ADA itself: As the Court clearly stated in Olmstead: 

“We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings . . . . Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it. Olmstead v. L.C., 527 U.S. 581, 601-602 (1999). 

In fact, the Court specifically incorporated the right of choice in the second prong of its holding: 

“(b) the transfer from institutional care to a less restrictive setting is not opposed by the affected individual,” Olmstead, at 587

Even DOJ and ACL’s concept of what constitutes the most integrated setting contradicts the view of Justice Ginsburg: 
“[For some individuals, no placement outside the institution may ever be appropriate. ‘Some individuals, whether mentally retarded or mentally ill, are not prepared at particular times - perhaps in the short run, perhaps in the long run - for the risks and exposure of the less protective environment of community settings;’ for these persons, ‘institutional settings are needed and must remain available.’ ” . . . Each disabled person is entitled to treatment in the most integrated setting possible for that person – recognizing on a case-by-case basis, that setting may be an institution” Olmstead, at 605. 
 Not only are DOJ and ACL ignoring the plain language of governing law and decision, they are ignoring the harmful effects of their policies. Journalists have time and again documented the high rates of abuse and mortality for our most disabled citizens who have been forced out of congregate care facilities into unprepared communities. Federal agencies should stop dictating the lives of the severely disabled, and instead, join hands with the community of individuals with I/DD to ensure that all people with I/DD receive quality services and supports wherever they choose to reside. 

The ADA and Olmstead are the beacons for providing more opportunities for people with I/DD, but they do not dictate one-size-fits-all solutions. They are to provide rights and protection for everyone. Individual choice among the widest possible range of quality living and occupational options is what is necessary to realize the goals of the ADA and Olmstead. VOR supports the full reading of Olmstead, making individual choice of services paramount and ensuring a full range of living and work options in order to meet the spectrum of needs of this very diverse population. 

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VOR is a national organization that advocates for high quality residential and work options and human rights for people with intellectual and developmental disabilities. Established in 1983, VOR is a 501(c)(3) non-profit organization, governed by a volunteer board of directors and funded solely by dues and donations. VOR receives no government support. 

Thursday, June 27, 2019

A Critique of the Proposed Disability Integration Act

June 27, 2019 
by Jill Barker, mother of Danny and Ian Barker 
Ann Arbor, Michigan 


The Disability Integration Act (DIA) of 2019 is a bill that has been introduced in the U.S. Senate (S. 117) and in the U.S. House of Representatives (H.R. 555) “to prohibit discrimination against individuals with disabilities who need long-term services and supports, and for other purposes.” Discrimination on the basis of disability is already prohibited under numerous laws, regulations, and court decisions going back to the 1970’s. It is the “other purposes” of the proposed law that cause alarm, especially when overly prescriptive policies override the judgment of individuals and their families in determining the needs of people with disabilities. 

The DIA attempts to promote and impose an ideology of full inclusion on all people with disabilities. It envisions “full integration in the community” for everyone, regardless of their need for specialized treatment and care or their preferences for how and where services are delivered. Considering the full range of need and the diversity of people with disabilities, most may desire “full integration in the community”, but for some, a fully integrated life in the community may not be possible or desirable. 

In the disability community, there are fierce debates over how and where people with disabilities should live and receive services. The DIA does not reflect the full range of perspectives on these issues, especially my own views and those of many others who have family members with severe and profound intellectual disabilities. Missing from the debate, as far as this piece of legislation is concerned, are people with disabilities and their families who rely on and benefit from the programs, services, and residential options that this bill would eventually eliminate.

The advocacy groups that worked on this legislation are ideologically opposed to institutions and all other congregate residential or work settings, regardless of the needs or preferences of individuals and their families. 

Let me introduce you to my sons, Danny and Ian

Danny is 42 years old and has severe cerebral palsy, profound intellectual disabilities, intractable seizures, reflux, a permanently dislocated hip, a feeding tube, and a severe visual impairment. He is unable to communicate in any specific way, although we know when he is feeling good and when he is not. He experiences frequent medical crises - in 2017, he was treated in the Emergency Department at the University of Michigan more than 15 times for seizures that would not stop and five times for aspiration pneumonia, for which he was hospitalized. He lives in a community group home with five other people with disabilities with similar needs. Despite the severity of his disabilities, he is happy and content with his living situation and gets a great deal of love and attention in that setting. 

My son Ian is 34 years old and had problems at birth similar to those of his brother. He has disabilities as profound as Danny’s and, like Danny, he needs total care. He is unable to recognize dangerous situations, much less to protect himself from them. He shares a room with his brother in the same group home where they receive good care, but the continued availability of that care is precarious due to our chronically underfunded mental health system. Their direct care workers perform difficult jobs that are undervalued and often unrecognized for their importance. My sons’ need for 24/7 care and supervision is dependent on the group home receiving adequate funding and support. 

Direct harmful effects of the DIA on Danny and Ian 

The DIA arbitrarily proposes to redefine Home and Community-Based Services (HCBS) so that my sons’ group home would no longer be considered "Community-Based". [See the DIA, page 9, where the definition of a community-based dwelling “…is a group or shared residence…in which no more than 4 unrelated individuals with an LTSS disability reside..” ] If adopted, there is no reason to think that HCBS Medicaid funds would continue to support their group home. It would increase the instability of the current system of care, increase costs, and drive service providers out of business, because the four-person limit denies possible economies of scale to control operating costs. 

General harmful effects of the DIA 

The effect of the “community integration for all” approach in the DIA will result in making specialized services difficult to access. People with disabilities will have to justify, not just that a service is appropriate to their needs, but that it is also used by people who are not disabled. If one receives dental services at a clinic that specializes in serving the needs of people with intellectual and behavioral disabilities, it should not be necessary to prove it is integrated by showing that people without those problems also use the clinic’s services. 

The DIA imposes a goal of independence on many individuals for whom a limited degree of independence or none at all may ultimately be achievable. No federal law should impose or assume goals that do not reflect individual abilities and needs. [On page 11 of the DIA, the definition of “an individual with an LTSS disability” makes the assumption that an independent life is achievable regardless of the person’s disabilities.] 

Under the DIA, decisions for how and where people with disabilities live and receive services will be imposed by federal policy rather than allowing the judgment and experience of people with disabilities and their families, and others who know them, to be the basis of those decisions. 

The proposed DIA promotes the notion that money will be ”saved” by eliminating institutions (Intermediate Care Facilities for Individuals with Intellectual Disabilities - ICFs/IID), skilled nursing facilities, group homes serving more than four individuals, and other congregate settings. The presumed savings would enable the states to expand services to more people in community settings, but at the expense of those with the greatest needs. Despite the shift of Medicaid funding to community settings from institutions, waiting lists have soared and the “savings” to serve more people with disabilities have not materialized. According to the UCP Case for Inclusion 2019, page 9, spending doubled on Home and Community based services from 2006 to 2016, the number of people living in larger state institutions was cut in half, while waiting lists for services tripled

Non-existent and poor quality services as well as unsafe and unaffordable housing for people with disabilities in the community are staggering problems throughout the country. This legislation would likely push states to move people, often against their will, into unsafe and unprepared communities from congregate settings without dealing with the reality of the present crisis in community care. 

The DIA, the ADA, and Olmstead 

The Americans with Disabilities Act regulations on discrimination state that, “A public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” [emphasis added]. This makes clear that the appropriateness of the setting to the individual is of primary importance. The DIA uses the phrase, “most integrated setting” five times and each time it leaves off the phrase “…appropriate to the needs of qualified individuals with disabilities”. Why? Does consideration of the appropriateness of a setting to the needs of the individual conflict with the ideology of “full inclusion” and “community for all”? 

Under Findings and Purposes, the DIA assumes that placement in an institution such as an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) or other congregate setting of more than four people with disabilities is inherently discriminatory. This is not consistent with the ADA or the U.S. Supreme Court Olmstead decision interpreting the ADA: 
  • The ADA does not restrict individuals from receiving needed services in specialized settings for people with disabilities nor does it allow public entities to prevent access to services and benefits available to all. 
  • The 1999 U.S. Supreme Court Olmstead decision affirms this interpretation of the ADA and includes protections and choice for people in institutional settings and those needing an institutional level of care. 
The DIA violates existing law, in that it specifically states that it would eliminate institutions (pp. 21 & 32-33) and thus restrict a State’s ability to maintain a range of options for the care and treatment of people with a diversity of disabilities: 
  • "Unjustified isolation, we hold, is properly regarded as discrimination based on disability. But we recognize, as well, the States' need to maintain a range of facilities for the care and treatment of persons with diverse mental disabilities, and the States' obligation to administer services with an even hand." (Olmstead v. L. C., 527 U.S. 581, at 597)
  • “We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings. . . Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it." (Olmstead v. L. C., 527 U.S. 581, at 601-602)
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Let’s look before we leap. Legislation that is this sweeping and that affects so many vulnerable people who are already at the mercy of others who would exploit them for their own purposes, should not go forward without a full analysis of all its intended and unintended consequences. Most importantly, for these most vulnerable people, FIRST, DO NO HARM.

[This post was updated for clarity on 7/2/19, but the substance remains the same. JRB]

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