A full implementation of the home and community-based care principles embodied in the landmark Olmstead Supreme Court decision will achieve two of the chief goals being pursued in the current push for national health reform, namely, saving money and improving health care outcomes. This is the claim advanced in “Still Waiting: The Unfulfilled Promise of Olmstead” (June 24, 2009, pdf), a recent report from the Washington, D.C.-based Bazelon Center for Mental Health Law.

Main points in the report include:

• States must identify how many people with disabilities are unnecessarily segregated for care and how to reintegrate them, and must shift funding from institutions to community-based services.
• Billions of dollars can be saved by hitching implementation of Olmstead programs to health care reform in order to provide community services to people with mental illnesses.
• States continue the wasteful practice of putting people with mental illnesses into institutional settings that are demonstrably more expensive and less effective than community-based settings. They often do this in response to pressure from profit-oriented providers.
• There is a critical need to support judicial nominees, including Supreme Court nominees, who understand and intend to uphold Olmstead, the ADA, and other civil rights laws.

The report also offers detailed explanations and examples of what exactly is meant by the terms “services in the community” and “community supports,” and highlights a number of effective community programs that already exist around the nation. And it offers specific calls-to-action, urging the federal government, for example, to pass the Community Choice Act and amend Medicaid to make home and community-based services available to more people. The call-to-action also urges state governments to adjust their health care systems to procure more federal funds for community-based services.

In 1999, U.S. Supreme Court ruled in Olmstead that the unjustified institutional isolation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act.

But, as highlighted in President Obama’s recent pledge on Olmstead’s 10^th anniversary to support people with disabilities, the decision’s central principles have never been fully realized in actual practice. In its new report the Bazelon Center says the time has come to remedy this, especially given the prominence of national health reform as a current political and social issue.

“The current system is broken in many ways,” the report says. “The continuing failure to provide the community services envisioned in the Olmstead ruling wastes public resources. Multiple studies of alternative approaches find that institutional care is more expensive than early and consistent community options.”

At a press briefing, Ira Burnim, the Bazelon Center’s legal director, said, “We have only seen progress toward implementing Olmstead principles in the past decade through litigation. It is time for states to follow the integration mandate given by the ADA and reinforced by the Supreme Court.