Olmstead Plan Elements
The United States Supreme Court in the case of Olmstead v L.C. indicated a State may be able to meet its obligation under the Americans with Disabilities Act (ADA) by demonstrating that it has a comprehensive, effectively working plan for placing qualified disabled persons in the most appropriate integrated setting, and has a waiting list(s) that moves at a "reasonable pace."
OCR, strongly recommends that States develop an Olmstead plan. The development of such a plan would provide an internal framework for assessing and coordinating existing services. The State should designate a team that is responsible for drafting the Olmstead plan. This team should include representatives from all state agencies or divisions that serve populations affected by the Olmstead decision.
It is vitally important that all stakeholders be involved in this planning process. This includes disabled persons and advocate groups. The State group designated to draft the State's Olmstead plan should work closely on an on-going basis with a representative group of stakeholders to develop the plan. Working closely with the stakeholders allows the State's Olmstead team to work directly with those persons whose lives are most affected by the decisions made by the Olmstead team.
Plan development principles recommended by the U.S. Department of Health and Human Services stress the importance of starting with the area of needs assessment.. An Olmstead plan should address the assessment process for each eligible population. It may be useful to think about a needs based system rather a diagnosis based system. The plan should clearly delineate the process for determining who needs which services. Assessments should be completed on an on-going basis.
The Plan should inventory the services currently available to disabled persons, the number of people currently receiving each type of service, the number of people currently seeking each type of service but not yet served and, the supports currently available in the community. Completing such an inventory will allow the State to determine where additional services need to be developed.
The Plan should provide for the collection of data that will allow the State to monitor its compliance with Title 11 of the ADA. This data should be reviewed on an annual basis.
The Plan should address the needs of institutionalized persons as well as persons who have the potential to be institutionalized. These populations would include the MR/DD population, both children and adults; the mentally ill population, both children and adults; and the physically disabled, both children and adults (including the elderly).
Following are the key elements in an Olmstead plan. Each lists a principle followed by information which should be collected to determine compliance with the ADA. For each informational item a response should be prepared keeping in mind the distinct populations covered under Olmstead.
Plan Development Principle
Assess what partners are needed to ensure the Plan is complete and effectual. Furnish an opportunity for these interested parties to be involved in the Plan development and follow-up on an on-going constructive basis.
Identification of persons responsible within the state agency(ies) for developing the Plan, indication of specific action steps necessary for completing the Plan, and the timeframes for completing each action steps
Identification of key stakeholders
Identify the groups involved in the development of the programs that are designed to provide services in the most integrated setting. Describe the nature of input. This includes all relevant state agencies, advocacy groups, and providers.
Description of the process to be used to collaborate with a group of the identified stakeholders
A description of how the State is involving people with disabilities (and their representatives, where appropriate) in the plan development and implementation process.
Current System Principle
Ensure that processes are in place that would prevent or correct improper institutionalization of individuals with disabilities. An accurate census of individuals with disabilities who are currently institutionalized and who may be eligible for community placement should be completed. All community based services should be identified and assessed as to what extent they are able to serve persons in the most integrated setting. All community based services that meet the needs of qualified disabled individuals, who wish to live in the community or to remain in their own homes, should be evaluated. Recommendations for improvements in these services should be sought.
An unduplicated count of individuals currently residing in institutions, by type of institution (nursing home, group home, ICR/MR, IMD,etc.)
An unduplicated count of individuals currently residing in institutions who have been determined as ready to move to community placements, separated by type of institution An unduplicated count of individuals currently served in the community.
A description of any current waiting lists and the median time it takes for a person on the waiting list to be placed for each population affected (e.g. elderly people with disabilities, people with physical disabilities, developmental disabilities, mental illness, etc.).
A description of the process to get on the waiting list.
If the State has no waiting list for a particular program, a description of how persons are selected for services when openings become available For each program or service that has a waiting list an explanation of what a "reasonable pace" is for the waiting list.
The number of individuals not currently residing in institutions who, without the provision of community services, would be at substantial risk of being institutionalized.
Current services and programs available to state residents in institutions. including a description of the individual programs, current level of participation and current level of funding.
Current services and programs available to provide community support, including a description of the individual program, current level of participation, funding level.
Needs Assessment Principle
The State should evaluate the existing assessment procedures that identify individuals with disabilities who are currently institutionalized and who may be eligible for community placement and those who are at risk of institutionalization, and act in an expedient and useful manner after the individualized assessment has been made.
The State should assure that the assessment process is objective and free from conflict of interest.
A description of the process by which individuals' needs are assessed for the provision of services, both upon initial entry into the system and on an on-going basis. Individuals should be reassessed at least once a year. This applies both to persons currently institutionalized and to those at risk of institutionalization.
A description of how the physicians/assessors are selected.
A description of the persons performing the needs assessment and their qualifications.
The schedule for assessing and reassessing individuals' needs as described above.
A description of the appeal process for individuals who are denied the appropriate placement of their choice based on the needs assessment .
A description of the process for obtaining a second opinion.
Informed Choice Principle
Provide qualified individuals with disabilities and their families or guardians an opportunity to make informed choices on whether and how their needs can best be met in community or institutional settings. Informed choice implies that the disabled individual and/or their family or guardian is made aware of all available placement and program options sufficiently in advance of any program/placement deadlines so that the disabled individual has ample opportunity to consider the choices available. The types of information, education, and referral systems should be addressed and evaluated to ensure that qualified individuals with disabilities and their families make informed choices.
The process by which all individuals, those new to the system and those currently residing in institutions, and those who could be institutionalized, are fully informed of, and play a part in, all options for receiving services.
The process by which all interested disabled individuals, especially those in institutions, can request services in a community setting.
An assessment of what information, education, and referral systems would be necessary to assure that people with disabilities are effectively disseminated the information necessary for them to make informed choices.
Changes in Structure/Service Delivery Principle
Consider what physical, medical and programmatic infrastructure must be developed and implemented to achieve the placement of qualified individuals with disabilities into more integrated community based settings at the State and community level.
The changes in structure of state programs necessary to provide optimal services in the most integrated setting, including any plans for closure of state institutions or changes or improvements to the way current services are delivered.
Plans for implementing the structural changes identified in the item above, including timeframes:
- A description of all new or expanded community-based programs necessary to provide optimal services in the most integrated setting and an estimate of how many people will be served by each such new or expanded program.
- Plans for implementing the new or expanded community-based services identified above, including timeframes.
- Plans to shorten the time individuals are on waiting lists.
- The identification of all funding sources, federal, state and local, for provision of services in the most integrated setting.
- A description of all efforts made through legislative and/or administrative processes, etc. to re-allocate existing funds or to obtain additional funding, if the need has been determined during the assessment process, from various sources, to increase the availability of community-based services.
Monitoring/Quality Assurance Principle
Ensure that quality assurance, improvement, and sound management are instrumental in the implementation of the plan, and are evaluated as to whether or not they can be conducted effectively.
Description of the process by which the State will monitor completion of the action steps and timeframes listed under "Plan Development".
Identification of the individuals responsible for monitoring compliance with the State plan.
A timeframe for on-going self-assessment and monitoring of plan implementation including a discussion of Olmstead implementation in any annual report required by the State.
The plan for moving persons, who have been identified as being able to benefit from community-based services, from institutions to community settings. The plan should include specific institutions to be targeted, numbers of persons to be moved, timeframes for completion, the plan for monitoring completion of these items in a timely manner, and consequences for not meeting timelines
The process by which the state will evaluate the quality of services provided to ensure that all providers of service meet acceptable standards of quality.
The plan by which the State will provide services to non-institutionalized persons who require such services to avoid institutionalization.
A timeframe for on-going assessment and maintaining of plan implementation including preparation of a discussion of Olmstead implementation in any report required by State Law.
