Category Archives: Uncategorized

Innovation – automation – what happens to the brain and thinking?

This post is on a different topic – kind of an eclectic mix of issues that have bothered me this week.  To start, I know nothing about Microsoft, Bill Gates and how he managed the company or how Steve Ballmer manages the company but I heard something interesting regarding innovation and the ability of the employees to use innovative thought which helps with progress.  The critique I heard was that Mr. Ballmer does not allow innovation and therefore Microsoft is not progressing.  Regardless if this is true or not, I have no clue and I’m also sure this is an extreme oversimplification of the whole story.

Taking this issue to nursing, my career, I see this lack of innovation and total adherence to automation making it impossible for nurses to think anymore.  Nurses are become robots, unable to analyze and be the advocate they once were.  Hospitals are ruled by protocols which make it impossible to individualize care needed for that particular patient.  Who makes all these protocols?  I do not think it is the bedside nurse, the nurse who has the most knowledge regarding how to care for that individual patient.

Being paid not to think as a nurse is scary.  I have been reprimanded several times for mundane issues  - all because I saw a problem and wanted to investigate to improve the situation.  Nurses are not allowed to do this.  I was called into a meeting with 4 managers over the fact that I called the manufacturer of a product we use to inquire about removing the outer bag of the IV solution.  The hospital protocol did not make sense and actually hindered patient care.  I did find out the answer and I was right – I even provided all the information to the managers but that didn’t matter because the hospital protocol knows better than the manufacturer of the product. I was told that I had no right to contact the manufacturer to ask a question!  And here I had thought that we should ask the manufacturer.  Guess not!

IV bag with cover images (19)

Recently I was a patient in the hospital.  I have chronic lung problems, part of my long term disability from being a caregiver for my child with intense 24 hour care needs.  Every person needs to have and advocate for them when they go into the hospital.  You must request that the nurses document things – if they are not written down, they were not done.  I got in an argument with the ER Doctor regarding my oxygen saturation.  Even though I could watch it go down into the 80′s and I knew I needed supplemental oxygen, this ER Doc told the nurse to take off my oxygen because I didn’t need it because my level was 98!  That was one spot check after I had been able to clear my lungs and totally not indicative of my respiratory status.  I started to get upset and he wondered why I was upset?  I was upset because he was not listening to me nor was he listening to the nurses who told him I needed the oxygen.  He just wanted to get me out of his ER.

I can’t tell you how many times the little red laser light read my bar code to put the medication that was going to be administered on the Electronic Medical Administration Record.  Did the nurse look at the medication too and make sure it was the right one or are they all trusting the little red light and the bar code to do do the thinking for them.  I don’t know but I’m not sure I like all this automation – makes the brain lazy!

Now, today, I heard the horrible 911 call from another nurse in a nursing facility.  It is against the nursing facility protocol for the nurse to do CPR.  The policy is if they find a patient unresponsive to call 911 and wait for assistance.  The 911 dispatcher was pleading with the nurse to start CPR and even saying “you are going to let this woman die?”  Turns out, yes.

Elderly Woman Dies After Nurse Refuses to Give Her CPR

What is this?  What is happening?  Are nurses so afraid that they will be in trouble if they do not follow the protocol that they let people die?

I just do not understand.  I love being a nurse and I love nursing.  Maybe though that is because when I started nursing, we were allowed to be innovative and were encouraged to think.  Times have changed and I’m not ready to change with these idiotic policies that harm people.

NCD – Deinstitutionalization Delusions

Dear National Council on Disability,

As a healthcare professional and advocate for our most vulnerable citizens, I ask that the National Council on Disability rethink your position regarding deinstitutionalization.

The council is advocating for negligent care by pushing forward with deinstitutionalization.  Not only is this removing choice from these citizens (as guaranteed under the 1999 US Supreme Court Decision Olmstead) but also acting in violation of the US DD Act.

Supportive communities offer comprehensive care for our citizens with the highest support needs and most complex care.  These communities (which unenlightened or inimical people call institutions – I assume because they are unfamiliar with these communities or people who have their homes in these communities)  are homes to many of our loved ones.  Living in a community, sharing services and supports, is a very cost effective method to care for those who have a high cost of care.

Moving these people to dispersed homes, isolating them from family, friends, caregivers and healthcare providers in the name of “deinstitutionalization” makes a mockery of advocacy.  It is the exact opposite of what an advocate should do.

These dispersed homes often have unstable, inadequate staffing ratios and staff who are not trained well.  There is little coordination of care leaving the vulnerable person at higher risk for crisis care.  When care is finally given, generally these people have more advanced problems which require longer hospitalizations than if they had been managed with coordinated care which was accessible.  Promoting this type of “care” is promoting negligence.

When a person is totally dependent on another person (and often a paid provider) to provide all care a

nd assist in all activities, what happens when there is no provider who shows up to work? When an unfamiliar, untrained provider “fills in”? When the provider does not speak your language? What happens if a person wants to go outside or on a walk but there is not enough staff to go on an outing and also stay home to care for a housemate?  People become isolated and imprisoned.What happens is people do not see them anymore.  When our vulnerable citizens are not seen they are forgotten, the risk of abuse greatly increases.  When there is no one watching, no oversight, no one even knows they are there, people’s lives are destroyed.  This is what happens.

Is the deinstitutionalization movement aimed destroying these people’s lives one by one, hoping no one will notice?  If people who lived in a supportive community were dispersed, we wouldn’t have to see them or deal with them.  Is that what this is about?  It appears that way to me.

Supportive communities provide safe environments which are sustainable, employ a wide variety of profess

ionals who are specially trained and must meet annual standards of care.  There is oversight which is monitored and there are clear standards which must be met.  Why would one deny a person the right to safe, appropriate care?

Assuming dispersed homes are a better environment for many of these people is a false assumption

.  Take a tour of not only supportive communities but also dispersed homes, learn about the caregiving staff, learn about access and availability of healthcare, dental care, therapies, recreational and work opportunities before making a decision about what you think would be best for someone you do not know.  Listen to the people who know, love and care for these citizens.  They are the experts .  The experts are saying that we need supportive communities to best care for some of our citizens who are the most vulnerable.  Denying them this choice is not only inhumane but against our laws.

I know what I’m talking about.  My 18 year old son has thrived since being able to move to a supportive community at age 15.  He had been cycling in and out of the hospital with many complications due to a dual diagnosis of developmental disability and mania/psychosis.  Since moving to his community he has not been hospitalized once.  He has the supports he needs to be stable and he loves his home.

My son was honored as a member of the Shorecrest High School Homecoming Court this past Fall. (S

horeline Public School )   Far from being isolated he is well known in his community being very active in ma

ny recreational programs.  Living in a supportive community has enabled him to contribute, belong and participate in our community at large.

Thank you very much,

Cheryl Felak, RN, BSN

HOMECOMING 1

Because We Care – Beyond Inclusion

Attachment below  is just a “sample” list of actual citations from Licensed Adult Family Homes for p

eople with Developmental Disabilities in Washington State.  This list is FAR from complete and it is shameful the abuses and negligence which our citizens are subjected to.  It is very disturbing to know that this is probably only the tip of the iceberg and that many of these are repeat, uncorrected offenses with little or no punishment.

WA State Licensed Adult Homes for People with DD Citations 2011 adn 2012 Samples

 

Caregifted – getaways for exhausted caregivers

Undersung

Today I learned of this wonderful program called Caregifted.  Here is the story of one exhausted mom who was able to benefit from this program – Free Vacations for Exhausted Caregiver.

Currently I am doing research on family quality of life.   When families are given no choice, when supports are taken away, when families are forced into isolation and become invisible because of their efforts to care for their adult children with complex needs, families fall apart.  We need to support the family in order to support the individual.  There are countless families who seem to disappear, they cannot work, they do not socialize, the lose touch with family and friends  and their life is defined by their child.  These families need respite and support.

Even a few hours a week which could be relied upon by a trained caregiver would be enough for some to just relax, get away  and give them energy to feel alive and part of the community again.  Why isn’t this happening?  Why do families have to go to battle to have minimal, if any, support?

Inclusion is a delusion without support.  Policymakers are forcing families into ruin by taking away choice and also denying these families support they need to survive.   Our children with complex needs, both behavior and medical, do not grow out of these needs, they become invisible as they grow up and become isolated, with their families.   There are very few  supports in our communities able to manage a grown adult with the emotional, physical  and developmental behaviors of a toddler.  If there is support is that support available when and where the family needs it?

Research in the past couple of years (Journal of Intellectual Disability Research, Journal of Intellectual & Developmental Disability, Center for Health Care Strategies, Inc.,British Journal of Learning Disabilities to name a few journals with recent published research) is starting to look at family quality of life and congregate care.  It is becoming more clear, especially for those with complex behavioral and medical needs, the person with the ID/DD and their family may do better, be happier and have a higher quality of life (both family and individual) when they are able to live in a supportive community of congregate type care.

Back to Caregifted – I believe this is truly a wonderful program. The one unfortunate caveat is that a prerequisite of applying is that applicants must have trustworthy caregivers available to care for their child to have a vacation.   That is part of the problem – where do families get this?

Please view the trailer for the documentary Undersung

Sylvia’s comments and thoughts shared

Sylvia Fuerstenburg, Executive Director of The Arc of King County, has again written an essay regarding the advocacy of The Arc for people against the right to live in supportive communities.   I just cannot wrap my brain around how an advocacy group, which receives thousands of dollars of public funds each year, is allowed to openly discriminate against a segment of the population which they are PAID to advocate for.  They clearly do not understand the situations of those who have homes in supportive communities and do not seem to realize that moving many of these people from their chosen communities and homes will only increase the crisis to the community as a whole.

Below is my letter to Ms. Fuerstenburg and Mr. Lance Morehouse, the Outreach and Advocacy Coordinator for King County Parent Coalition:  Please send your comments also.  I do not think that my comment will be published given past history of The Arc blocking critical information for families regarding supportive communities. but I keep trying to get through.

Dear Sylvia and Lance,

I would appreciate the opportunity to make a comment regarding your letter in the December Newsletter.  I do hope that my comments will be available for all to read and discuss.

I wholly support the mission of The Arc to advocate for people to live in the community of their choosing.  “The Arc believes that all people, regardless of the severity of their disability, can live successfully in the community with individualized and appropriate supports.”  I think that all advocates believe this – the problem is finding funding and maintaining a stable, qualified support staff as caregivers for those who need supports.

Do you listen to the people in the community talk about the difficulty they have in finding even someone to provide a couple of hours of respite?  Do you read about the very high staffing turnover of caregivers in community homes (up to 45% in some areas).  Do you listen to families of people living in family homes about how many caregivers they interview and hire each year to help with caregiving in the home?   Do you hear the parents who cannot work or who have lost their job because they have used too much “sick” time because they cannot get another caregiver?  Do you hear the families who are bankrupt or struggling financially because they cannot get help caring for their child?  Do you hear the families who use the ER or have to have their child admitted to the hospital for crisis care – the only “respite” those families receive?

It does not appear that The Arc hears these voices – if you did, it would be negligent to increase capacity of this residential population, particularly of those who need high supports, which would then over-tax an already under-funded and under-staffed community residential service system.

I have never heard that one is “too disabled to live in the community” from a person who advocates for a continuum of care, including living in a supportive community.  You’re right, no one is “too disabled” but there are people who do require a team of support people to keep them safe and healthy.  Sure, with unlimited funds, everyone could live in a residential neighborhood – but that is not the reality.  Our funds are limited.

As Lance said in the October 23, 2012 DD Task Force meeting, his son was able to live at home for 17 years with the help of 19 hours a day of licensed nursing care.   I’m very happy that their family had this opportunity but this is not a cost effective system to manage a large number of people who may need this level of nursing and caretaking support.  If all those in the supportive communities chose to live in a neighborhood residential home and required this high level of support to survive, would our state be able to financially handle that?  I know it wouldn’t.  So why then, does The Arc advocate for this type of residential service (which is clearly more expensive than a supportive community) and then say that those in the supportive community are taking more than their share?

It should really be the opposite – our state should be thanking those who choose to share services, and thanking those who choose to live in a supportive community home for many reasons.  These communities have a track record of having a more stable workforce and the fact that many services can be shared among residents is much more cost effective system for those with high support needs.

These supportive communities are far from segregated – in fact, most of the residents who have homes in these communities are out shopping, going to school, participating in parks events, go to church, attend neighborhood and city functions and more.  You just may not be aware of them because they have the support that they need to be out and about – unlike people locked away in their “community residential” home because a caregiver did not show up for work or the staff is untrained in behavior management and therefore unable to take the resident out of the house, or some other reason.

Living in a supportive community allows one more freedom.  Many of our citizens of all ages and types voluntarily choose to live in some sort of supportive community for various reasons.  Why are our citizens with ID/D being denied this right to choose which community is best for them?  Isn’t this discrimination against them due to their disability?  Isn’t the Arc against that type of discrimination?  Apparently not since The Arc advocates, and uses public funds, to do just that – discriminate against our most vulnerable.

It’s time for a change – let people have the choice – true choice – give them the information, allow them to decide what is best for them.

Thank you,

Cheryl Felak, RN, BSN

Photo and link from

December 2012 Newsletter

 http://hosted.verticalresponse.com/437417/c96b185e8e/1461566135/cdb5bffe12/

The Arc o f King County receives publlic funds from King County and Washington State to share information and advocate for individuals with DD

The Arc o f King County receives public funds from King County and Washington State to share information and advocate for individuals with DD

Is this how the Attorney General investigates reported fraud? If so, we are in trouble.

Is this how our Attorney General’s Office typically investigates concerns of fraud?

If so, I’m rather concerned about the competency level of the investigators.  This information was retrieved from Public Records.  I have left out the names of the agency, reporter and Attorney General Investigator’s name.  If you are interested in learning more, please contact me.

Reported to Attorney General Fraud Unit:

A provider in a supported living home listed herself for two positions:

Licensed nurse = – worked 53,505 hours in 2010 (most likely a typo) – Washington State paid her $123,063 or this position

Aid – worked 1,195 hours in 2010 – Washington State paid her $15,705 for this position

This person was paid a total of $138,768 in 2010 for her combined positions

(8760 hours in one year)

ATG Response:

Thanks for this referral. Do you know what the financial impact of reporting the overlap hours? If she didn’t report the aid hours, how would that affected the group home rate?

Reporter response:

I’m not quite sure what you are asking and why - what I can tell you is that I’m concerned about the number our hours that his one person stated she worked and was paid for.  It’s not the rate that I’m concerned about.

This one person stated that she worked 53,505 (obviously a typo, I think that she meant 5,350) as a licensed nurse and 1195 as an aide – that makes 6545 hours that this one person worked in a year.  Given that there is 8760 hours in a year, that means that she only had 6 hours a day every day of the year to sleep and attend to the other aspects of her life.  Is this doaable?  Does the state allow people to legally work that much?

That’s what I’m concerned about.  To me this seems obvious what the issue is but maybe I’m missing something – please let me know.

ATG Response:

In order for my office to prove fraud charges, specifically, theft we need to determine amount of loss to the State of Washington relating to Person’s inaccurate reporting of hours.  If she inflated hours worked on a cost report, I’m assuming that could possible impact the rate she is paid in subsequent years?  I’m trying to determine financial impact.

Reporter Response:

Wouldn’t it be fairly easy to determine the financial impact?  How many hours can one person work – subtract that from what was reported and the difference is the number of hours that was overreported.    A normal 40 hour a week job is 2160 hours a year.  This person claimed to work 6545 hours.  That means that she worked 4385 hours of overtime?  Is that even legal.

I’m sorry that this appears so difficult to figure out.  From my perspective it’s very easy.  I don’t understand what your difficulty is.

 

Why is the ATG Investigator asking these odd questions of the reporter?  What am I missing in this scenario?

Stop thisTrainwreck waiting to happen!

Please stop SSB 5459 – There is so much wrong with this bill that it will be hard to sum up in a concise and effective letter.  The critical issue is to stop this now and think about what the ramifications of such drastic changes will be if this bill is passed.

  1.  This bill is based on regurgitated false information from years past.  Senator Adam Kline continues to talk about “the 1970’s” with regards to our facilities today.  He is correct about the changes that needed to take place in 1970 but he’s far removed from the realities of the situation today and the recommendations from the experts of TODAY
  2. There are many in the community who are eligible and have requested admission to an RHC.  DDD has continually denied admission.  This is the only reason for a declining census in our RHCS.  There needs to be a survey sent out to all in the community who are eligible to inquire about their choice.  I believe you will find many who have chosen the RHC but their choice has been denied.  It is time that DDD actually supported and adhered to the Olmstead decision and respected people’s civil right to have a choice in where they want to live.  This is the very first thing that should be done before any or our RHCS are consolidated or closed.
  3. The reports that are generated by DDD are based on false information.  These need to be scrutinized.  I have researched the data and have found so many errors and flaws in the analysis of that data.  It is incredible that these reports are continued to be passed around as “fact” without anyone in the department questioning the concerns that I have raised.
  4. Rather than answering my letters regarding the fact that the “key points” are not supported by the data, DDD ignores the questions; Executives from The Arc accuse me of being “abusive” for questioning these reports.  As any person who has done research would know, it is expected to have people question your work.  When they question you, it is an opportunity to prove your point – not to call the questioner ABUSIVE.
  5. DDD reports that they have a Quality Assurance program which is up to date.  I will be sending  a synopsis of the issues I have had in researching the QA reports that should have been done, that DDD says they do, and the lack of knowledge about where they are, if they were even done and the multitude of players involved who do not communicate or know who has what report.  It’s a huge issue of “passing the buck” and nothing is getting done.  This NEEDS to be addressed before anything else can move on.  How can DDD say they have quality assurance when they don’t even have reports done, completed or available or even know who does them? DDD has not even complied with the requirements of The Roads to Community Living grant by completing the necessary surveys of the people who have participated.  The whole grant could be in danger without DDD following through with the requirements.
  6. People contacted regarding QA – still no data available – these people just keep sending emails around saying the next person has the data.  No one has it.  Players involved in this game:  (12 names which I won’t post here but sent to our House Ways and Means Committee members)  You would think that one of these people would be able to give a straight answer.  It’s time that DDD and the DDC are held accountable for their actions and lack thereof.
  7. DSHS is focusing their efforts on closing the RHCs.  The RHCS are about the only safe place for our citizens with DD.  The community homes which DDD so proudly talks about are a shambles – no safety or QA oversight, poorly trained staff with a high turnover, inadequate staffing levels and this is just the beginning.
  8. We hear about how wonderful the homes are in the community.  Just this past month I have been told by family members who have a grown brother and a 17 year old son in an Alpha Supported Living home and a SL Start home respectfully that they are not allowed to bring a visitor to the house.  What type of home is it in which as a sister or mother (or other family member) cannot even drop in to see their loved one or to bring a visitor to meet with them?  Why would they have these policies?  This is certainly not a home in which I would place my loved one. At the RHC, I can visit whenever I want, I don’t have to pre-arrange a visit, I can bring whoever I want to visit with my son.  There are no restrictions on my visitation with my own son.
  9. Rather than embarking on projects that are experimental and also on successful programs with people who are happy with those programs, it is time for DSHS and DDD to fix and bring up to standard the issues in the community.  This is where the energy and money needs to go.  These advocates talk about how they support those in the community yet their actions are contrary to that.  The problems with abuse, lack of oversight, lack of trained caregivers, and lack of services in the community will only be compounded by passing SSB 5459.

Please for the sake of not only our most vulnerable citizens who are safe and healthy in their current homes but also for all those in the community who will be hurt even more by the changes  that this bill support, DO NOT PASS SSB 5459.

Very Scary article about persons with Developmental Disability being hospitalized

Journal of Intellectual & Developmental Disability – September 2010; 35(3) 155-164

  •  People with ID continue to experience a higher burden of illness than the general population and this is reflection the overrepresentation people with ID in hospital settings.
  • Needs such as toileting and nutrition, poor communication between staff and patient, oversedation, medication errors, pateint fear and anxiety, insufficeint pain management and poor discharge preparation
  •  Carers (parents and caregiving staff from residential placment) have described vigilance as necessary to ensure adequate care and safety and to minimize fear and anxiety
  • Group home staff are not trained to care for people with serious or chronic heatlh contidions, but have basic first aid training.
  • This study had 76% hospitalization rate over 2 years.  Extensive strategies used by family and caregivers to improve hospital experiences for people with ID.
  • Carers perceived staff to be generally uncomfortable with or indiffernet to the needs of people with ID Care practices that did not acknowledge their special needs were interpreted as indiffernece:  “they don’t’ wash them, they don’t even brush their hair or clean their teeth.  They don’t put their glasses on them etc.”
  • Staff don’t respond to needs – mostly toiliting and nutrition little help with food prep/eating, problems incontenence  and not being changed as needed.
  • Lack of caring or that hospital staff had little or no prior experience or understanding of people with ID  Carers wondered if hospital staff saw people with ID as having little value.  Should a treatment even be tried?  was patient worthy of it?
  • Inabiltiy to treat pain effectively = pain only managed if someone were present to “translate” and insist that the pain be treated.  Not treated if patient didn’t complain.
  • Failure to assess the specific situaiton and respond accordingly – diagnoses and treatment  option were explained to people who lacked the capacity ot understand or hospital staff incorrectly assumed that the patient was unable to understand.
  • Many misinterpretations of behavior that expressed fears, desires or preferences.
  • No care because patient doesn’t know to push button or call out for help
  • Hospital staff fail to heed carer’s advice – poor outcomes for residents.
  • Identified concerns about the lack of attention paid by hospital staff to their descriptions of residnets fears and phobias and warnings about residents reactions to certain approaches – can have catastrophic responses
  • Many challenging behaviors due to lack of structure and staff discomfort –lead to fear, confusion and increased behavior issues.
  • Discharge plans show misunderstanding of what group homes can handle – early discharge due to problems in hospital yet group homes unable to manage early discharge – staff not trained to manage illness and treatments
  •  Difficulties due to hospital staff constantly changing – maybe one shift would follow instructions but not the next.
As a parent who has had a child with ID/DD and mental Illness hospitalized, I can attest to the truth of these statements.  I can not tell you how many times, I arrived on the unit and my son had not gone to the bathroom, had his face washed, had dirty teeth, had food spilled down his shirt, among other issues.  This was all with a 1:1 aid to care for him too.  I wrote out very easy instructions on how to communicate with him, what he liked to do and how to calm him – I don’t believe anyone even looked at them even though I went over them with the staff.  Overall, I was very disappointed in the care that my son received at two of our major hospitals here in the Seattle Area.  There needs to be major improvements in this area.

  • In hospitals with clear policies, resources and systems in place to address the special needs of people with ID, much better outcomes

  • This study confirms previous findings of poor supports and treatments of people with ID in

     hospitals. Need to rethink role of group homes, staff training and supports while in hospital

DDD Errors and misinformation

Due to continued reliance on the reports from DDD and DSHS, I am now writing daily reports informing our senators of the flawed data and analysis in the information they are receiving.  If anyone would like sources of the original documents and data, let me know – I have them.

The Olmstead Decision

I realize that our legislators are very busy trying to sort out the facts and many are probably not sleeping very much right now.  I certainly would not want to be in any of their shoes – but they are also not in my shoes nor have many of them lived the life of being a parent of a child with developmental disabilities.  Until you have lived it, it is very, very hard to even imagine what life would be like.  It’s easy to take a glimpse here and there and make assumptions but that cannot be generalized to what the total responsibility of caring for a family member with very intense care needs involves.

Senator Adam Kline is one such person who does not comprehend the intensity of care needs or the issues involved in supporting a continuum of care for our citizens with developmental disabilities.  Senator Kline references studies published by DSHS as reliable sources for cost comparison.  If one were to look at the original source, one would see how flawed these DSHS reports are.  Of course, that takes time and energy and our legislators need to rely on agencies to provide this information.  What do we, as citizens, do when these agencies themselves are part of the problem?

Yes, Senator Kline is correct in saying that this is not all about cost but that we need to address the issue of quality of life and the least restrictive environment.  To me, that is actually the main issue and it is for this reason that I fight so hard to maintain our continuum of care for our most profoundly affected citizens with disabilities.  Yes, there are many of our citizens with developmental disabilities that do much better in residential neighborhood communities – in fact, that is probably the best alternative for most of our citizens.  But, for some, that alternative is as if placing them in isolation, unable to interact with the outside world, at the mercy of a mostly untrained and inexperienced care staff and with little oversight to make sure that our citizens are being treated humanely.  This is the violation of human rights – not what Senator Adam Kline is talking about.

No one is disputing the issue that Senator Kline writes about with regards to “individuals ought not to be institutionalized when their needs for habilitation can be met in a less restrictive alternative.”  What he is really missing though is that for many, our state operated residential centers (RHCs) are the least restrictive alternative.  So it sounds to me as if Senator Kline is encouraging people disobey the US Supreme Court in the Olmstead decision by supporting moving our residents out of their community which is the least restrictive for them into a more restrictive community.

The Olmstead Decision

The Court based its ruling in Olmstead on sections of the ADA and federal regulations that require states to administer their services, programs and activities “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.”

Under the Court’s ruling, certain principles have emerged:

  • unjustified institutionalization of people with disabilities is discrimination and violates the ADA;
  • states are required to provide community-based services for persons with disabilities otherwise entitled to institutional services when the state’s treatment professionals reasonably determine that community placement is appropriate; the person does not oppose such placement; and the placement can reasonably be accommodated, taking into account resources available to the state and the needs of others receiving state-supported disability services;
  • a person cannot be denied community services just to keep an institution at its full capacity; and,
  • there is no requirement under the ADA that community-based services be imposed on people with disabilities who do not desire it.
This is the part that Senator Kline needs to re-read.  He seems to be missing this information when citing the Olmstead Decision.
For more information and letters sent to our Washington State Legislators, they are in the links section.