-  Civil Rights for Providers of Health Care and Human Services      -  Provider Obligations 
  -  Civil Rights Clearance for Medicare Provider Applicants 
  -  Compliance & Enforcement        -  Resolution Agreements 
    -  Enforcement Examples 
  -  Training 
  -  Civil Rights Laws, Regulations & Guidance        -  Regulatory Initiatives 
    -  Regulations Enforced by OCR 
  -  Civil Rights and COVID 

                      -   
                      -   
                      -   
                      -   
                      -   

# OCR Olmstead Enforcement Success Stories

## Preventing Discrimination Against People with Disabilities in Health Care and Social Services

### CASE DESCRIPTIONS BY STATE

#### CALIFORNIA

##### **San Francisco County and City, Laguna Honda Hospital and Rehabilitation Center (LHH)**

                              - Allegation: San Francisco County entered into a settlement agreement resolving complaints related to Laguna Honda Hospital that were jointly investigated by DOJ and the HHS Office for Civil Rights.	                                 - Disposition: San Francisco County agreed that: (1) through interdisciplinary team assessments by qualified professionals, informed decision making by the affected individuals (including those with developmental disabilities or mental illness and those at risk for homelessness), development and implementation of individual transition plans, and post-placement quality assurance and monitoring, each individual LHH resident will be served in the most integrated setting appropriate to his or her individualized needs; and (2) in accordance with LHH residents' federal constitutional and statutory rights, each LHH resident will be provided with adequate and appropriate protections, care, treatment, support and services to meet his or her individualized needs, consistent with generally accepted professional standards.

#### COLORADO

##### **Adams County, Department of Social Services**

                              - Allegation: This complaint was filed on behalf of a man with a brain injury who resided in the community by receiving services under a Medicaid waiver for persons with brain injury. The complaint  alleged that the man’s  ability to remain in the most integrated setting was in jeopardy because Adams County was making it unnecessarily difficult for him to apply and transition to a Medicaid waiver for individuals who are elderly, blind and disabled (EBD). The complaint alleged that the man would require the EBD waiver upon the expected expiration of his brain injury waiver services.	                                 - Disposition: OCR and the county negotiated an agreement that satisfactorily resolved the complaint. The man never experienced a break in services provided under the waivers. Furthermore, as part of the resolution, OCR provided civil rights training for the county's home and community based services waiver staff.

##### **State Departments of Health Care Policy and Financing, Social Services, and Adams County**

                              - Allegation: This complaint was filed on behalf of a 30-year-old man with a brain injury who resides in the community with his family. The complaint alleged that the man is at risk of institutionalization because the State and County denied him appropriate services and supports to enable him to live in the community.	                                 - Disposition: Through OCR's intervention and assistance, the State provided the man with a week of in-home services so that his mother could have respite from her care-giving responsibilities. Furthermore, the State replaced rehabilitation equipment he used and reimbursed his family for specialized glasses they had purchased for the man. The State also investigated the complainant's assertion that a mechanical device used to lift the man was not working properly, and identified and paid for a replacement device.

##### **State Department of Health Care Policy and Financing**

                              - Allegation: This complaint was filed on behalf of a woman with Multiple Sclerosis who lives in her own home. The complaint alleged that the State's policies put the woman at risk of unnecessary institutionalization because she could not obtain the daily and overnight care she needed to continue living in her home when her husband was carrying out responsibilities related to his National Guard service.	                                 - Disposition: Through OCR's intervention and assistance, the woman began receiving two additional Certified Nursing Assistant (CNA) visits a day when her husband was away for National Guard duty. The woman found this level of care adequate for her needs and the State also provided information to her regarding the woman’s options, should she believe that the level of home health care services she receives is inadequate. The woman continues to receive Medicaid waiver services, including cleaning, meal preparation, and the use of certain medical equipment.

##### **Health Care Quality Improvement Organization, Denver**

                              - Allegation: The complainant, a person diagnosed with Parkinson's disease and lupus, alleged that the State discriminated against him on the basis of disability and national origin when he was determined ineligible for Home and Community-Based Services for the Elderly, Blind and Disabled (HCBS-EBD) waiver program. The complainant contended that without the HCBS-EBD waiver services he was at risk for unnecessary nursing home placement.	                                 - Disposition: As a result of OCR intervention and assistance, the complainant's HCBS-EBD services were restored. With his services restored, the complainant, after a short nursing home stay, was able to return to his own home. 

##### **Assisted Living Facility, Durango**

                              - Allegation: This complaint was filed on behalf of a woman diagnosed with Parkinson's disease. The complainant alleged that the State failed to make reasonable accommodations for her disability that would ensure her continued residency in an assisted living facility. The woman feared that without reasonable accommodation she would be evicted from the assisted living facility and risked being unnecessarily institutionalized.	                                 - Disposition: OCR proposed that the parties enter into mediation to resolve their dispute and as a result of OCR's mediation efforts, the parties executed a Settlement Agreement that prevented the complainant's eviction from the assisted living facility and resolved the issue of reasonable accommodation.

##### **State Department of Human Services**

                              - Allegation: This complaint was filed on behalf of a man diagnosed with Down syndrome, vision and speech impairments, neck fusion, and a bladder disease requiring daily catheterization. The complaint alleged that the State failed to provide him with residential services even though he had been approved for these services more than two years earlier. The complaint alleged that the man was at risk of unnecessary institutionalization because his caretaker was unable to continue caring for him.	                                 - Disposition: As a result of OCR intervention and assistance, a settlement was reached that 1) enrolled the man in the home and community-based services waiver program for individuals with developmental disabilities, 2) placed him in an apartment, and 3) met his catheterization needs, including training of staff on methods of catheterization. The settlement also ensured development of an individual plan to provide appropriate services and supports to ensure his successful placement in the community.

Back to Top

#### CONNECTICUT

##### **State Department of Mental Health and Addiction Services**

                              - Allegation: This complaint was filed on behalf of a 22 year old woman with cerebral palsy and other health impairments. The woman had lived in the community previously and was placed in a nursing home because of changes in her living situation and health care status. She wanted to move back into the community.	                                 - Disposition: Through OCR’s intervention and assistance, the woman leased an apartment and enrolled in an Outreach and Engagement Program for counseling and case management services.

##### **State Departments of Mental Retardation, and Children and Families**

                              - Allegation: This complaint was filed by a mother on behalf of her son who was diagnosed with numerous mental and physical disabilities including mental retardation and a seizure disorder. The complaint alleged that the state was not providing her son with services in the most integrated setting appropriate to his needs. The mother sought personal and home health care services for her son, in the family home.	                                 - Disposition: As a result of OCR intervention and assistance,  the State agencies took actions to support the son’s  return to community living and that the following services would be provided: home health, nursing, respite care, repairs to the family van, money for clothing, and modifications (for physical accessibility) to the family's home.

##### **State Department of Mental Retardation**

                              - Allegation: This complaint was filed by a mother on behalf of her son, a man who has a variety of disabilities including severe mental retardation, obsessive compulsive disorder, and a seizure disorder. He received care in a State-run intermediate care facility for individuals with mental retardation, but sought community placement.	                                 - Disposition: Through OCR's intervention and assistance, The State agency placed the man in the community with supportive services and created a plan for finding a suitable roommate to live with the him.

##### **Nursing Home, New Haven**

                              - Allegation: The Connecticut chapter of a nationwide advocacy group filed complaints with OCR on behalf of individuals who were residents in a number of long-term care facilities. When OCR conducted an on-site visit to one of these facilities, a facility resident told OCR that like his roommate, he would like to be discharged to a less restrictive setting with appropriate housing and employment support. The resident has a variety of disabilities including traumatic brain injury and a seizure disorder.	                                 - Disposition: Upon OCR's intervention and assistance, the facility's discharge planning staff worked cooperatively with the pertinent State agency to comply with the resident’s request for community placement and was moved into an apartment.

##### **Nursing Home, Avon**

                              - Allegation: The Connecticut chapter of a nationwide advocacy group filed this complaint on behalf of a man diagnosed with a variety of disabilities including mobility impairments who was living in a nursing home for more than 4 years. The Director of Nursing at the nursing home determined that the man should be discharged to a community setting and yet, the State was uncooperative.	                                 - Disposition: Upon OCR's intervention, the State placed the individual in an apartment using a Medicaid waiver for individuals with acquired brain injury.

##### **Nursing Home, Hartford**

                              - Allegation: The Connecticut chapter of a nationwide advocacy group filed this complaint on behalf of a man who was living in a nursing home for more than 7 years and sought community placement.	                                 - Disposition: Upon OCR's intervention and assistance, the State found the man eligible for an Acquired Brain Injury waiver program which provided the man with community-based services.

Back to Top

#### DELAWARE

##### **State Department of Health and Social Services, and** [State] **Psychiatric Center**

                              - Allegation: An advocacy group filed this complaint on its own behalf, and on behalf of nine individuals and a class of individuals with mental illness who resided at a State psychiatric hospital. The complaint alleged that hospital residents who sought discharge and whose treating professionals had determined that community placement was appropriate were subjected to inappropriate institutionalization.	                                 - Disposition: Through OCR's intervention and assistance, the State took actions to address the individual and systemic issues involved in this complaint, including placing into the community more than 50 individuals. After OCR made a preliminary finding that six of the nine individuals identified in the complaint were ready for discharge, the State discharged these individuals to community-based settings. The State also agreed to provide OCR with a list of an additional 66 individuals who were ready for discharge, to work toward placing these individuals into the community and to review with OCR the progress in discharging these individuals after one year. The State placed 45 of these 66 individuals into the community within one year.

##### **State Department of Health and Social Services**

                              - Allegation: This complaint was filed on behalf of a woman diagnosed with cerebral palsy and osteoarthritis. The woman uses a wheelchair for ambulation and requires substantial assistance in all aspects of daily living. The woman, who had lived in an institution for approximately 25 years, expressed a desire to live in the community. Treatment professionals determined that she was eligible and qualified to receive services in the community. However, after more than 12 months of delay in providing a community-based residential placement, a complaint was filed that alleged that the State had failed to provide services in the most integrated setting.	                                 - Disposition: As a result of OCR intervention, the woman was discharged from the institution to a community-based apartment.

Back to Top

#### GEORGIA

##### **Georgia Department of Community Health**

                              - Allegation: The complaint alleged that the Georgia resident has been segregated from the community for 17 years and has been consistently requesting to leave the nursing home from the moment she was admitted.  Read the Letter of Findings

##### **State of Georgia Olmstead Settlement Agreement**

More than 10,000 individuals with developmental disabilities and mental illness in Georgia will have the opportunity to live in their home communities with appropriate supports and services as a result of a statewide settlement agreement. 
                              - Allegation: OCR received complaints from multiple advocacy organizations in Georgia alleging that individuals with mental illness and developmental disabilities were not served in the most integrated setting appropriate.	                                 - Disposition: The State entered into a voluntary compliance agreement with OCR, but failed to comply with its terms. OCR issued a letter of non-compliance and DOJ filed suit to enforce the ADA.  This settlement has been filed with the Court and resolves the pending  Olmstead  complaints against the State.  The requirements and timetables in the agreement will ensure that Georgians with disabilities will have new opportunities for community living.   Read the Settlement Agreement  |  Read the Settlement Agreement Fact Sheet

##### **State of Georgia**

                              - Allegation: The agreement resolves statewide complaints filed with OCR by four state advocacy groups alleging that, in violation of the ADA, Georgia failed to treat qualified individuals with developmental disabilities and mental health disabilities in the most integrated setting appropriate to their needs.	                                 - Disposition: Georgia will engage in a comprehensive planning process, with consumer input, to update its State Olmstead Plan in order to provide adequate community services to address the needs of all Georgians with disabilities who are currently living in institutions or at risk of institutionalization. The State’s implementation of the agreement will rely, in part, on a $44 million dollar Money Follows the Person Rebalancing Demonstration Grant awarded by CMS. In addition, experts from SAMHSA will work with state officials to develop community mental health infrastructure to carry out the requirements of the agreement.  Read the Settlement Agreement  |  Read the Summary of the Settlement Agreement

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of a man with a disability who resided in an institution for more than 27 years. The complaint alleged that the State's policies and practices forced the man to live in an unnecessarily segregated institutional setting in order to receive long-term care services in violation of the ADA's integration regulation.	                                 - Disposition: As a result of OCR's intervention, the man was moved from the institution and placed in the community.  

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of a man diagnosed with cerebral herpes encephalitis and a seizure disorder. The man had lived in a transitional care facility for several years and received services under an Independent Care Waiver Program (ICWP). The man moved out of the facility but was not satisfied with the care he received. Therefore, he requested to transfer back to his previous living arrangement. The man was informed that he could not receive services under the ICWP if he returned to the transitional care facility. The complaint alleged that he was being denied services in a setting most appropriate to his needs.	                                 - Disposition: Through OCR's intervention and assistance, the State agreed to move the man back to his former living arrangement with ICWP services.

##### **State of Georgia**

                                - Allegation: This complaint was filed on behalf of a man diagnosed with a Traumatic Brain Injury. The man received services at an institution under an Independent Care Waiver Program (ICWP). The man was informed by the State that his ICWP services would be phased out. The complaint alleged that the State's actions would force the man into a living arrangement inappropriate to his needs	                                   - Disposition: Through OCR's intervention and assistance, the State agreed to change its policy and allow the man’s ICWP services to continue.

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of an individual with mild mental retardation, impulse control disorder and deafness who had lived in an institution for more than 21 years. The individual’s treatment team recommended community placement with proper supports, including sign language capability. When progress in implementing community placement was delayed for approximately 20 months, a complaint was filed alleging unnecessary institutionalization in violation of the ADA's integration regulation.	                                 - Disposition: Through OCR's intervention and assistance, the individual secured community placement with appropriate support services.

##### **State of Georgia**

                                - Allegation: This complaint was filed on behalf of an individual with severe mental retardation, organic personality syndrome and a seizure disorder. The individual’s treatment team recommended community placement conditioned upon behavior management being available. When progress in implementing this recommendation was delayed for approximately eight months, a complaint was filed alleging inappropriate institutionalization in violation of the ADA's integration regulation.	                                   - Disposition: Through OCR’s intervention and assistance, the individual was approved for services and placed in the community.

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of a woman with speech and hearing disabilities, a seizure disorder, mild scoliosis, and moderate mental retardation. The woman had lived in an institution for more than 12 years and the complaint alleged that the State's policies and practices forced the woman to live there unnecessarily, in violation of the ADA's integration regulation.	                                 - Disposition: Through OCR's intervention and assistance, the woman secured appropriate services and was placement in the community.

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of a woman diagnosed with moderate mental retardation, psychiatric disorders and a seizure disorder who resided in an institution. The woman’s treatment team recommended community placement for two successive years and because of the delay of approximately 20 months in providing community placement, a complaint was filed alleging unnecessary institutionalization in violation of the ADA's integration regulation.	                                 - Disposition: Through OCR’s intervention and assistance, the individual was approved for services and placed in the communit y.

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of a woman diagnosed with moderate mental retardation and other disabilities. The woman was admitted to an institution during her childhood and resided there for more than 38 years. The complaint alleged that the State's policies and practices forced the woman to live in an unnecessarily segregated setting in violation of the ADA's integration regulation.	                                 - Disposition: Through OCR intervention and assistance, the woman was approved for services and moved to the community.

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of a man with severe mental retardation who had resided for many years in state psychiatric institutions. While at these institutions, the man never received habilitation and training that was appropriate for his disability. Because he lacked adequate training, he was never offered the opportunity for community placement. The complaint alleged that his continued institutionalization is a violation of the ADA's integration regulation.	                                 - Disposition: As a result of OCR's intervention and assistance, the State took action to provide the man with a community placement transition plan and necessary training, and then moved him into the community.

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of a woman who has schizophrenia. The woman had lived in an institution for several years, but wanted to move to a more integrated setting. The complaint alleged that her continued institutionalization and the failure of the State to move her to a setting most appropriate to her needs violated the ADA's integration regulation.	                                 - Disposition: As a result of OCR intervention, the State provided the woman with appropriate services and placed her in the community.

##### **State of Georgia**

                              - Allegation: This complaint was filed on behalf of a man diagnosed with mental retardation who had lived in state institutions since early childhood. The complaint alleged that during the man’s annual reviews, the habilitation review committee found that he had no need for 24 hour medical care. Further, the complaint alleged that the committee found the man could have all of his habilitation needs met in a less restrictive community setting. The complaint alleged that the failure of the State to place the man in a setting most appropriate to his needs is a violation of the ADA's integration regulation.	                                 - Disposition: Through OCR's intervention and assistance, the man secured the necessary support services for placement in the community.

Back to Top

#### ILLINOIS

##### **Laden Township, State Department on Aging, and** [State] **Family Senior Services**

                              - Allegation: The complainant, who is blind, alleged that he needed additional services to remain at home and avoid institutionalization.	                                 - Disposition: As a result of OCR intervention and assistance, the complainant was provided with additional reader/senior companion services and such practical assistance as a taxi cab coupon book, case manager services and assistance in applying for waiver services.

##### **State Department on Aging**

                              - Allegation: This complaint alleged that the State failed to provide the complainant with the full quantity of needed services in his home, as was appropriate based on his disability and age.	                                 - Disposition: As a result of OCR intervention and assistance, the complainant, after a brief hospitalization, was re-enrolled in the Community Care Program and granted 45 hours of service per month. The complainant was satisfied with the number of service hours and homemaker services provided by the State.

##### **State Department of Human Services, Eligibility Assessment Agency, Olympia Fields**

                              - Allegation: The complainant, a man with a developmental disability, had lived in an Intermediate Care Facility for the Developmentally Disabled for approximately 13 years. The man alleged that the State failed to provide him with a placement in the most integrated setting appropriate to his needs in violation of the ADA and the Olmstead decision.	                                 - Disposition: As a result of OCR intervention and assistance, the man secured a placement into a Community Integrated Living Arrangement home. The man was satisfied with the community based placement.

##### **State Department of Human Services, Eligibility Assessment Agency, Northbrook**

                              - Allegation: The complainant alleged that the State failed to provide him with a one-to-one assistant which he needed to avoid unnecessary institutionalization.	                                 - Disposition: As a result of OCR intervention and assistance, the man secured a reassessment and an agreement from the State to increase the one-to-one assistant care from 11 hours a week to 35 hours a week, which permitted the man to remain in the community.

##### **State Department of Human Services**

                              - Allegation: This complaint was filed to enable a man diagnosed with autism to make an appropriate transition from the state educational system for children to adult community services. The complaint alleged that the State failed to provide funds for adult day care services, and that without those services the man was in danger of being unnecessarily institutionalized.	                                 - Disposition: As a result of OCR intervention and assistance, the man secured an agreement that included a State-approved family Community Integrated Living Arrangement (CILA) award in excess of $50,000. The receipt of this award permitted the complainant to obtain ten hours of direct support services and fifteen hours of respite services on a weekly basis. In addition, he received forty hours of professional staff service per week. Moreover, the State is providing 208 hours per year in individual support to the complainant.

##### **State Department of Human Services**

                              - Allegation: This complaint was filed on behalf of a woman with quadriplegia who had been placed in a nursing home instead of being referred to community services when she lost her housing. The complaint alleged that the State failed to provide the woman with the independent living resources which would allow her to leave the institution and live in a more integrated setting.	                                 - Disposition: As a result of OCR intervention and assistance, the woman received the necessary community integration resources including a Determination of Need assessment, a housing voucher, and a vocational rehabilitation evaluation. The woman was able to move into the community.

##### **State Department of Human Services**

                              - Allegation: This complaint alleged that the State failed to find an appropriate community placement for a man with a disability and he was forced to live in a nursing home rather than receive services in the most integrated setting appropriate to his needs.	                                 - Disposition: As a result of OCR’s intervention and assistance, the man was able to move from the nursing home to a community residence. The State further changed the man’s Medicaid status so that he can more readily access the Medicaid services he needs in the community.

##### **State Department of Human Services**

                              - Allegation: This complaint alleged that the State failed to provide a person with mobility impairments the appropriate services in the most integrated setting. This resulted in the complainant being unnecessarily institutionalized in a nursing home.	                                 - Disposition: As a result of OCR’s intervention and assistance, the complainant moved from the nursing home to a community residence.

##### **State Department of Human Services**

                              - Allegation: The complainant, a woman with multiple sclerosis and quadriplegia, alleged that the State failed to provide her with sufficient service hours to remain in her home. As a result she was forced to move to a nursing home which was a less integrated setting.	                                 - Disposition: As a result of OCR's intervention and assistance, the woman was discharged from the nursing home to an apartment of her own. The move was made possible from funds made available by the State's Community Reintegration Grant.

##### **State Department of Human Services**

                              - Allegation :The complainant, a woman with mental and neurological impairments, alleged that the State failed to provide community housing options and therefore that she was forced to live in a nursing home.                                  - Disposition : As a result of OCR's intervention and assistance, the woman was discharged from the nursing home, moved to a community residence, and was provided Medicaid services in the community.

##### **State Department of Human Services**

                              - Allegation: This complaint was filed on behalf of a woman with a developmental disability after her guardian and an advocacy organization had been unable to move her from a 10-bed facility to a more independent and integrated community-based living arrangement. The complaint alleged that the State failed to provide funds for the more integrated placement, thus unnecessarily keeping her in a more restrictive environment.	                                 - Disposition: As a result of OCR's intervention and assistance, the woman secured a placement in a more integrated living arrangement approved by the guardian.

Back to Top

#### INDIANA

##### **Family and Social Services Administration**

                              - Allegation: This complaint was filed on behalf of a 41-year-old man with moderate mental retardation who had lived with a parent until the parent began experiencing health problems. The man’s family applied for Medicaid waiver services however, the man was placed on a waiting list. The complaint alleged that the man had waited for services for more than two years while living in group homes that the man and his family found inappropriate. Shortly before the complaint was filed, the man’s sister moved the him to an apartment she located, where family members provided him with his only community supports. The complaint alleged that the man had been denied a "priority" waiver by the State and thus was at risk of inappropriate institutionalization.	                                 - Disposition: After OCR initiated its investigation, and the man’s sister continued her advocacy, the State provided him with a Medicaid waiver slot. 

##### **Family and Social Services Administration**

                              - Allegation: Three complaints were filed with OCR alleging that the State-administered Aged and Disabled Medicaid Waiver Program requires that program recipients not leave home in order to receive benefits. The complaints contended that if the program recipients left their homes they would lose their benefits, thus being forced into a less integrated nursing home setting.	                                 - Disposition: As a result of OCR's intervention and assistance, the State issued notices of clarification to all service providers, including home health providers. Specifically, the notices clarified that the Aged and Disabled Medicaid Waiver does not have a rule requiring program recipients to remain in their homes in order to receive services. In addition, OCR helped ensure that the State sent notices directly to the complainants explaining the rules of the program and confirming that individuals are not required to be confined to their home to receive services under the waiver.

##### **Family and Social Services Administration**

                              - Allegation: The complainant alleged that the State failed to enroll him in the Medicaid Aged and Disabled Waiver program that would allow him to live in his own home. As a result, the man believed that he was at risk of unnecessary institutionalization.	                                 - Disposition: OCR determined that the complainant had not applied to the State for the Aged and Disabled waiver and therefore was not on the waiting list to receive services. Following OCR's intervention, the State "fast tracked" the man’s application and assessment for the Aged and Disabled Waiver Program. The man was found eligible for the waiver and is living in the community.

Back to Top

#### KENTUCKY

##### **State Department of Mental Health and Mental Retardation Services**

                              - Allegation: OCR initiated a compliance review of the Kentucky Department of Mental Health and Mental Retardation Services (DMHMRS) and its four state-owned or contracted psychiatric hospitals in order to evaluate whether DMHMRS moved psychiatric hospital patients from the institution to the most integrated settings appropriate to their needs. Through the review, OCR identified concerns regarding timely discharge of patients, the adequacy of assessments, the existence of formalized transition plans, the scope of outplacement efforts, and the adequacy of community resources to meet the complex needs of some patients. Prior to the conclusion of the review, DMHMRS agreed to work voluntarily with OCR on these issues.	                                 - Disposition: Through a Voluntary Resolution Agreement with OCR, DMHMRS agreed to undertake a variety of actions, including: (a) transitioning institutionalized patients who are identified as appropriate for community placement to more integrated settings; (b) developing a formalized procedure for identifying and assessing psychiatric hospital patients who are appropriate for community placement; (c) assessing current resources and providers to identify barriers to their use and the need for any specific new services or providers; and (d) creating a timeline for the transition of psychiatric hospital patients determined appropriate for community placement and a formal transition plan for each of these individuals. DMHMRS also provides OCR with certain information each month, including the names of individuals discharged and the reasons for the continued institutionalization of individuals who have not been discharged.		                                   - The steps taken by DMHMRS pursuant to this agreement helped facilitate the community placement of persons residing in psychiatric hospitals, including individuals who filed complaints with OCR. Some OCR complainants alleged that they remained institutionalized despite the recommendations of their treatment teams that community placement was appropriate. After OCR began its investigation, complainants were discharged from the institution and began receiving community services.

##### **State of Kentucky**

                              - Allegation: The complainant, a 23-year-old woman with mild mental retardation, alleged that she was inappropriately institutionalized in a facility for individuals with mental retardation. The woman, who desired placement in a group home close to her family, alleged that her treatment team agreed that she could benefit from less restrictive placement in the community and she had previously been referred for community placement. The complaint alleged that the State was denying her services in the most integrated setting appropriate to her needs.	                                 - Disposition: As a result of OCR's intervention and assistance, the woman was discharged from the institution and began receiving community-based services.

##### **State of Kentucky**

                              - Allegation: The complainant, a 47-year-old-man with developmental disabilities, had been institutionalized for 40 years. He alleged that his treatment team agreed that he could benefit from a less restrictive environment, and that the State had denied him services in the most integrated setting appropriate to his needs.	                                 - Disposition: After OCR began its investigation, the complainant's needs were assessed and the man was placed with a community-based provider.

##### **State of Kentucky**

                              - Allegation: The complainant alleged that she was inappropriately institutionalized in a State facility, and thus denied the opportunity to receive services in the most integrated setting appropriate to her needs.	                                 - Disposition: After OCR began its investigation, the woman was placed in a community-based setting.

##### **State of Kentucky**

                              - Allegation: This complaint was filed on behalf of a 46-year-old man with severe mental retardation who resided in an institution. The complaint alleged that the man wanted to live in a group home and that his treatment team agreed that he could benefit from a community placement in an appropriately structured environment.	                                 - Disposition: After OCR began its investigation, the man was discharged from the institution and began receiving community-based services.

##### **State of Kentucky**

                              - Allegation: This complaint was filed on behalf of a 55-year-old-man diagnosed with psychiatric, developmental and physical impairments. The man had resided in an institution for more than 35 years. The complaint alleged that, to receive long-term care services, the State's policies and practices forced the man to live in an unnecessarily segregated institutional-based setting in violation of the ADA integration regulation.	                                 - Disposition: As a result of OCR's intervention and assistance, the man was discharged from the institution to a group home.

##### **State of Kentucky**

                              - Allegation: This complaint was filed on behalf of a 66-year-old woman with psychiatric, developmental and physical impairments who was residing to an institution. The complaint alleged that to receive long term care services, the State's policies and practices forced her to live in an unnecessarily segregated institutional-based setting in violation of the ADA's integration regulation..	                                 - Disposition: With OCR's intervention and assistance, the woman moved from the psychiatric hospital to the less restrictive environment of a nursing home. There she is being provided the level of care which has been deemed appropriate by her treatment team and facility administration.

##### **State of Kentucky**

                              - Allegation: This complaint was filed on behalf of a 39-year-old woman diagnosed with mental illness and blindness. She has an extensive history of hospital placement since adolescence and had been residing in an institution for several years at the time the complaint was filed. The complaint alleged that to receive long term care services, the State's policies and practices forced her to live in an unnecessarily segregated institutional setting in violation of the ADA's integration regulation.	                                 - Disposition: As a result of OCR's intervention and assistance, the woman was able to move from the institution into a placement in a less restrictive community-based setting close to her parents' home.

##### **State of Kentucky**

                              - Allegation: This complaint was filed on behalf of a 46-year-old man who was admitted to an institution pursuant to a court order. The man was diagnosed with psychiatric and developmental impairments. While at the institution, the man’s condition improved and various efforts were made to place him in an alternative living arrangement. None of these efforts were successful. As a consequence, the complaint alleged that the State's policies and practices required the man to live in an unnecessarily segregated institutional setting in violation of the ADA's integration regulation.	                                 - Disposition: As a result of OCR's intervention and assistance, the man secured a placement in a group house with two other individuals. The man has his own room and bathroom. He attends a community day program and is learning to administer his own medication. The man’s advocate reports that his transition and adjustment have gone very well.

Back to Top

#### LOUISIANA

##### **State Department of Health and Hospitals**

                              - Allegation: The complainant, who has quadriplegia, alleged that he was denied community-based services and thus that he was at risk of unnecessary institutionalization.	                                 - Disposition: After OCR initiated its investigation and began communicating with the State about this matter, the man began receiving two hours of service per day for bathing, dressing and other needs.

##### **State Department of Health and Hospitals**

                              - Allegation: The complainant, a 24-year-old man with paraplegia, had been residing in a nursing home for four years and sought community services. He alleged that the State's failure to provide him with community services denied him the opportunity to receive services in the most integrated setting appropriate to his needs.	                                 - Disposition: After OCR initiated its investigation and began communicating with the State about this matter, the man was discharged from the nursing home, began receiving services from a personal care attendant, and began receiving training to obtain part-time employment.

Back to Top

#### MARYLAND

##### **State Department of Health & Mental Hygiene**

                              - Allegation: These complaints, filed by an advocacy organization, alleged that the State failed to provide services in the most integrated setting appropriate. During the course of OCR's involvement with the State on this issue, 28 individual complaints were filed against the State.	                                 - Disposition: As a result of OCR's intervention and the State's cooperation, 19 of the 28 individuals who had filed complaints were moved from institutional settings to community based settings. OCR determined that the State was in compliance with the law with respect to the remaining nine individuals. OCR also recognized that while the State had made significant progress in systemic planning and involving interested parties in the planning process, considerable work remained to be done.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a woman with mental illness and dementia, who had resided in a psychiatric facility for more than ten years. The complaint alleged that the woman’s treatment team believed that she could be appropriately served in the community, and that the woman had been ready for discharge for more than one year.	                                 - Disposition: At the time, OCR resolved this case and other cases, through a process developed for Olmstead complaints filed on behalf of Marylanders. This process included the identification of individuals for whom community services were appropriate and monthly meetings between OCR and the State to monitor ongoing efforts to improve community placement.  Through this process, after OCR initiated its investigation, the woman was moved into an assisted living community residential services program and provided with day services.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: The complainant, who was diagnosed with mental retardation and mood disorder, had resided in a psychiatric facility for several years. The complaint alleged that she was denied services in the most integrated setting appropriate for her needs, and that treatment professionals had  determined that she could be appropriately served in a community based setting.	                                 - Disposition: At the time, OCR resolved this case and other cases, through a process developed for Olmstead complaints filed on behalf of Marylanders. This process included the identification of individuals for whom community services were appropriate and monthly meetings between OCR and the State to monitor ongoing efforts to improve community placement. Through this process, the complainant was moved to an assisted living community residential services program and provided with day services.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a nine-year-old boy who resided at a chronic care facility. This child had a history of neurological impairment and seizure disorder and utilized a ventilator. The complaint alleged that the child had been ready for discharge for several months, and that a community-based residential provider was willing to serve him. The complaint alleged that the State denied the child the opportunity to receive services in the most integrated setting appropriate to his needs.	                                 - Disposition: At the time, OCR resolved this case and other cases, through a process developed for Olmstead complaints filed on behalf of Marylanders. This process included the identification of individuals for whom community services were appropriate and monthly meetings between OCR and the State to monitor ongoing efforts to improve community placement. Through this process, the child was moved into an assisted living community residential services program and provided with day services. 

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint concerned a 47-year-old man with mental illness, deafness and morbid obesity who resided in a psychiatric institution. The complaint alleged that although the man was ready for discharge from the institution, the State was unwilling to provide funding for an adequate level of community support services. Thus, the complaint alleged, the man was unnecessarily institutionalized and denied services in the most integrated setting appropriate to his needs.	                                 - Disposition: At the time, OCR resolved this case and other cases, through a process developed for Olmstead complaints filed on behalf of Marylanders. This process included the identification of individuals for whom community services were appropriate and monthly meetings between OCR and the State to monitor ongoing efforts to improve community placement.  Through this process, the man was moved into an assisted living community residential services program and provided with day services.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a man with a severe seizure disorder, mental retardation, cerebral palsy and deafness. The man was admitted involuntarily to an institution for treatment of episodes of intermittent explosive disorder. He had formerly resided in several different group residential settings. Some months later, the man’s treatment team recommended that he be placed in a residential facility which could meet his unique needs. However, no community-based residential program existed at that time that could meet his combined residential, social, medical, communication and behavioral needs and the man remained institutionalized. The complaint alleged that the State had failed to place him in the most integrated setting appropriate to his needs.	                                 - Disposition: With OCR's intervention and assistance, the man was discharged to a community-based service provider that was able to meet his unique needs. 

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of an 80-year-old woman diagnosed with a depressive disorder and deafness. She had numerous medical problems including ataxia, hepatitis, congestive heart failure, hypertension and cognitive disabilities. Prior to her admission to an institution, she resided in the community in her own apartment. A few months later, the institution recommended that she be discharged to a supervised aftercare facility. However, due to various intra agency disputes, her discharge was delayed. The complaint alleged that the State was in violation of the ADA and the Olmstead decision because of the failure to place her in the community.	                                 - Disposition: Working with the State, OCR was able to resolve the delayed discharge issues. The woman was provided with senior residential housing by a community provider for individuals with hearing impairments.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a 78-year-old male who is deaf and has a number of other medical problems. He was diagnosed with adjustment disorder and suicidal ideation at the time of his admission from the community to an institution. The complaint alleged that he was inappropriately confined to an institution in violation of the ADA and the Olmstead decision.	                                 - Disposition: Working with the State, OCR was able to secure the man’s discharge to a community mental health program for people with deafness.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a 22-year-old man diagnosed with psychiatric and developmental impairments and substance abuse. The man was placed in a maximum security forensic hospital by the court. Some months later, the court directed that the State provide him with housing and treatment in the community as an alternative to institutionalization. However, community placement was delayed, reportedly because of funding issues and the need for an opening in a residential program. Because of the delay, the complaint alleged that the man was not receiving services in the most integrated setting appropriate to his needs.	                                 - Disposition: Working with the State, OCR was able to resolve the delayed placement and the man was discharged to a community-based provider.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a 26-year-old man diagnosed with psychiatric and developmental disabilities. The man was placed in a psychiatric facility. Several months later, the institution applied to the State for community placement. The request was denied because the man’s  mental retardation diagnosis was then in question and therefore he did not qualify for certain services. The complaint alleged that he was not receiving services in a setting that is most appropriate to his needs.	                                 - Disposition: With OCR intervention and assistance, the man was found eligible for services and he was discharged to a community service provider.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a 36-year-old woman with cerebral palsy, moderate mental retardation and bipolar disorder. The woman had resided in an institution for more than 20 years. The woman visited several group homes in preparation for discharge; however, her discharge was delayed. The complaint alleged she was not receiving services in the most integrated setting appropriate to her needs.	                                 - Disposition: OCR was able to help resolve the delay in providing the woman with community services and she was discharged to a group home where she resides with two housemates.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a 41-year-old woman with visual impairments, cerebral palsy and moderate mental retardation. She has lived in an institution for the past 25 years. The woman had expressed a desire to move from the institution to a community-based setting.	                                 - Disposition: The OCR investigation found that the State had made reasonable efforts to place the woman in a community setting. However, the woman has exercised her choice not to move from the institution at this time. The State has assured OCR of its continuing commitment to pursue community placement with this individual in the event that she changes her mind and finds a suitable placement.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a 20-year-old woman diagnosed with a severe neurological impairment and mental retardation with associated physical impairments. She requires 24-hour-a-day oxygen, turning every 2 hours and assistance with all activities of daily living. The complaint alleged that she was not receiving services in the most integrated setting appropriate to her needs in violation of the ADA and the Olmstead decision.	                                 - Disposition: As a result of OCR intervention, the woman was moved out of the hospital and placed in an alternative living arrangement operated by the county Association of Retarded Citizens.

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of a 20-year-old woman diagnosed with severe mental retardation, cerebral palsy, and a variety of physical impairments. She requires 24-hour staffing and assistance with all activities of daily living and has difficulty verbally communicating her basic needs. The complaint alleged that she was not receiving services in a setting most appropriate to her needs in violation of the ADA and the Olmstead decision.	                                 - Disposition: With OCR intervention and assistance, the woman moved out of the hospital to a community living arrangement more appropriate to her needs. 

##### **State Department of Health & Mental Hygiene**

                              - Allegation: This complaint was filed on behalf of  a woman diagnosed with mental retardation and schizoaffective disorder. The woman had resided in an institution for more than five years, but had sought services in the community. The complaint alleged that the failure of the State to place her in the most integrated setting appropriate to her needs was a violation of the ADA and the Olmstead decision.	                                 - Disposition: Working with the State and other stakeholders, OCR helped secure the woman’s move into the community.

Back to Top 

#### **MICHIGAN**

##### **State Department of Community Health**

                          - Allegation: This complaint alleged that the State reduced her home and community-based waiver hours and put her at risk of institutionalization.	                             - Disposition: As a result of OCR intervention, the State restored the complainant's service hours.  

#### **MINNESOTA**

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with a mental disability who had been admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the person was eligible for home and community-based services. However, placement was delayed. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the most integrated setting appropriate to their needs.	                             - Disposition: As a result of OCR intervention and assistance, the person was provided with a home and community-based services program.

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with mental illness who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the complainant was eligible for home and community-based services. However, placement was delayed, reportedly due to the person’s  history of violence associated with mental illness. After approximately nine months of delay, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the most integrated setting appropriate to their needs.	                             - Disposition: Working with the State, OCR helped secure a new foster care service provider who was willing to serve the person in a foster care home.

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with a mental disability who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the person was eligible for home and community-based services. However, placement was delayed. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the most integrated setting appropriate to their needs.	                             - Disposition: Through OCR intervention and assistance, the person was provided with a home and community-based services program.

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with a mental disability who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the person was eligible for home and community-based services. However, placement was delayed due to treatment related to diabetes, appendicitis and difficulty finding a community placement to meet the person’s  needs. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the most integrated setting appropriate to their needs.	                             - Disposition: Working with the State, OCR helped secure the person’s placement in a foster care home.

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with a mental disability who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the person was eligible for home and community-based services. However, placement was delayed. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the most integrated setting appropriate to their needs.	                             - Disposition: As a result of OCR's intervention and assistance, the person was placed in a community residential mental health program. 

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with a mental disability who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the person was eligible for home and community-based services. However, placement was delayed. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the most integrated setting appropriate to their needs.	                             - Disposition: Working with the State and the person’s guardian, OCR helped secure placement in a community Intermediate Care Facility/Mental Retardation program.

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with a mental disability who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the person was eligible for home and community-based services. However, placement was delayed. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the most integrated setting appropriate to their needs.	                             - Disposition: As a result of OCR intervention and assistance, the person was provided with home and community-based services.

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with a mental disability who was admitted to an institution. Upon admission, an initial needs assessment conducted by treatment professionals determined that the person was eligible for home and community-based services. However, placement was delayed. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the most integrated setting appropriate to their needs.	                             - Disposition: As a result of OCR intervention and assistance, the person was provided with home and community-based services.

##### **State Department of Human Resources**

                          - Allegation: This complaint was filed on behalf of a person with a mental disability living in an institution, alleging that the State failed to provide appropriate home and community-based services.  The person had allegedly tried for more than a year to be discharged from the institution.	                             - Disposition: Working with the State, OCR helped secure the necessary services to permit the person’s provisional discharge from the institution and placement in a community-based apartment operated by the State.

Back to Top

#### **MISSISSIPPI**

##### **Mississippi Department of Rehabilitation Services and Mississippi Division of Medicaid**

                            - Allegation: This complaint was filed on behalf of a man with significant disabilities, who has a life-threatening condition and was at risk of institutionalization.  The man had called 911 and often summoned his attendants early to address his increasingly dangerous medical situation when non-medical attendants would have provided sufficient assistance.   The complaint alleged that the State failed to provide appropriate community-based services for the man since he could  be served in the community with adequate supports.	                               - Disposition: As a result of OCR intervention and assistance, the State of Mississippi agreed to provide the man with additional personal attendant care and other services to prevent institutionalization.  Read the Letter of Findings

#### **MISSOURI**

##### **State Department of Social Services (MDSS) and the Bureau of Special Health Care Needs**

                          - Allegation: The complaint was filed by a mother on behalf of her daughter, who has a number of developmental and physical impairments.  The complaint alleged that the State had reassessed the number of hours of necessary in-home nursing services, resulting in inadequate care and placing her daughter at risk of unnecessary institutionalization.	                             - Disposition: As a result of OCR’s intervention and assistance, the complainant’s daughter received a feeding tube and her health improved.  With these changed circumstances, the mother determined that she could provide adequate services for her daughter with the reduced number of hours of nursing services.

##### **State Department of Mental Health**

                          - Allegation: This complaint was filed by the mother of a 12-year-old girl with autism. The complaint alleged that the daughter was at risk of unnecessary institutionalization, because the State failed to provide the daughter with Medicaid waiver services. The complainant's daughter was receiving all of the services available under the Medicaid waiver, but the services were being paid for solely with State funds, not Medicaid funds. The complaint asserted that these non-Medicaid funds could be taken away at any time.	                             - Disposition: OCR worked with the parties to improve communication between the complainant and the covered entity about the child's needs and available services and funding. As a result of OCR’s intervention and assistance, the girl received a Medicaid waiver slot.  

##### **State Department of Mental Health**

                          - Allegation: This complaint was filed by a man with a mental disability who alleged  that he was in danger of unnecessary institutionalization unless a supported living placement could be arranged for him. He stated that the State had suggested a group home placement, but this would not be the most integrated setting appropriate to his needs.	                             - Disposition: Working with the State and other stakeholders, OCR helped facilitate a placement into a shared, private apartment, with access to appropriate support services

##### **State Department of Social Services, Division on Aging, and Department of Mental Health**

                          - Allegation: This complaint was filed on behalf of a 40-year-old woman with quadriplegia and mild brain damage. The complaint alleged that she had been without in-home care for many months, and that while a nursing home placement had been attempted, it could not adequately meet her needs.  As a result, she was in danger of unnecessary institutionalization because of the failure of the State to provide her with adequate in-home care.	                             - Disposition: As a result of OCR’s intervention and assistance, the State developed a service plan for the woman that authorizes personal services 24-hours a day, seven days a week. The plan assures that she has maximum control over these services by giving her authority to hire, manage and fire her own attendants. 

##### **State Department of Social Services, Division of Medical Services**

                          - Allegation: This complaint was filed by a 44-year-old woman with paraplegia and multiple health problems, who needed help paying for adult diapers in order to remain independent and in her own home.  The annual cost of the diapers was more than 20% of her annual income.  The complaint alleged that the State Medicaid program does not pay for diapers to persons unless they are institutionalized, and this was a failure of the State to provide services in the most integrated setting appropriate to her needs.	                             - Disposition: Working with the woman and other stakeholders, OCR found an independent agency that agreed to provide the woman with diapers free of charge.

Back to Top

#### **MONTANA**

##### **State Department of Public Health and Human Services**

                          - Allegation: Complaints were filed by disability rights advocates on behalf of developmentally disabled sheltered workshop participants, alleging that  the Montana Department of Public Health and Human Services (DPHHS) discriminated against them by failing to afford them the opportunity to work in an integrated setting.	                             - Disposition: OCR worked with the State of Montana as it engaged in Olmstead planning The DPHHS addressed the allegations by (1) converting to a consumer choice/individualized model of service delivery; (2) allowing money to follow the person; (3) modifying the developmental disability service provider reimbursement rate to eliminate the incentive for providers to direct consumers to sheltered employment or day services; and (4) collecting information from focus groups and individual consumers to learn more about their employment experiences, goals, and concerns using a Systems Change Grant.

#### **NEBRASKA**

##### **State Department of Health and Human Services**

                          - Allegation: This complaint was filed by  a person with a disability living in an institution, alleging that the State had failed to take action to permit him to live closer to his family in a less restricted setting.	                             - Disposition: As a result of OCR's intervention and assistance, the complainant was moved from the institution to a private apartment. OCR also helped ensure that the complainant received vocational training.

#### **NEW JERSEY**

##### **State Department of Human Services (NJDHS) , Division of Developmental Disabilities (DD)**

                          - Allegation: The complainant alleged that her 28 year-old son, who has post traumatic stress disorder and developmental disabilities, was institutionalized and therefore deprived of the opportunity to live in the least restrictive and most integrated setting possible.	                             - Disposition: As a result of OCR’s intervention and assistance, the affected party was placed in a supervised group home closer to his mother’s residence where his needs were being met in a community setting.

##### **State Department of Human Services (NJDHS) , Division of Developmental Disabilities (DD)**

                          - Allegation: This complaint was filed on behalf of an institutionalized 48-year-old woman who was placed in a state operated center for persons with developmental disabilities. The complaint alleged that the State discriminated against the woman by keeping her institutionalized at the center.	                             - Disposition :  After a series of meetings between NJDHS, DD and OCR, appropriate community based services were identified and the woman was able leave the institution and  move into the community.

##### **State Department of Human Services (NJDHS) , Division of Developmental Disabilities (DD)**

                          - Allegation: This complaint was filed on behalf of a 31-year-old woman living in a Developmental Center who was diagnosed with traumatic brain injury, developmental delay, and cognitive, emotional and behavioral difficulties.  The complaint alleged that the Division of Developmental Disabilities failed to provide appropriate home and community-based services to the woman.	                             - Disposition :  As a result of OCR’s intervention and assistance, the woman was able to move to a more integrated setting in the community that both she and her parents found satisfactory.

##### **State Department of Human Services (NJDHS) , Division of Developmental Disabilities (DD)**

                          - Allegation: The complainant, a 43-year-old man diagnosed with schizophrenia, severe hearing loss and a developmental disorder, had resided at a State Psychiatric Hospital since 1988. The complaint alleged that keeping him institutionalized at the State Psychiatric Hospital violated his right to live in the most integrated setting appropriate to his needs.	                             - Disposition:  As a result of OCR’s intervention, the man was discharged to a community placement with intensive, 24 hour services and supports for deaf individuals with mental illness.

##### **State Department of Human Services (NJDHS) , Division of Developmental Disabilities (DD)**

                          - Allegation: This complaint was filed on behalf of a young woman with neurological impairments who had resided both with her family and in a group home setting, and who had also experienced a number of emergency psychiatric hospitalizations. The woman was living at home when the complaint was filed. The complaint alleged that  she was at risk of inappropriate institutionalization due to the State's denial of appropriate home and community based services and its failure to provide the woman with a behavior modification evaluation, a traumatic brain injury evaluation, and a vocational assessment.	                             - Disposition:  As a result of OCR’s intervention and assistance, the woman was placed in a group home operated by an agency that had previously provided  her with services considered by her and her family to be appropriate and successful. She also began working after transitioning into this placement.

##### **State Department of Human Services (NJDHS) , Division of Developmental Disabilities (DD)**

                          - Allegation: This complaint was filed by an advocacy organization on behalf of a 42-year old man with mental illness who had been residing at a psychiatric hospital for over three years. The complaint alleged that the NJDHS discriminated against the man by keeping him institutionalized at the hospital.	                             - Disposition: As a result of effective collaboration between OCR and NJDHS, the man was discharged from the hospital and relocated to a boarding home. The boarding home is a less restrictive and more integrated setting compared to the hospital, and the man's family was satisfied with the new placement. 

##### **State Department of Human Services (NJDHS) , Division of Developmental Disabilities (DD)**

                          - Allegation: The complaint was filed on behalf of a 49-year old man with mental illness who had been residing at a psychiatric hospital for almost 16 years. The complaint alleged that the NJDHS discriminated against the man by keeping him institutionalized at the hospital.	                             - Disposition: As a result of effective collaboration between OCR and NJDHS, the man was discharged from the hospital and relocated to a specialized residence. The specialized residence is a less restrictive and more integrated setting than the hospital, and the man has expressed satisfaction with the new placement. 

##### **State Department of Human Services (NJDHS) , Division of Developmental Disabilities (DD)**

                          - Allegation: This complaint was filed on behalf of a 62-year-old woman with cerebral palsy. She had lived in her own apartment, but after hospitalization for a fall, she was institutionalized in a nursing home. The complaint alleged that the State discriminated against the woman by depriving her of the opportunity to live in the most integrated setting appropriate to her needs.	                             - Disposition: OCR’s intervention and assistance revealed that the nursing home did not want to discharge the woman without additional hours of home care service and a personal emergency call device. The State agreed to approve additional hours of home care services , and the woman’s treatment team agreed to obtain an emergency call device for her use. She was then discharged to her apartment with these support services.

##### **State Department of Human Services, Division of Developmental Disabilities, and Enable, Inc., Princeton**

                          - Allegation: The complainant, a 41-year-old woman with Cerebral Palsy, alleged that the Division of Developmental Disabilities (DD) and Enable, Inc. discriminated against her by failing to provide her with appropriate home and community based services, placing her at risk of inappropriate institutionalization.	                             - Disposition: As a result of OCR’s investigation, DD, the complainant, and Enable, Inc. agreed to a new contract for Enable, Inc. to provide her with appropriate home and community based services.

##### **State Department of Human Services, Division of Mental Health Services**

                          - Allegation: This complaint was filed on behalf of a man diagnosed with epilepsy and Tourette’s syndrome, who was institutionalized at a psychiatric hospital.  The complaint  alleged that the State of New Jersey discriminated against him by failing to provide appropriate home and community based services.	                             - Disposition: Following OCR’s involvement, the individual was discharged and now lives in a group home in the community.

##### **Ancora Psychiatric Hospital, Hammonton**

                          - Allegation: This complaint was filed on behalf of a 45-year-old man diagnosed with pervasive developmental disorder, autistic disorder, bipolar disorder, Tourette's Syndrome and mild mental retardation. The man had lived with his elderly parents for 44 years, and when they were no longer capable of caring for him, he was admitted to an institution and placed on a Developmental Disabilities (DD) emergency list for residential placement.  Several months later, an independent evaluation was conducted and it was recommended he be transferred as soon as possible to a residential placement.  Despite these recommendations, an Individual Habilitation Plan (IHP) was not developed for almost a year after he became eligible for DD services.  The IHP stated the man wanted to live in the community with 3 to 5 other individuals, find a job, and maintain contact with his family.  The complaint alleged that he was being prevented from moving into the community in violation of the ADA and the Olmstead decision.	                             - Disposition: With OCR’s intervention and assistance, the long delay in residential placement was resolved and  the man moved into a group home where he receives day program services appropriate for persons with autism and developmental disabilities.

Back to Top

#### **NEW MEXICO**

##### **State Department of Human Services**

                          - Allegation: This complaint was filed on behalf of a 22-year-old woman with quadriplegia who lived in a nursing home. She has limited mobility, uses a wheelchair, and requires daily assistance with all major life activities. The woman was put on the State's Central Registry for a Developmental Disabilities (DD) waiver, which would enable her to live in the community. However because of the substantial waiting time and  to begin receiving DD waiver services, the  complaint  alleged that the State was violating the woman’s rights under the ADA by requiring her to remain in an institution and denying her the opportunity to receive services in the most integrated setting.	                             - Disposition: Working with the State and the woman’s advocate, OCR helped secure a crisis developmental disability waiver placement. The waiver covered all necessary services and the woman  is living on her own in the community.

##### **State Department of Human Services**

                          - Allegation: The complainant, a man requiring home accessibility modifications to move in with his family in Utah, alleged  that the State violated his rights under the ADA by requiring that he remain in an institution and failing to provide him with services in the most integrated setting.	                             - Disposition: Working with the State of Utah, the Navajo Tribal Government, and the complainant’s advocate, OCR helped secure the home modifications and a Utah waiver, enabling the complainant to live at home.

#### **NEW YORK**

##### **State Department of Health**

                          - Allegation: The complaint was filed on behalf of a 56 year-old woman with several disabilities who uses a wheelchair and a walker.  The complaint alleged that by being institutionalized in a nursing home, the woman was deprived of the opportunity to live in the most integrated setting appropriate to her needs.	                             - Disposition:  As a result of OCR’s intervention and assistance, the woman was discharged to an accessible apartment that allowed her to be independent and use her wheelchair and walker.

##### **State Department of Health**

                          - Allegation: This complaint was filed on behalf of a man with traumatic brain injury. The complaint alleged the man was deprived of appropriate home health care services, forcing him to remain in a hospital and thus was denied services in the most integrated setting appropriate to his needs.	                             - Disposition: Working with the State and other stakeholders, OCR helped the man obtain services under the Traumatic Brain Injury (TBI) waiver program, and secure occupational, physical, and speech therapies, as well as physical modifications to his home.

##### **State Department of Health**

                          - Allegation: This complaint was filed on behalf of a 29-year-old man with quadriplegia and a spinal cord injury, residing in an institution.  The complaint alleged that the man wanted to live in the community in his own apartment, and the institution believed a discharge to the community with appropriate services would be appropriate, but no progress was being made to accomplish this objective.	                             - Disposition: With OCR’s intervention and assistance, the man secured appropriate housing in the community and moved into his own apartment with appropriate aide services.

##### **State Department of Health**

                          - Allegation: This complaint was filed on behalf of  a woman who has multiple sclerosis. The woman had received home health services from a  provider for several years, but after being hospitalized for surgery, she was released to an institution a few months later.  The complaint alleged that the woman wished to return to her apartment, but  was told by her  provider that she would only receive services for two hours a day, rather than the six to eight hours per day she had previously received. Without adequate supports, it was not possible for the woman to live in the community.	                             - Disposition: With OCR's intervention and assistance, the  woman was moved to a wheelchair accessible apartment where she receives 24-hour attendant services through the Consumer Directed Personal Assistance Program.

##### **State Department of Health**

                          - Allegation: The complainant, who has quadriplegia, lives at her home and uses a motorized wheelchair. She requires a great deal of help in bathing, dressing, bowel and bladder assistance, and other activities of daily living. She is in the Consumer Directed Personal Assistance Program where aides are paid $6.00 an hour. She is responsible for locating, hiring, training and scheduling the aides. The complainant believed that discrimination existed because the county in which she lives pays a lower hourly rate in Medicaid funds to medical assistants than other counties in the State. The complainant alleged that she is at risk of unnecessary institutionalization since it is extremely difficult to find aides because of the low reimbursement rate.	                             - Disposition: In collaboration with the State and other stakeholders, OCR negotiated an increase in the reimbursement for home health aides in the county where the complainant resided, from $6 to $10 per hour. At this new rate, the complainant was able to secure a home health aide and remain in a community setting. 

##### **State Department of Health**

                          - Allegation: This complaint was filed on behalf of a 56-year-old woman who has cerebral palsy. The woman  had lived in group homes and a private home where she received home care services, but was hospitalized for treatment of a hiatal hernia and acid reflux disease. The complaint alleged that when the woman’s condition stabilized, she was transferred to an institution against her wishes.	                             - Disposition: With OCR's intervention and assistance, the woman was able to move into her own apartment and receive community-based services through the Consumer Directed Program. Through a home and community-based service waiver, she was also provided with residential habilitation, day habilitation and individual supportive services to help her with reintegration into the community.

##### **State Department of Health**

                          - Allegation: This complaint was filed on behalf of a woman diagnosed with a visual impairment and renal failure secondary to diabetes, a seizure disorder, and mild to moderate mental retardation. The complaint alleged that  the woman was required to remain in an acute care hospital against her will. Prior to her hospitalization, the woman lived in an apartment and received home health aide services as well as residential habilitation and day habilitation under the State waiver program. She could not be safely discharged from the hospital to her own home because home health aide services had been denied.	                             - Disposition: Working closely with the State and service providers, OCR was able to secure an arrangement for the safe discharge of the woman  to her own home. The woman  is also receiving adequate supportive services that allow her to remain in the community.

##### **State Department of Health**

                          - Allegation: This complaint was filed on behalf of a 50-year-old woman who has multiple sclerosis. The woman  was hospitalized due to a burn and was subsequently transferred to an institution. Prior to her institutionalization, the woman had lived in her own home with her two children. The complaint alleged the woman  wants to return to the community.	                             - Disposition: As a result of OCR's intervention, the woman was discharged from the institution and obtained a private apartment where she receives 18 hours of personal care services per day through the Consumer Directed Personal Assistance Program.

##### **Sullivan County, State Departments of Health and Family Services, and Health**

                          - Allegation: This complainant, a woman with  a variety of physical and mental impairments, alleged that State and County agencies had discriminated against her on the basis of her disability in denying her home health care services. The complainant alleged that the denial of home care services placed her at risk of unnecessary institutionalization.	                             - Disposition: Working with the State and the woman’s advocate, OCR helped secure 8 hours of personal care services per day for the complainant.  These supportive services allowed her to remain in her apartment.   

##### **Genesee County, State Departments of Health and Social Services**

                          - Allegation: This complaint was filed on behalf of a woman with diabetes, mild mental retardation, blindness and mobility impairments.  The complaint alleged that the woman was discriminated against when the State and County terminated her independent living arrangement. After being denied alternative community placement and supportive services, the woman entered an institution .  The complaint alleged that the woman was prevented from receiving services in the most integrated setting appropriate to her needs.	                             - Disposition: Following OCR's intervention and assistance, the complainant moved to her own apartment and began receiving personal assistance services.

##### **State Department of Health, Office of Mental Retardation and Developmental Disabilities**

                          - Allegation: This complaint alleged the inappropriate institutionalization of a 66-year-old woman with visual impairment, renal failure secondary to diabetes, a seizure disorder and moderate mental retardation. The woman had been admitted to a hospital after a fall, and wanted to return to her home. She had been placed on "alternative level of care" status, in which she could be discharged as long as she received appropriate home care services. However, no home health care agency would provide her with services due to a determination that she could not self-direct her care.	                             - Disposition: As a result of OCR's intervention and assistance, the woman was discharged to her own apartment and provided with 24-hour-per-day supervision, case management services, day program services, medication management, dialysis and diabetes monitoring.  Additionally, guardianship was awarded to a local community services agency.

##### **Madison County, State Departments of Social Services, and Health**

                          - Allegation: The complainant, a 23-year-old man with paraplegia who resided in an institution, alleged that he had been denied an appropriate amount of personal assistance services. The complainant alleged that his physician had prescribed 24-hour supervision for him to successfully live in the community, but a county social service agency had approved him for only 11 hours of personal assistance services each day. The complainant alleged that he needed 24-hour care due to his medical needs and limited physical abilities, and that the denial of 24-hour care resulted in his inappropriate institutionalization.	                             - Disposition: Following OCR's intervention and assistance the complainant's physician's order was amended to prescribe 11 hours daily of direct personal assistance services, supplemented with 13 hours per day of informal supports. The complainant was then discharged to a community placement where it was confirmed that he was receiving appropriate services.

##### **Herkimer County, State Department of Health (NYSDOH), and New York Alternatives Program**

                          - Allegation: The complainant, a 44-year-old man with quadriplegia, alleged that he was at risk of inappropriate institutionalization due to his inability to obtain Licensed Practical Nursing (LPN) services. NYSDOH decreased the complainant's night-time LPN care from two hours per night to one hour per night following a fair hearing decision. The complainant alleged that no area home health care provider would agree to serve him for only one hour per night, and that without nightly LPN care, he would be forced to enter a nursing home.	                             - Disposition:  Following OCR's intervention and assistance NYSDOH agreed to adjust the schedule and payment rate for the complainant's LPN services to a level that the man considered satisfactory. 

##### **Nursing Home, Staten Island**

                          - Allegation: This complaint was filed on behalf of a man with mobility impairments and developmental disabilities. He was admitted into an institution because of its intensive therapy program to improve neuromuscular skeletal dysfunction. The complaint alleged that the man was not receiving physical therapy, but was being treated as a psychiatric patient. The man wanted to move into a living situation that was more attuned to his disability and service requirements.	                             - Disposition:  Following OCR's intervention and assistance, the man was moved to a less restrictive Intermediate Care Facility (ICF) that is in the most integrated setting appropriate to his needs. He received a new wheelchair, began receiving day treatment services, and when OCR visited the facility, the man reported being satisfied with the services.     

##### **Residential Health Care Facility, Rochester**

                          - Allegation: This complaint was filed on behalf of a 32-year-old man with quadriplegia, who had previously lived in an apartment with the assistance of a home health aide. The man lost his apartment and was involuntarily transferred to an institution. He was subsequently offered a wheelchair accessible apartment that was suitable to his needs, but was unable to move to the apartment because of his inability to obtain home health care services. The complaint alleged that the man was verbally denied home health care services because he was not able to provide appropriate back-up for these services.	                             - Disposition: After OCR's intervention, the man was accepted into a Consumer Directed Program, which allowed him to coordinate and employ his own personal care assistance aides. OCR assisted the man with securing an aide and he was discharged from the institution into his own apartment in the community.

##### **Monroe County Department of Social Services**

                          - Allegation: This complaint alleged the Monroe County Department of Social Services discriminated against a woman when it refused to assist her in being discharged from Park Ridge Hospital to her own home. The woman resided in a rural area with a small number of certified home health attendants available twenty-four hours a day, seven days a week.	                             - Disposition: As a result of OCR’s intervention and assistance, the New York State Department of Health approved the woman’s request for private nursing services twenty-four hours a day, seven days a week.. She was then discharged to her own home.

##### **Monroe County, State Departments of Health, and Social Services**

                          - Allegation: A woman with multiple sclerosis had lived in the community with home care for over 20 years. For the last 13 years, she had received 8 to 10 hours of care per day, including a Personal Emergency Response System (PERS), which allowed her to be left alone for a limited period of time. During a hospitalization, the State agency providing her with home care, closed her case. Efforts to secure home health services from other sources were unsuccessful and the woman was placed in an institution against her will.	                             - Disposition: Working with the Consumer Directed Personal Assistance program and the State, OCR was able to secure an arrangement which permitted the woman to move back into her home and receive an increase to 16 hours per day of attendant services.

##### **State Department of Health, Home Health Care Agency, Patchogue**

                          - Allegation: This complaint was filed on behalf of a woman who required a wheelchair for ambulation. The woman was authorized to receive Medicaid home care services for assistance. The complaint alleged that Medicaid and the State failed to provide her with the aide services authorized by her care plan. Because she was having difficulty obtaining home care services from the State, the woman was institutionalized and allegedly could not be discharged.	                             - Disposition: Working with the State and other stakeholders, OCR helped secure the Medicaid home health aide services authorized under the woman's care plan. With services in place, the woman moved from the institution to her own home.

##### **State Department of Health, Hospital, Rochester**

                          - Allegation: This complaint was filed on behalf of a woman  with a brain injury who had lived in the community for several years with home health care services and other supportive services provided through the Traumatic Brain Injury Waiver. The woman suffered some complications and was admitted to an acute care facility. After her convalescence, the woman was unable to return to the community because of the loss of her home health care services. The complaint alleged that the State is violating the ADA by forcing the woman to remain in an acute care hospital setting and refusing to reinstate her home health services.	                             - Disposition: With OCR's intervention and assistance, the woman was accepted into the Consumer Directed Program where she receives 24-hour attendant services and her attendants are paid a higher wage (enhanced rate) so she can easily recruit replacements as necessary. With her home health services restored, she was discharged from the hospital and moved into her own apartment.

##### **State Department of Health, Nursing Home, Binghamton**

                          - Allegation: This complaint was filed on behalf of a woman with mobility impairments who uses a wheelchair. The woman had  admitted herself to an institution due to a kidney stone and related health issues. She was told her stay at the institution for rehabilitation would not exceed one month during which time she was to receive health care services to recover from her kidney stone. After her recovery, the woman was prevented from returning to the community because she was not able to secure required attendant care. The complaint alleged that the State and the treating institution violated the ADA by forcing her to remain in a skilled nursing facility and denying her the opportunity to return to the community and receive services in the most integrated setting.	                             - Disposition: With OCR's assistance, the woman was able to secure 20 hours of necessary attendant care support per week through the Consumer Directed Program. OCR also helped ensure that the woman received residential habilitation services under a Medicaid waiver. She is now living in her own accessible apartment in the community. 

##### **Suffolk County, State Departments of Health, and Social Services**

                          - Allegation: This complaint was filed on behalf of a man with muscular dystrophy. The complaint alleged that he had not been receiving home health services authorized by his care plan. The man believed that without appropriate attendant care, he will face the risk of being forced from his home into an institution.	                             - Disposition: Working with the State and other stakeholders, OCR secured a change in the man's home health care plan obtained an increase in home health care services to 5 hours per day. This increase allowed the man to remain independent.

##### **State Department of Health, Home Health Care Agency, Hauppauge**

                          - Allegation: This complaint was filed on behalf of a woman who has had a stroke, an aneurysm and back surgery. She uses a cane for assistance in walking. Although  she was authorized to receive Medicaid home care services for assistance, care has been inconsistent. Because she was having a problem obtaining adequate home care services, the woman  believed that she was in danger of unnecessary institutionalization.	                             - Disposition: Following OCR's intervention and assistance,  the woman is now receiving all the Medicaid home care services authorized in her care plan, permitting her to remain in the community. 

##### **State Department of Health, Home Health Care Agency, Watertown**

                          - Allegation: This complaint was filed on behalf of a 14-year-old female who has physical and developmental disabilities. She is authorized to have 24-hour nursing care services due to her condition. The agency providing services allegedly prohibited her nurses from accompanying her anywhere outside of her home except to school. The girl would like her nurses to accompany her outside of her home and school so that she can have full access to the community.	                             - Disposition: Working with the State and the provider, OCR was able to secure an agreement that permits appropriate nursing coverage outside the school and home, thereby assuring full access to community living.

##### **Finger Lakes Developmental Disabilities Service Office, Rochester**

                          - Allegation: This complaint was filed on behalf of a man with a disability who was in danger of losing a promised apartment that would allow him to live in the most integrated setting. The complaint alleged that the man had been unable to move into the apartment because a "back fill" replacement for him had not been found to take his spot in his supportive living arrangement.	                             - Disposition: With OCR's intervention and assistance, the outstanding back fill problem was resolved. The man is currently living in his own apartment and receiving services through the home and community-based waiver program.

##### **State Department of Health, Home Health Care Agency, Kings Park**

                          - Allegation: This complaint was filed on behalf of a woman who has arthritis and requires assistance with ambulation. The complaint alleged that the State reduced the 152 hours a week of home health care assistance, resulting in less time to assist in household chores. Additionally, the complaint alleged that the State was refusing to allow a home health aide to accompany the woman to her medical appointments. The woman believed that without adequate Medicaid home care services she was at risk of being unnecessarily institutionalized.	                             - Disposition: With OCR's intervention and assistance, the woman was accepted into a new State personal aide program and is now receiving adequate personal care services. 

##### **State Office of Mental Retardation and Developmental Disabilities**

                          - Allegation: This complaint was filed on behalf of a 34-year-old man with an extensive history of psychiatric hospitalizations and treatment. He was admitted to an institution reportedly because he became agitated and aggressive at home. After his psychiatric stabilization, the man remained institutionalized. The complaint alleged that he is being denied placement in the community in violation of the ADA and the Olmstead decision.	                             - Disposition: With OCR's intervention and assistance, the man was placed in a permanent transition home consisting of habilitation services, social worker services, registered nurse habilitation specialist services, psychiatric services and other services.

##### **Westchester County, State Departments of Health, and Social Services, and State Office of Mental Retardation and Developmental Disabilities**

                          - Allegation: This complaint was filed on behalf of a woman diagnosed with spinal muscular atrophy/quadriplegia. Prior to her institutionalization, she lived with her elderly mother in a private home. She wants to live in the community and receive services in a more integrated setting.	                             - Disposition: Working with the State and other stakeholders, OCR was able to secure a private apartment and two twelve hour aides daily, making it possible for the woman to live in the community.

##### **State Department of Health, Nursing Home, New Hartford**

                          - Allegation: This complaint was filed on behalf of a woman with multiple sclerosis who lived in an institution. The woman believed that with proper supports, she is fully capable of living in the community. The complaint alleged that because community supports have not been provided, she is involuntarily confined to an institution in violation of the ADA and the Olmstead decision.	                             - Disposition: With OCR's intervention and assistance, the woman moved into her own apartment and is receiving adequate supportive services.

Back to Top

#### **OKLAHOMA**

##### **State Department of Human Services (ODHS)**

                          - Allegation: The complainant, a man  with multiple physical disabilities, alleged that he did not receive services as described in his Advantage Waiver Program service plan.  He believed ODHS' failure to follow his service plan put him in danger of institutionalization.	                             - Disposition: Following OCR's intervention, the complainant is now receiving personal service assistance to meet his needs through Advantage Consumer-Directed Personal Assistance Services and Supports.

##### **State Department of Human Services (ODHS)**

                          - Allegation: Five complainants with quadriplegia filed complaints regarding a change in eligibility criteria for a Medicaid waiver program that provides community services to individuals who are elderly or have physical disabilities. The complainants alleged that they were at risk of unnecessary institutionalization due to the change in waiver’s eligibility criteria concerning the age of onset of disability.	                             - Disposition: OCR worked with the State on its Olmstead planning process and identification of barriers to community living.  The State requested and received approval from the HHS Centers for Medicare and Medicaid Services (CMS) for an amendment to the waiver program's eligibility criteria that would raise the age of onset of disability for eligible individuals. When this amendment took effect, all of the complainants were once again eligible for the waiver program and received appropriate community-based services.

##### **State Department of Human Services (ODHS)**

                          - Allegation: The complainant, a man with quadriplegia who uses a wheelchair, alleged that Oklahoma's Advantage Waiver program (a Medicaid waiver program for individuals with physical disabilities) failed to provide him a full range of services to allow him to continue living in the most integrated setting in the community. The complainant lives on his own in an apartment on his mother’s property.  He alleged that ODHS allowed contractors to endanger his well-being by providing no back-up services for providers who failed to show up for work and by failing to provide enough hours to let him live independently (a minimum of 42 hours a week).  His mother provided additional care in the evening; however, his dependency on his mother strained their relationship.  The man began to pay for his own aides for 15 months because they could not be certified to provide the service through a Medicaid home health agency due to felony convictions.  The complainant also had his services terminated by several home health agencies due to his reportedly uncooperative and inappropriate behaviors.	                             - Disposition: OCR and ODHS worked together  to secure a Section 8 apartment for the complainant, and he is receiving 42 hours  of home visits 7 days a week of personal care and assistance with homemaking chores; skilled nursing visits; medication; and medical supplies and equipment.

##### **State Department of Human Services (ODHS)**

                          - Allegation: This complaint was filed on behalf of a 35-year-old woman with quadriplegia. She is a graduate student at a local university. The complaint alleged that the university's program for persons with physical disabilities failed to provide her with sufficient services to enable her to live in on-campus housing , the most integrated setting appropriate to her  needs.	                             - Disposition: OCR and ODHS worked together to obtain 45 hours a week of home health services to provide the woman with  daily personal care and housekeeping services; skilled nursing visits; medication; medical supplies and equipment; and a mechanical lift. She is now able to live in on-campus housing and continue her education.

##### **State Department of Human Services (ODHS)**

                          - Allegation: This complaint was filed on behalf of a 47-year-old man who has quadriplegia and lives in his own apartment. The complaint alleged that ODHS discriminated against him by failing to provide continuous services, in the most integrated setting appropriate to his needs. Also, the complaint alleged that the State is placing him at risk of entering a nursing home because he is not receiving the necessary services to live independently.	                             - Disposition: Following OCR’s intervention and assistance, the man is now receiving the following services through Oklahoma's waiver program for individuals with physical disabilities: 1) AM and PM visits 7 days a week to provide personal care and assistance with homemaking chores; 2) total assistance to transfer from a bed to a wheelchair; 3) skilled nursing visits; and 4) medical supplies and equipment. Additionally, the Veterans Administration provides all medications and wheelchair repairs.

Back to Top

#### **PENNSYLVANIA**

##### **State Department of Public Welfare**

                          - Allegation: The Philadelphia chapter of a nationwide advocacy group alleged that the State is failing to provide services in the most integrated setting to persons with disabilities.	                             - Disposition: After OCR’s intervention, the State developed a long term plan to address the waiting list for mental retardation services in Pennsylvania, created ongoing regional planning groups to address community mental health for adults and a program for reducing beds in State mental institutions and for transferring funds to the community. The State also initiated a home and community based services stakeholder planning team to examine services for people with disabilities.

#### **RHODE ISLAND**

##### **State Department of Mental Health, Retardation and Hospitals**

                          - Allegation: This complaint was filed on behalf of a woman with mental illness, mental retardation and physical impairments who resided with her parents. The complaint alleged that the State denied the woman services in the most integrated setting appropriate to her needs by attempting to force  her to live in a group home setting instead of in her own apartment with a coordinated plan of care.	                             - Disposition: After OCR's intervention and assistance, the State agreed to adopt a comprehensive plan to evaluate and provide services for the woman so that she could live in her own apartment.

##### **State Department of Mental Health, Retardation and Hospitals**

                          - Allegation: This complaint was filed on behalf of a 20-year-old woman with psychiatric and cognitive impairments who lived in a group home with other residents who were more than twice her age. The complaint alleged that this placement denied the woman the opportunity to receive services in the most integrated setting appropriate to her needs. The complaint asserted that the woman wanted to live in her own apartment, pursue education and employment opportunities, and be around individuals her own age.	                             - Disposition: As a result of OCR's intervention and assistance, the woman was moved into an apartment and began receiving services from a community health center, including regular medication and caseworker services.

##### **State Department of Mental Health, Retardation and Hospitals**

                          - Allegation: This complaint was filed by the State Protection and Advocacy agency on behalf of a young man who has a variety of disabilities including bipolar disorder and Tourette's syndrome. He had been living in a state psychiatric hospital for three years, had multiple other hospitalizations and sought community placement.	                             - Disposition: Through the intervention and assistance of OCR, the young man left the institution and moved into a supported apartment. He also found a part-time job. 

##### **State Department of Mental Health, Retardation and Hospitals**

                          - Allegation: This complaint was filed by the State Protection and Advocacy agency on behalf of a young man who has a variety of disabilities including mild mental retardation, attention deficit hyperactivity disorder and a chronic kidney problem. He had been living in a state psychiatric hospital for over a year. Prior to turning age 21, he had been enrolled in several residential schools. He sought community placement.	                             - Disposition: Through the intervention and assistance of OCR, the young man left the institution and moved into an apartment with a roommate.

Back to Top

#### **TENNESSEE**

##### **Tennessee Department of Finance and Administration, Bureau of TennCare**

                          - Allegation: The complainant, a man who has several disabilities including coronary artery disease and quadriplegia and requires assistance with all activities of daily living, alleged that his application for a home and community based services waiver was denied because there were no open spaces available in the program. The man also alleged that because there is no established time period to provide individuals on the home and community based services waiting list with waiver services, he is at risk of institutionalization.	                             - Disposition: As a result of OCR’s intervention and assistance, the man was approved for TennCare home and community based waiver services and has  begun to receive personal care visits, homemaker services and respite services in the community.

#### **TEXAS**

##### **State Department of Aging and Disability Services (DADS)**

                          - Allegation: An advocacy group filed a complaint on behalf of a man with disabilities who resided in a nursing home, but wanted to live in the community.	                             - Disposition: After OCR’s intervention and assistance, the man was enrolled into a managed care organization and is living in his own apartment in the community, with the assistance of Money Follows the Person (MFP) funding from the Centers for Medicare and Medicaid Services.  He also obtained furniture for his new apartment through DADS Transition Assistance Services and receives weekly visits from a nurse for medication management.

##### **State Health & Human Service Commission, and State Department of Human Services**

                          - Allegation: The complainant, a woman who has a mobility impairment, depression and asthma, alleged that she was unnecessarily confined to a nursing home as a result of the determination by a State contractor that the she did not require Home and Community-Based Waiver services.	                             - Disposition: As a result of OCR’s intervention and assistance, the State found the complainant eligible for community-based services. Shortly thereafter, she moved from the nursing home back into her own home, where she received the necessary supports.

##### **State Department of Human Services**

                          - Allegation: The complainant alleged that her daughter, who resided at home, was at risk of unnecessary institutionalization because the skilled nursing care provided to the daughter by the State's Comprehensive Care Program (CCP) would be eliminated when the daughter turned 21, and she would no longer be eligible for CCP services. The complainant's daughter has cerebral palsy and requires constant care.	                             - Disposition: After OCR’s intervention, the complainant's daughter began receiving 16 hour a day services from an attendant who is supervised by and consults with a nurse, an arrangement all parties deem satisfactory.

##### **State Department of Human Services**

                          - Allegation: This complaint was filed on behalf of a 10-year-old boy with mental retardation and physical impairments. The complaint alleged that the State failed to provide the child with essential home and community-based services when he was found ineligible for Primary Home Care Medicaid Waiver services.	                             - Disposition: Working with the State, OCR determined that while the child was not eligible for the Primary Home Care Medicaid Waiver, he was qualified for similar services available under the State's Mental Health and Mental Retardation home and community services program, and continues to live in the community.

##### **State Department of Human Services**

                            - Allegation: This complaint was filed on behalf of a man with a mobility impairment and mild mental retardation. The complaint alleged that he was in danger of unnecessary institutionalization due to recommendations from his health care provider that he should be immediately moved to a nursing home.	                               - Disposition: As a result of OCR’s intervention and assistance, institutionalization was averted and the man received adequate community-based services and assessment for continued community living.

##### **State Department of Mental Health and Mental Retardation**

                          - Allegation: This complaint was filed on behalf of a man with mental retardation and mobility impairments who is a former nursing home resident living  in his own apartment with supportive services. The complaint alleged that the State intended to terminate his community services and  that  he was at risk of unnecessary institutionalization.	                             - Disposition: As a result of OCR's intervention and assistance, the state continued the man's community services pursuant to the ADA and Olmstead decision.

##### **Mental Health and Mental Retardation Services of Tarrant County (MHMRTC)**

                          - Allegation: The complainant is a man with a number of psychiatric and physical impairments who uses a wheelchair for mobility and requires 24 hour-a-day oxygen.  He alleged that the County discriminated against him based on disability by providing him with inadequate care and services. He alleged that he was not receiving necessary and appropriate mental health services from the County, was unable to access certain services due to his mobility impairment, and feared that the lack of services would result in his becoming institutionalized and/or in drastic and unnecessary deterioration of his physical and mental health. The man stated that he was receiving inadequate food and experiencing problems with emergency response, a lack of accessible transportation, and inadequate progress towards community reintegration.	                             - Disposition: Working with the County and other stakeholders, OCR helped create a plan agreeable to the complainant and his service providers to resolve the allegations.

Back to Top

#### **UTAH**

##### **State Departments of Health, and Human Services**

                          - Allegation: This complaint was filed on behalf of a 27-year-old woman with physical impairments, mental retardation and other medical conditions. The woman resided with her parents, but wanted to live independently. While residing at home,  she received supportive services, including participation in a day training program, respite for her parents, financial assistance for services to assist her in participating in community activities, transportation to the day program and case management. The complaint alleged that she had been on a waiting list to receive residential services in the community for 11 years. The complaint alleged  that  her family was told that she would receive community residential services if her parents died and if no siblings were available to care for her.	                             - Disposition: After OCR's intervention and assistance,  the woman’s parents attended an annual meeting to assess  her needs,  she was removed from the waiting list and provided with a residential placement in  an apartment with two other individuals, and receives day services and transportation.

##### **State Departments of Health, and Human Services**

                          - Allegation: This complaint was filed on behalf of a 57-year-old woman who was residing in a nursing home and who has a variety of neurological, physical, development and psychiatric impairments. The complaint alleged that the State failed to provide the  woman with appropriate community-based services, and instead, placed her in a nursing home and on a waiting list for community care. The complaint alleged that the woman was unnecessarily institutionalized.	                             - Disposition: Working with the State and the woman's advocate, OCR learned that resolving this complaint would require finding an appropriate placement both the woman and for her husband, a fellow nursing home resident with his own serious impairments. The State demonstrated to OCR that it was actively engaged in efforts to locate an appropriate placement where the couple could live together, having completed an assessment process for the couple and soliciting bids from providers interested in serving them.

##### **State Departments of Health, and Human Services**

                          - Allegation: This complaint was filed on behalf of a man with multiple physical impairments and mental retardation. The complaint alleged that although the State had approved him for residential services, he has remained on a waiting list for services for more than 11 years. The complaint contends that the State informed the man that he would only be able to access residential services if there were a critical need (i.e., death of a parent and the other parent or siblings are unable to care for him).	                             - Disposition: As a result of OCR’s intervention, the man was removed from the waiting list and placed in an apartment with two other persons where he receives residential services which permit him to live independently in the community.

Back to Top

#### **VIRGINIA**

##### **State Department of Medical Assistance Services**

                          - Allegation: Thirty-two individuals with mental retardation who resided in the community complained of an inability to obtain services from the State's Mental Retardation (MR) Waiver Program. These individuals alleged that the State's failure to provide them with waiver services put them at risk of unnecessary institutionalization.	                             - Disposition: Following OCR’s intervention and assistance, the State created a Task Force to develop an Olmstead plan to address the MR Waiver Program and its waiting list in order to resolve the issues presented by these complaints.  The Governor issued an Executive Order to begin implementing the recommendations of the Task Force, which included increasing MR waiver slots by 160 over a two-year period, and specific budget strategies to address ongoing issues of community integration.  As a result,  the State provided community-based services to the majority of the individual complainants, and provided OCR with detailed information about the status of the complainants who had not yet received services.

#### **WASHINGTON**

##### **State Department of Social and Health Services**

                          - Allegation: The complainant, an individual with quadriplegia, alleged that the State violated the Olmstead decision by maintaining that Medically Needy Medicaid clients whose income exceeded the Categorically Needy level could receive long-term services only in a nursing home. As a result, because of his income level, the complainant was only able to receive the Medicaid long-term personal care services he needed if he resided in a nursing home.	                             - Disposition:  As a result of OCR’s intervention, the State established two new waiver programs under which the State could provide long-term personal care services to both Categorically Needy and Medically Needy clients in the full-range of settings from institutional to in-home. The State also agreed to commit State funds to equalize the personal needs allowance provisions available for Medically Needy and Categorically Needy individuals, thus making home-based services equally available to Medically Needy individuals.

##### **State Department of Social and Health Services**

                          - Allegation: This complaint was filed on behalf of a woman diagnosed with mental illness and unspecified physical disabilities who lived in a facility for people with mental illness. The complaint alleged that despite the woman’s best efforts, and those of her treatment team, she was unable to move to a more integrated setting because of the difficulty of finding community-based services for persons with mental illness.	                             - Disposition: At OCR's urging, the State accelerated its efforts to provide the  woman with community placement and  she moved to the community shortly thereafter.

##### **State Department of Social and Health Services**

                          - Allegation: This complaint was filed by a patient at one of the public psychiatric hospitals in the State of Washington. The complainant, a woman with a mental disability, alleged that she had lived in psychiatric hospitals for more than three years and all her attempts to be moved into a more integrated setting appropriate to her needs had been unsuccessful. The woman alleged that the State's failure to move her into the community constituted discrimination on the basis of disability.	                             - Disposition: Working closely with the State, OCR helped establish a new procedure to accelerate the turn-around time for acceptance of an individual into the community resource network. As a result of these efforts, the woman was moved into a group home. In addition, other similarly situated individuals were helped by the new procedure to remove barriers to the expeditious placement of individuals in particular communities.

##### **Eastern State Hospital**

                          - Allegation: The complainant, a woman with mental illness who had been institutionalized for 12 years in a State psychiatric hospital, alleged that she requested discharge from the facility for years, but to no avail. She alleged that she was not receiving services in the most integrated setting appropriate to her needs.	                             - Disposition:  Following OCR's intervention and assistance, the woman was placed in a community facility that was appropriate to her needs.

Back to Top

#### **WEST VIRGINIA**

##### **State Department of Health and Human Services (WVDHHS), Aged and Disabled (A&D) Waiver Program**

                          - Allegation: An advocacy group filed a complaint alleging that a participant in the A&D waiver program was at risk of institutionalization because her contract service providers were failing to provide the hours of care for which she was eligible at the times and frequency outlined in her Plan of Care.	                             - Disposition: Following OCR’s intervention, WVDHHS provided technical assistance to the individual's contract service provider. The contract service provider has located additional staff and now consistently provides an average of 92% of the monthly hours of care for which the individual is eligible.

##### **State Department of Health and Human Services**

                          - Allegation: A complaint was filed by a mother on behalf of her adult son alleging that he was not receiving services in the most integrated setting appropriate for his needs. The complainant's son was residing at a psychiatric hospital.	                             - Disposition: Through the Olmstead Mediation Pilot Project coordinated by OCR and the U.S. Department of Justice, the complainant's son was relocated to a supervised apartment, which was a more integrated setting as compared to the hospital.

##### **State Department of Health and Human Resources**

                          - Allegation: This complaint was filed on behalf of a man with muscular dystrophy who is ventilator dependent and requires 24-hour nursing services. These services, which the man has been receiving for several years, allowed him to live in his own apartment. The complaint alleged that these services were scheduled to be discontinued in the near future  and that discontinuation of these services would put him at risk of unnecessary institutionalization.	                             - Disposition: Working with the State, OCR was able to find another provider who agreed to provide the services the man requires through the State's Developmental Disabilities waiver.

Back to Top

#### **WISCONSIN**

##### **State Department of Health and Family Services**

                          - Allegation: This complaint was filed on behalf of a 55-year-old man with a spinal cord injury who uses a wheelchair and has lived in a nursing home for more than four years. The complaint alleged the State had determined that the man was eligible for a Medicaid waiver program that would provide him with community-based care, but  expected to remain on the waiver program waiting list for approximately five years. The complaint alleged that the man was denied services in the most integrated setting appropriate to his needs.	                             - Disposition:  After OCR’s intervention, the State provided the man with services in an eight-bed community residential facility. In addition, the man’s service plan indicated that the eight-bed setting would offer the opportunity to assess the possibility of a more independent living arrangement in the future. 

##### **State Department of Health and Family Services**

                          - Allegation: A number of complaints were filed on behalf of individuals with mental retardation, and in some cases other impairments, who resided in an institution for people with mental retardation. Each of these complaints alleged that the individuals were denied services in the most integrated setting appropriate to their needs and wanted to move from the institution to a community-based setting, such as a group home or an apartment.	                             - Disposition: After OCR’s intervention and assistance, the institution was closed and  each  individual was provided with a satisfactory community based placement, either in a group home or assisted living arrangement. 

##### **State Department of Health and Family Services**

                          - Allegation: This  complainant alleged that the State failed to provide a man  with cerebral palsy an opportunity to live in the most integrated setting appropriate to his needs. The man had been living at home with his parents but was not receiving Medicaid waiver services due to a lack of funding. The complaint further alleged that continued home placement under those circumstances came at great personal sacrifice by the family and posed the risk of unnecessary institutionalization.	                             - Disposition:  As a result of OCR’s intervention and assistance, the man was approved for Community Integration Program services. Among the services provided via this Medicaid waiver program are workshops, day programming and respite care. Transportation was also authorized, but was put on hold until the provider had an opening.

##### **State Department of Health and Family Services**

                          - Allegation: This complaint was filed on behalf of a man with cerebral palsy who lived in a nursing home for 28 years, since the age of 18, and wished to move to a community setting. The complaint alleged that the State failed to provide the man with an opportunity to live in the most integrated setting appropriate to his needs in violation of the ADA's integration regulation. He had been on a waiting list for five  years and was told that his name would not come up to the top of the list for another one to two years.	                             - Disposition: With OCR’s intervention and assistance, the man moved from the nursing home to an apartment. The move was facilitated by  Community Option Program (COP) Waiver Funding for Nursing Home Relocations for one year. The County will receive funding annually for its COP-Waiver allocation to continue the placement.

##### **State Department of Health and Family Services**

                          - Allegation: This complaint alleged that the State failed to provide a person with cerebral palsy and cognitive disability, with an opportunity to leave a nursing home and live in a community setting.	                             - Disposition: Working with the State, OCR helped secure the person's move from the nursing home to an adult family group home. Funding for the relocation became available by placing the person into the County's family care management program.

##### **Dunn County, State Departments of Health and Family Services, and Human Services**

                          - Allegation:  A woman filed this complaint on behalf of her 25-year-old son, who was diagnosed with the genetic disorder Prader-Willi Syndrome. The complainant's son had been alternating between living at home and in various institutional placements for two years that were not programmatically appropriate. The complainant alleged that her son wanted community-based services through a Medicaid waiver program, but that the State had failed to provide him with these services due to a very long waiting list for the waiver program.	                             - Disposition:  Following OCR's intervention and assistance, the complainant’s son was moved to a supervised apartment with a variety of supportive services, including pre-vocational activities, transportation, case management, and two hours of personal care services each day. The State worked with OCR to devise a unique solution, in which the State approved an enhanced payment rate so that the community placement could be made.

##### **Dunn County, State Departments of Health and Family Services, and Human Services**

                            - Allegation: This complaint alleged that the State failed to find an appropriate community placement for a person with neurological and physical disorders, forcing the person to reside in a nursing home.	                               - Disposition: As a result of OCR’s intervention, the person was moved from the nursing home to a community-based Adult Family Home. The move was made possible when the State provided the County with Community Option Program Waiver Funding for Nursing Home Relocations.

##### **Dunn County, State Departments of Health and Family Services, and Human Services**

                            - Allegation: This complaint alleged that the State discriminated against a man who had suffered a stroke on the basis of disability, by denying him participation in the Community Options Program (COP) and the additional home services that would enable him to continue to live at home.	                               - Disposition: Following OCR's intervention and assistance, The State purchased a lift chair and installed a hand rail on the stairs of the man's mobile home. Furthermore, the man is began participating in the Senior Citizen Center's Meals on Wheels program.

##### **Dunn County, State Departments of Health and Family Services, and Human Services**

                            - Allegation: The complainant, a 79-year-old woman who uses a wheelchair and is unable to communicate due to a stroke, had lived in a 20 bed Community-based Residential Facility (CBRF) for more than two years. Her stay at the CBRF was paid for through private funds. When the complainant's funds were exhausted, she contacted the State about Medicaid assistance. She was reportedly told that there was a waiting list for Medicaid waiver services and that it was possible she would have to move to a nursing home, where Medicaid would pay the cost of the placement. Her complaint alleged that the State had failed to provide the necessary resources to permit her to live in the most integrated setting appropriate to her needs.	                               - Disposition: Working with the State and other stakeholders, OCR helped secure Community Options Program  funds that allowed the complainant to remain in the community.

##### **Sheboygan County, State Departments of Health & Family Services, and Human Services**

                          - Allegation: This complaint alleged that the State discriminated against a man with cognitive and physical impairments on the basis of disability by failing to provide him the residential and supported employment services that he had tried to obtain on his own for five years. The complaint alleged he was at risk of unnecessary institutionalization.	                             - Disposition: Working with the State, OCR helped secure seven hours per month of Supported Employment job coaching; three hours of support per week for housekeeping, shopping, and other tasks the man cannot perform on his own; and two hours of support two days per week to help him develop additional self-help skills. In addition, the State bears the cost for the man’s specialized transportation service.

##### **Milwaukee County, State Department of Health & Family Services, and Human Services**

                          - Allegation: The complainant, a woman with developmental and neurological impairments, alleged that the State discriminated against her on the basis of disability by failing to provide her with appropriate home and community-based services. By placing her on a waiting list, the State failed to place her in the most integrated setting appropriate to her needs.	                             - Disposition: Following OCR's intervention and assistance, the complainant  was provided the option of placement in a group home or an apartment with community services. However, she chose to move out of state to live with her extended family. The State assisted  her with her moving expenses.

##### **Milwaukee County, State Department of Health & Family Services, and Human Services**

                          - Allegation: Seven complaints were filed by the Wisconsin Coalition for Advocacy (the State Protection and Advocacy agency) alleging that the State discriminated against the individuals on the basis of disability by failing to place them in the most integrated setting appropriate to their needs. All seven lived in an Intermediate Care Facility for individuals with mental retardation. All had expressed an interest in living in the community, but were on waiting lists with an estimated wait of between 5 and 10 years before waiver funds would be available.	                             - Disposition: After OCR’s intervention and assistance, the State took over receivership of the facility due to financial and programmatic concerns, and adopted a plan to move 90% of the residents to community settings and close the facility. All seven individuals moved into the community.

##### **Grant County, State Departments of Health & Family Services, and Human Services, and Iowa County,** [State] **Unified Board**

                          - Allegation: The complainant, a woman with cerebral palsy, alleged that the State failed to provide a community placement that would enable her to leave the  nursing home and live in the community.	                             - Disposition: Working with the State, OCR helped secure community placement for the woman.   

##### **Sauk County, States Department of Health and Family Services, and Human Services**

                          - Allegation: This complaint alleged that the State failed to provide assistance to enable a man with a neurological condition and cognitive impairments to remain at home, thus putting him at risk of unnecessary institutionalization.	                             - Disposition: As a result of OCR’s intervention and assistance, the State conducted a comprehensive review to determine appropriate services for the  man. The State assigned a new case manager to ensure that the programs for which  he was eligible for were made available, and that an independent team of stakeholders assists the case manager in overseeing service delivery

Back to Top

Content last reviewed December 10, 2015