Office for Civil Rights

DELIVERING ON THE PROMISE:
OCR's COMPLIANCE ACTIVITIES PROMOTE COMMUNITY INTEGRATION

INTRODUCTION

The HHS Office for Civil Rights (OCR) is responsible for investigating complaints alleging a violation of the Americans with Disabilities Act (ADA) "integration regulation," which states that individuals with disabilities have a right to receive public services in the most integrated setting appropriate to their needs. Typically, these "most integrated setting" complaints filed with OCR allege a violation of ADA rights as set out in the Supreme Court 1999 decision, Olmstead v. L.C., which interpreted the integration regulation. (Note 1)

OCR's response to Olmstead complaints has had a significant impact in facilitating the community integration of individuals with disabilities. These complaints have been filed by or on behalf of a wide range of individuals, including individuals with physical, psychiatric, developmental and cognitive impairments, and individuals of all ages, including children, young and middle-aged adults, and elderly persons. As a result of OCR's efforts, many individuals have been able to move from an institution to the community, and many individuals have avoided unnecessary institutionalization. For example:

• OCR's intervention and assistance have helped secure community services for individuals who had been institutionalized for decades.



• OCR's efforts have resulted in the provision or restoration of community services for individuals who lost their housing and/or community-based supportive services when they entered institutions due to an acute health care problem.



• OCR's work with complainants, states and other parties have resulted in providing community services to individuals with disabilities through "waiver" programs.



• OCR's efforts have resulted in individuals receiving increased hours of personal care and assistance; in one instance, with OCR's collaborative efforts the local government increased the county-wide hourly rate for home health care providers.



• OCR's work has resulted in individuals with disabilities having greater control over their community-based care and services.



• OCR has helped ensure that individuals are provided reasonable accommodations where they resided, rather than having to move to a more restrictive setting.

In March 2002, in response to President Bush's Executive Order 13217, Community-Based Alternatives for People with Disabilities, HHS committed to broadly disseminate individual accounts of how its civil rights compliance activities have facilitated community integration. (See Delivering on the Promise, HHS' Report to the President on Executive Order 13217, available at www.hhs.gov/newfreedom/final/hhs.html.) Accordingly, OCR is providing the following accounts of some 100 satisfactorily resolved OCR complaints.

More than 80 of these cases involved individuals who moved from institutional to community settings; more than 30 cases involved individuals residing in the community who avoided institutionalization as a result of OCR's work. As can be seen from these accounts, the resolution of these matters varied according to each set of facts and circumstances, and was tailored to appropriately and practically address the interests of the parties involved. Complainants, government entities and other parties worked cooperatively with OCR, often devising creative solutions to the issues involved in the complaints.

Individual descriptions of these cases follow. The summaries are grouped by state, and identified by the governmental or other entity against whom the complaint was filed. Some personal details about the complaints have been removed to protect the complainants' privacy. For more information about these cases, please contact OCR, using the OCR docket number or numbers provided at the conclusion of each description.

In addition to OCR's efforts to respond to individual complainants, OCR is actively involved in systemic efforts to ensure the provision of integrated, community-based services to people with disabilities. For example, OCR acted as a mediator to successfully resolve private litigation between the State of Louisiana and individuals with disabilities who alleged systemic violations of Title II of the ADA in Louisiana's long-term care system. OCR staff throughout the country have served as catalysts to encourage more than 40 states to develop the "comprehensive, effectively working plan" for services to people with disabilities discussed in the Olmstead decision, and have provided states with a wide variety of technical assistance relating to plan development. (A detailed report about state planning efforts is available from the website of the National Conference of State Legislators, at www.ncsl.org/programs/health/forum/olmsreport.htm) Moreover, OCR has been an integral part of HHS' response to Executive Order 13217 and the President's New Freedom Initiative for individuals with disabilities. (The text of Executive Order 13217, more information about the New Freedom Initiative and HHS' role in carrying out the initiative can be found at www.hhs.gov/newfreedom.) OCR will continue both the investigation and resolution of complaints, and broad-based systemic activities as part of its continuing work in this important civil rights area.

INDIVIDUAL CASE DESCRIPTIONS

COLORADO

Health Care Quality Improvement Organization, Denver, Colorado
Allegation:
The complainant, a person diagnosed with Parkinson's disease and lupus, alleged that the State discriminated against him of 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. (OCR Docket # 08003043)

Assisted Living Facility, Durango, Colorado
Allegation:
This complaint was filed on behalf of a person 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 complainant 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. An initial mediation session was held in person with all the parties and numerous teleconferences followed. 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. (OCR Docket # 08003060)

Colorado Department of Human Services
Allegation:
This complaint was filed on behalf of a person 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 complainant alleged that he 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 complainant in the home and community-based services waiver program for individuals with developmentally 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. (OCR Docket # 08013023, 08013024 and 08013025)

CONNECTICUT

Connecticut 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 complainant 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 the intervention and assistance of OCR, the complainant leased an apartment and enrolled in an Outreach and Engagement Program for counseling and case management services. OCR was directly involved with ensuring that services were in place for the complainant to leave the nursing home and move to a community-based setting. The complainant received a variety of community-based services, including counseling and intensive case management. (OCR Docket # 01003083)

Connecticut Department of Mental Retardation/Connecticut Department of Children and Families
Allegation:
The complainant alleged that the State failed to provide her son, who has numerous mental and physical disabilities including mental retardation and a seizure disorder, with services in the most integrated setting appropriate to his needs. The complainant sought corrective action with the desired end of receiving personal and home health care for her son.

Disposition:
As a result of OCR's investigation, both State agencies took actions to support the individual's return to community living. Through the collaborative actions of OCR, the State, and the complainant, it was agreed 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. (OCR Docket #s 01003084 and 01003094)

Connecticut Department of Mental Retardation
Allegation:
This complaint was filed by a mother on behalf of her son, a young man who has a variety of disabilities including severe mental retardation, obsessive compulsive disorder, and seizure disorder. He received respite care in a State-run intermediate care facility for individuals with mental retardation, but sought community placement.

Disposition:
The State agency agreed that the young man should be placed in the community with supportive services. The process was delayed due to the cost submitted by one of the contractors. Through OCR's intervention and assistance, all parties agreed on the plan and timetable for finding a suitable roommate and a provider to deliver the supportive services. OCR will monitor this case until all elements of the plan are implemented. (OCR Docket # 01003054)

Nursing Home, New Haven, Connecticut
Allegation:
The Connecticut chapter of a nationwide advocacy group filed complaints with OCR on behalf of individuals who were then 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. He has a variety of disabilities including traumatic brain injury and 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 complainant's wish. As a result, he was placed on a waiting list with the New Haven Housing Authority and eventually moved into an apartment. (OCR Docket # 01003129)

Nursing Home, Avon, Connecticut
Allegation:
The Connecticut chapter of a nationwide advocacy group filed this complaint on behalf of an individual living in a nursing home for more than 4 years. The individual has a variety of disabilities including mobility impairments. The Director of Nursing at the nursing home determined that he should be discharged into a community setting. The complainant alleged that the State agency was uncooperative.

Disposition:
Upon OCR's intervention, the State agency moved more promptly and placed the individual in an apartment using a Medicaid waiver for individuals with acquired brain injury. (OCR Docket # 01003073)

Nursing Home, Hartford, Connecticut
Allegation:
The Connecticut chapter of a nationwide advocacy group filed this complaint on behalf of an individual living in a nursing home for more than 7 years. He sought community placement.

Disposition:
At the time the complaint was filed, the State agency was evaluating whether the individual would be eligible for an Acquired Brain Injury (ABI) waiver. He stayed in the nursing home primarily because of the lack of affordable housing, the need for the right roommate, and supportive services. OCR's intervention resulted in the State agency providing the complainant with community services through the ABI waiver. (OCR Docket # 01003081)

DELAWARE

Delaware Department of Health and Social Services
Allegation:
This complaint was filed on behalf of an individual diagnosed with cerebral palsy and osteoarthritis. The complainant uses a wheelchair for ambulation and requires substantial assistance in all aspects of daily living. The complainant, 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 complainant was discharged from the institution to a community-based apartment. (OCR Docket # 03003065)

GEORGIA

State of Georgia
Allegation:
This complaint was filed on behalf of a person with a disability who resided in an institution for more than 27 years. The complainant alleged that the State's policies and practices forced him to live in an unnecessarily segregated institutional setting in order to receive long-tern care services in violation of the ADA's integration regulation.

Disposition:
As a result of OCR's intervention, the complainant was removed from the institution and placed in a less restrictive group home. (OCR Docket # 04013054)

State of Georgia
Allegation:
This complainant was filed on behalf of an individual diagnosed with cerebral herpes encephalitis and seizure disorder. He had lived in a transitional care facility for several years and received services under an Independent Care Waiver Program (ICWP). The complainant moved out of the facility but was not satisfied with the care he received. Therefore, he requested transfer back to his previous living arrangement. The complainant was informed that he could not receive services under the ICWP if he returned to the transitional care facility. The complainant 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 complainant back to his former living arrangement with ICWP services. (OCR Docket # 04013134)

State of Georgia
Allegation:
This complaint was filed on behalf of an individual diagnosed with Traumatic Brain Injury. The complainant received services at an institution under an Independent Care Waiver Program (ICWP). The complainant was informed by the State that his ICWP services would be phased out. The complainant alleged that the State's actions would force him into a living arrangement inappropriate to his needs.

Disposition:
After OCR met with the State to discuss the specifics of the complainant's situation, the State agreed to change its policy and allow complainant's ICWP services to continue. (OCR Docket # 04013135)

State of Georgia
Allegation:
This complaint was filed on behalf of an individual with mild mental retardation, impulse control disorder and deafness who has lived in an institution for more than 21 years. The complainant'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:
Working with the State, OCR secured community placement for the complainant with appropriate support services. (OCR Docket # 04013156).

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 complainant'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 intervention and assistance, the complainant was approved for services and placed in the community. (OCR Docket # 04013158)

State of Georgia
Allegation:
The complaint was filed on behalf of a woman with speech and hearing disabilities, a seizure disorder, mild scoliosis, and moderate mental retardation. The complainant had lived in an institution for more than 12 years. The complainant alleged that 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:
Working with the State, OCR helped secure approval of services for the complainant and placement in the community. (OCR Docket # 04013159)

State of Georgia
Allegation:
This complaint was filed on behalf of an individual diagnosed with moderate mental retardation, psychiatric disorders and a seizure disorder. The complainant resided in an institution. Her treatment team recommended community placement for two successive years. Because of the delay of approximately 20 months in providing community placement, a complaint was filed alleging inappropriate institutionalization in violation of the ADA's integration regulation.

Disposition:
Working with the State, OCR helped secure approval of services for the complainant and placement in the community. (OCR Docket # 04013060)

State of Georgia
Allegation:
This complaint was filed on behalf of a woman diagnosed with moderate mental retardation and other disabilities. The complainant was admitted to an institution during her childhood and resided at the institution for more than 38 years. The complainant alleged that the State's polices and practices forced her to live in an unnecessarily segregated setting in violation of the ADA's integration mandate.

Disposition:
Through OCR intervention and assistance, the complainant was approved for services and moved to the community. (OCR Docket # 04013061)

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 complainant never received habilitation and training that was appropriate for his disability. Because he lacked adequate training, he was never offered the community placement option. The complainant 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 complainant with a community placement transition plan and necessary training, and then moved him into the community. (OCR Docket # 04013163)

State of Georgia
Allegation:
This complaint was filed on behalf of a woman who has schizophrenia. The complainant had lived in an institution for several years, but wanted to move to a more integrated setting. The complainant 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 approved the complainant for services and placed her in the community. (OCR Docket # 04013166)

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 complainant alleged that during his annual reviews the habilitation review committee found that he had no need for 24 hour medical care (which he alleged is a state law requirement for institutional placement.) Further, the complainant alleged that committee found he could have all of his habilitation needs met in a less restrictive community setting. The complainant alleged that the failure of the State to place him in a setting most appropriate to his needs is a violation of the ADA's integration regulation.

Disposition:
Working with State officials, OCR helped secure the necessary support services for the complainant's placement in the community. (OCR Docket # 04023063)

ILLINOIS

Illinois Department of Human Services/Eligibility Assessment Agency, Olympia Fields, Illinois
The complaint, a man with a developmental disability, had lived an Intermediate Care Facility for the Developmentally Disabled for approximately 13 years. The complainant alleged that the State failed to provide him with a placement in the least restrictive environment in violation of ADA and the Olmstead decision.

Disposition:
After working closely with the State for six months, OCR secured the placement of the complainant into a Community Integrated Living Arrangement home. The complainant was pleased that OCR was able to resolve the situation when he was unable to do so. (OCR Docket # 05003196 and 05003197)

Illinois Department of Human Services/Eligibility Assessment Agency, Northbrook, Illinois
Allegation:
The complainant alleged that the State failed to provide him with a one-to-one assistant he needed to avoid unnecessary institutionalization.

Disposition:
Working closely with various components of the State, OCR secured a reassessment of the complainant, an agreement from the State to increase the one-to-one assistant care funding for the complainant from 11 hours for a 5-day week to 35 hours for a 7-day week, which permitted the complainant to remain in the community. (OCR Docket # 05003203 and 05003204)

Illinois Department of Human Services
Allegation:
This complaint was filed to enable a person diagnosed with autism to make an appropriate transition from the state educational system for children to adult community services. The complainant alleged that the State failed to provide funds for adult day care services, and that without those services the complainant was in danger of being unnecessarily institutionalized.

Disposition:
Working with the State for a year, OCR helped secure an agreement that included a State-approved family Community Integrated Living Arrangement (CILA) award in excess of $50,000, something the complainant had been trying to obtain for two years prior to OCR's involvement. The receipt of this award permitted the complainant to obtain ten hours of direct support services and fifteen hours of respite 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. (OCR Docket # 05003249).

Illinois 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 complainant alleged that the State failed to provide her with the independent living resources which would allow her to leave the institution and live in a less restrictive community setting.

Disposition:
Working with the State for a year, OCR ensured that the complainant received the necessary community integration resources including a Determination of Need assessment, a housing voucher, and a vocational rehabilitation evaluation. The complainant was able to move into the community. (OCR Docket # 05003253)

Illinois Department on Aging
Allegation:
The complaint alleged that the State failed to provide the complainant with additional hours of home services 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 a month and homemaker services provided by the State. (OCR Docket # 05003254)

Illinois Department of Human Services
Allegation:
The complaint alleged that the because the State failed to find an appropriate community placement, a person with a disability was forced to live in a nursing home rather than receive services in a less restrictive setting.

Disposition:
As a result of OCR intervention and assistance, the complainant was able to move from a nursing home to a community residence. The State further changed the complainant's Medicaid status so that he can access Medicaid services in the community. (OCR Docket # 05013099)

Illinois Department of Human Services
Allegation:
The complaint alleged that the State failed to find the a community placement for a person with mobility impairments, although the complainant could be appropriately served in the community. As a result, the complaint alleged that the complainant had no choice other than to reside in a nursing home.

Disposition:
Working with the State, OCR helped secure the complainant's removal from the nursing home to a community residence. (OCR Docket # 05013100)

Illinois Department of Human Services
Allegation:
The complainant, a woman with multiple sclerosis and quadraplegia, alleged that the State failed to provide her with sufficient service hours to remain in her home. As a result, the complainant alleged, she was forced to move to a nursing home.

Disposition:
As a result of OCR's intervention and assistance, the complainant 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. (OCR Docket # 05013101)

Illinois 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:
Working with the State, OCR helped secure the complainant's discharge from the nursing home and move to a community residence. The State changed the complainant's Medicaid status so that she can access Medicaid services in the community. (OCR Docket # 05013102)

Illinois Department of Human Services
Allegation:
This complaint was filed on behalf of a person with a developmental disability after her guardian and an advocacy organization had given up trying to move her from a 10-bed facility to a more independent and integrated community-based living arrangement that would foster skills to enable her to live more independently. The complainant alleged that the State failed to provide funds for the more integrated placement, thus making her remain in a more restrictive environment.

Disposition:
Working with the State for close to a year, OCR secured a placement in a more integrated living arrangement approved by the guardian. (OCR Docket # 05023007)

Illinois Department on Aging/Laden Township, Illinois 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. (OCR Docket # 05023028)

INDIANA

Indiana Family & 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 complainants contended that if they left their homes they would lose their benefits, thus being forced into a more restrictive nursing home setting.

Disposition:
Working with the State, OCR ensured that notices of clarification were sent to all providers of services, including home health providers. Specifically, the notices clarified that the Aged and Disabled Medicaid Waiver does not have an rule requiring clients 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. (OCR Docket #s 05003106, 05003109, 05003110)

Indiana Family & Social Services Administration
Allegation:
The complaint, a man with physical disabilities, alleged that the State failed to provide the complainant with supportive services that would enable him to live in his own home.

Disposition:
As a result of OCR's intervention and assistance, the State agreed to contact the complainant so that he could make a proper application to receive appropriate services under the State's Aged and Disabled Waiver. In addition, the State agreed to "fast-track" the complainant's application and assessment for the Aged and Disabled Waiver program. The complainant is now living in the community. (OCR Docket # 05003108)

Indiana Family & Social Services Administration
Allegation:
The complainant alleged that the State failed to enroll him in the Medicaid Aged and Disabled Waiver program that would enable him to live in his own home. As a result, the complainant 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 Complainant's application and assessment for the Aged and Disabled Waiver Program. The complainant was found eligible for the waiver and is living in the community. (OCR Docket # 05003111)

KENTUCKY

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

Disposition:
Working with the State, OCR helped secure the discharge of the complainant from the institution to a group home. (OCR Docket # 04003156)

State of Kentucky
Allegation:
This complaint was filed on behalf of a 66-year-old woman with psychiatric, developmental and physical impairments who was admitted to an institution. The complainant 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 complainant moved from the psychiatric hospital to 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. (OCR Docket # 04003168)

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 complainant 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:
Working with the State, OCR was able to effectuate the complainant's removal from the institution and her placement in a less restrictive community-based setting close to her parents' home. (OCR Docket # 04013012)

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 complainant was diagnosed with psychiatric and developmental impairments. While at the institution, the complainant's condition improved and various efforts were made to place the complainant in an alternative living arrangement. None of these efforts were successful. As a consequence, the complainant alleged that the State's policies and practices required him to live in an unnecessarily segregated institutional setting in violation of the ADA's integration regulation.

Disposition:
Working with the State and other stakeholders, OCR helped secure a placement for the complainant in a group house with two other individuals. The complainant has his own room and bathroom. He attends a community day program and is learning to administer his own medication. The complainant's advocate reports that his transition and adjustment have gone very well. (OCR Docket # 04023081)

MARYLAND

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a person with a severe seizure disorder, mental retardation, cerebral palsy and deafness. The complainant was admitted involuntarily to an institution for treatment of episodes of intermittent explosive disorder. The complainant had formerly resided in several different group residential settings. Some months later, the complainant'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 complainant remained institutionalized. The complainant 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 complainant was discharged to a community-based service provider which was able to meet his unique needs. (OCR Docket # 03993157)

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of an 80-year-old woman diagnosed with a depressive disorderand 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 the complainant be discharged to a supervised aftercare facility. However due to various intra agency disputes, her discharge was delayed. The complainant alleged that the State is in violation of 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 complainant was discharged to a community provider for individuals with hearing impairments, which provided her with senior residential housing. (OCR Docket # 03003032)

Maryland Department of Health and 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 complainant 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 complainant's discharge to a community mental health program for people with deafness. (OCR Docket # 03003031)

Maryland Department of Health and 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 complainant was placed in maximum security forensic hospital by the court. Some months later, the court directed that the State provide the complainant with housing and treatment in the community as an alternative to incarceration. However, community placement was delayed, reportedly because of funding issues and the need for an open slot to develop in a residential program. Because of the delay, the complainant alleged that he 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 complainant was discharged to a community-based provider. (OCR Docket # 03003030)

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of a 26-year-old man diagnosed with psychiatric and developmental disabilities. The complainant was placed in a psychiatric facility. Several months later, the institution applied for to the State for community placement. The request was denied because the complainant's mental retardation diagnosis was then in question and therefore he did not qualify for certain services. The complainant alleged that he was not receiving services in a setting that is most appropriate to his needs.

Disposition:
With OCR intervention and assistance, the complainant was found eligible for services and he was discharged to a community service provider. (OCR Docket # 030003054)

Maryland Department of Health and 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 complainant has resided in an institution for more than 20 years. The complainant visited several group homes in preparation for discharge. However, her discharge was delayed. The complainant alleged she is not receiving services in the most integrated setting appropriate to her needs.

Disposition:
OCR was able to help resolve the delay in providing the complainant with community services. The complainant was discharged to a group home where she resides with two housemates. (OCR Docket # 03003091)

Maryland Department of Health and 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 complainant has expressed a desire to move from the institution to a community-based setting.

Disposition:
The OCR investigation found that the State has made reasonable efforts to place the complainant in a community setting. However, the complainant 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 placement she likes. (OCR Docket # 03003070)

Maryland Department of Health and 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 complainant 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 complainant was moved out of the hospital and placed in an alternative living arrangement operated by the county Association of Retarded Citizens. (OCR Docket # 03003044)

Maryland Department of Health and Mental Hygiene
Disposition
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. She is able with difficulty to verbally communicate basic needs. The complainant alleged that she is not receiving services in setting most appropriate to her needs in violation of the ADA and the Olmstead decision.

Disposition:
With OCR intervention and assistance, the complainant moved out of the hospital to a community living arrangement more appropriate to her needs. (OCR Docket # 03003044)

Maryland Department of Health and Mental Hygiene
Allegation:
This complaint was filed on behalf of an individual diagnosed with mental retardation and schizoaffective disorder. The complainant had resided in an institution for more than five years, but had sought services in the community. The complainant 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 complainant's move into the community. (OCR Docket # 03003078)

MICHIGAN

Michigan Department of Community Health
Allegation:
The complainant alleged that the State reduced her home and community-based waiver hours, thus putting her at risk of institutionalization

Disposition:
As a result of intervention, the State restored the complainant's service hours. (OCR Docket # 05023057)

MINNESOTA

Minnesota 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 complainant 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 least restrictive setting.

Disposition:
As a result of OCR intervention and assistance, the complainant was provided with a home and community-based services program. (OCR Docket # 05013038)

Minnesota 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 complainant'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 least restrictive setting.

Disposition:
Working with the State, OCR helped secure a new foster care service provider who was willing to serve the complainant in a foster care home. (OCR Docket # 05013039)

Minnesota 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 complainant 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 least restrictive setting.

Disposition:
Through OCR intervention and assistance, the complainant was provided with home and community-based services program. (OCR Docket # 05013040)

Minnesota 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 complainant was eligible for home and community-based services. However, placement was delayed due to treatment related to diabetes and appendicitis and difficulty finding a community placement to meet the complainant's needs. As a consequence, a complaint was filed alleging inappropriate institutionalization and failure of the State to provide services in the least restrictive setting.

Disposition:
Working with the State, OCR helped secure the complainant's placement in a foster care home. (OCR Docket # 05013041)

Minnesota 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 complainant 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 least restrictive setting.

Disposition:
As a result of OCR's intervention and assistance, the complainant was placed in a community residential mental illness program. (OCR Docket # 05013042)

Minnesota 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 complainant 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 least restrictive setting.

Disposition
Working with the State and the complainant's guardian, OCR helped secure the complainant's placement in a community Intermediate Care Facility/Mental Retardation program. (OCR Docket # 05013043)

Minnesota 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 complainant 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 least restrictive setting.

Disposition
As a result of OCR intervention and assistance, the complainant was provided with home and community-based services. (OCR Docket # 05013044)

Minnesota 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 complainant 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 least restrictive setting.

Disposition:
As a result of OCR intervention and assistance, the complainant was provided with home and community-based services. (OCR Docket # 05013045)

Minnesota Department of Human Services
Allegation:
The complaint alleged that the State failed to provide appropriate home and community-based services to enable the complainant, a person with a mental disability, to leave a state institution and live in the community. The complainant 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 complainant's provisional discharge from the institution and placement in community-based apartment operated by the State. (OCR Docket # 05013090)

MISSOURI

Missouri Department of Social Services Division on Aging/Missouri Department of Mental Health
Allegation:
This complaint was filed on behalf of a 40-year-old woman with quadriplegia and mild brain damage. The complainant alleged that she was in danger of unnecessary institutionalization because of the failure of the State to provide her with adequate in-home care. The complainant and her mother alleged that she had been without in-home care for many months. The complainant's mother stated that nursing home placement for the complainant had been attempted, but that nursing homes could not adequately meet the complainant's care needs because of her special and complicated condition.

Disposition:
As a result of OCR intervention and assistance, the State developed a service plan that authorizes personal services for the complainant 24-hours a day, seven days a week. The plan assures that the complainant has maximum control over these services by giving her authority to hire, manage and fire her own attendants. (OCR Docket # 07993011 and 07993012)

Missouri Department of Social Services Division of Medical Services
Allegation:
The complainant, a 44-year-old woman with paraplegia and multiple health problems, alleged that the State Medicaid program does not pay for diapers to persons unless they are institutionalized. The complainant stated she needed help in paying for this item in order to remain independent and in her own home. The complainant's annual cost of adult diapers was more than 20% of the complainant's annual income.

Disposition:
With the complainant and other stakeholders, OCR explored options to provide diapers for the complainant. An independent agency agreed to provide the complaint with diapers free of charge. (OCR Docket # 07003069)

Missouri Department of Mental Health
Allegation:
A complainant with a mental disability alleged that he was in danger of unnecessary institutionalization unless a supported living placement could be arranged for him. The complainant stated that the State had suggested a group home placement, but this would not be the least restrictive setting.

Disposition:
Working with the State and other stakeholders, OCR helped facilitate the complainant's placement into a shared, private apartment , with access to appropriate support services. (OCR Docket # 07013202)

NEBRASKA

Nebraska Department of Health and Human
Allegation:
This complaint, a person with a disability living in an institution, alleged 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 assure that the complainant received vocational training. (OCR Docket # 07003168)

NEW JERSEY

Psychiatric Hospital, Hammonton, New Jersey
Allegation:
This complaint was filed on behalf of a 45-year-old man diagnosed with pervasive developmental disorder, autistic disorder, bipolar disorder, Tourette=s Disorder and mild mental retardation. The complainant alleged that he is being prevented from moving into the community in violation of the ADA and the Olmstead decision. The complainant had lived with his elderly parents who cared for him for 44 years. When his aged parents were no longer capable to taking care of him, the complainant was admitted to an institution and was placed on a Developmental Disabilities (DD) emergency list for residential placement. Some months later, an independent evaluation was conducted for the complainant and it was again recommended that complainant 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 the complainant became eligible for DD services. The IHP stated that complainant wanted to live in the community with 3 or 5 other individuals, find a job and maintain contact with his family.

Disposition:
With OCR intervention and assistance, the long delay in residential placement was resolved and the complainant moved into a group home where he receives day program services appropriate for persons with autism and developmental disabilities. (OCR Docket # 02023002)

NEW MEXICO

New Mexico 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. The complainant has limited mobility, uses a wheelchair, and requires daily assistance with all major life activities. The complainant was put on the State's Central Registry for a Developmental Disabilities (DD) waiver, which would enable the complainant to live in the community. However because of a substantial time lag with no movement on community placement under the DD waiver, a complaint was filed alleging that the State was violating the complainant'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 complainant's advocate, OCR helped secure a crisis developmental disability waiver placement. The waiver covered all necessary services and the complainant is living on her own in the community. (OCR Docket # 06003215)

New Mexico Human Services Department
Allegation:
The complainant 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:
OCR determined that complainant wished to move to Utah to be with his family, but the family home needed accessibility modifications. This prompted a collaborative effort between OCR, the complainant's advocate, the State of Utah and the Navajo Tribal Government to secure the home modifications and a Utah waiver, enabling the complainant to live at home. (OCR Docket # 06013031)

NEW YORK

Nursing Home, Staten Island, New York
Allegation:
This complaint was filed on behalf of a mentally retarded individual with mobility impairments. The complainant was admitted into an institution because of its intensive therapy program to improve neuromuscular skeletal dysfunction. The complainant alleged that he was not receiving physical therapy, and was being treated like a psychiatric patient. The complainant wanted to move into a living situation that was more attuned to his disability and service requirements.

Disposition:
With OCR's intervention and assistance, the complainant was moved to a less structured Intermediate Care Facility (ICF) that is in the most integrated setting appropriate to his needs. OCR visited the facility and found that the complainant had adjusted very well to his new surroundings and the facility appeared to be doing a good job meeting his needs for supports and services. OCR was informed by the Project Director during the tour that the complainant had learned the daily routine; has fit in well with the other consumers; received new clothes; received a refitted wheelchair and was participating in a day treatment program at the United Cerebral Palsy Center where he was doing well. (OCR Docket # 02003158)

New York State Department of Health
Allegation:
This complaint was filed on behalf of a 29-year-old man with quadraplegia who has a spinal cord injury. The complainant was residing in an institution and wanted to live in the community in his own apartment. Although the institution believed that a discharge to the community with appropriate supports would be safe for the complainant, allegedly no progress was being made in accomplishing this objective.

Disposition:
With OCR intervention and assistance, the complainant secured appropriate housing in the community and moved into his own apartment with appropriate aide services. (OCR Docket # 02003241)

New York State Department of Health
Allegation:
This complaint was filed on behalf of an individual who has multiple sclerosis. The complainant had received home health services from the provider for several years. She was hospitalized for surgery and released to an institution a few months later. Although the complainant wished to return to her apartment, she was told by the provider that her case with them had been closed. If it were reopened, the provider would provide her with 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 complainant to live in the community.

Disposition:
With OCR's intervention and assistance, the complainant was moved to a wheelchair accessible apartment where she receives 24-hour attendant services through the Consumer Directed Personal Assistance Program. (OCR Docket # 02013022)

Residential Health Care Facility, Rochester, New York
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 complainant lost his apartment and was involuntarily transferred to an institution. The complainant 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 complainant alleged that he was verbally denied home health care services because he was not able to provide appropriate back-up for these services.

Disposition:
With OCR's intervention, the complainant was accepted into a Consumer Directed Program which allowed him to coordinate and employ his own personal care assistance aides. OCR assisted the complainant in securing an aide and the complainant was discharged from the institution and is now living in his own apartment in the community. (OCR Docket # 02013023)

New York State Department of Health/ Monroe County, N.Y. Department of Social Services
Allegation:
The complainant has multiple sclerosis and 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 the complainant with home care closed her case. Efforts to secure home health services from other sources were unsuccessful and the complainant was allegedly placed in an institution against her will.

Disposition:
Working with the Consumer Directed Personal Assistance program and the State, OCR was able to put in place an arrangement which permitted the complainant to move back into her home and receive an increase to 16 hours per day of attendant services. (OCR Docket # 02013037)

New York 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 this low pay rate puts her 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. (OCR Docket # 02013038)

New York State Department of Health
Allegation:
This complaint was filed on behalf of a 56-year-old woman who has cerebral palsy. The complainant had lived in group homes and a private home where she received home care services. The complainant was hospitalized for treatment of a hiatal hernia and acid reflux disease. When her condition stabilized, the complainant alleged that she was transferred to an institution against her wishes.

Disposition:
With OCR's intervention and assistance, the complainant was able to move into her own apartment and receive community-based services through the Consumer Directed Program. OCR also assisted in her enrollment into a home and community-based service waiver which provided her with residential habilitation, day habilitation and individual supportive services to help her with reintegration into the community. (OCR Docket # 02013054)

New York State Department of Health/Home Health Care Agency, Patchogue, New York
Allegation:
This complaint was filed on behalf of an individual who required a wheelchair for ambulation. The complainant was authorized to received Medicaid home care services for assistance. The complainant 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 complainant 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 complainant's care plan. With services in place, the complainant moved from the institution to her own home. (OCR Docket # 02013061)

New York State Department of Health/Hospital, Rochester, New York
Allegation:
This complaint was filed on behalf of an individual with 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 complainant suffered some complications and was admitted to an acute care facility. After her convalescence, the complainant was unable to return to the community because of the loss of her traditional home health care services. The complainant alleged that the State is violating the ADA by forcing her to remain in an acute care hospital setting and refusing to reinstate her home health services.

Disposition:
With OCR's intervention and assistance, the complainant's home health services were restored. She was discharged from the hospital and moved into her own apartment. OCR also assisted in the complainant's acceptance 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. (OCR Docket # 02013075)

New York State Department of Health/Nursing Home, Binghamton, New York
Allegation:
This complaint was filed on behalf of a woman with mobility impairments who uses a wheelchair. The complainant 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 complainant was prevented from returning to the community because she was not able to secure required attendant care. The complainant 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 service in the most integrated setting.

Disposition:
With OCR's assistance, the complainant was able to secure the necessary attendant care support (20 hours per week) under the Consumer Directed Program. OCR also helped ensure that the complainant received residential habilitation services under a Medicaid waiver. The complainant is now living in her own accessible apartment in the community. (OCR Docket # 02013077)

New York State Department of Health/Suffolk County, N.Y. Department of Social Services
Allegation:
This complaint was filed on behalf of a person with muscular dystrophy. The complainant alleged that he has not been receiving home health services authorized by his care plan. The complainant 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 complainant's home health care plan and obtained an increase to 5 hours per day of home health care services. This increase allowed the complainant to remain independent. (OCR Docket # 02013101)

New York State Department of Health/Home Health Care Agency, Hauppauge, New York
Allegation:
This complaint was filed on behalf of a person who has had a stroke, an aneurysm and back surgery. She uses a cane for assistance in walking. Although the complainant 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 complainant believed that she was in danger of unnecessary institutionalization.

Disposition:
With OCR's intervention and assistance, the problems associated with the complainant's home health assistance were resolved. The complainant is now receiving all the Medicaid home care services authorized in her care plan, permitting her to remain in the community. (OCR Docket # 02013105)

New York State Department of Health/Home Health Care Agency, Watertown, New York
Allegation:
This complaint was filed on behalf of a 14-year-old female who has physical and developmental disabilities. The complainant is authorized 24-hour nursing care services due to her condition. The agency providing services allegedly prohibited the complainant's nurses from accompanying her anywhere outside of her home except to school. The complainant 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. (OCR Docket # 02013116)

Finger Lakes Developmental Disabilities Service Office, Rochester, New York
Allegation:
This complaint was filed on behalf of a person with a disability who was in danger of losing a promised apartment that would allow him to live in the most integrated setting. Allegedly, the complainant had been unable to move into the apartment because the State required a "back fill" replacement for the complainant and a "back fill" had not been found to replace complainant in his supportive living arrangement.

Disposition:
With OCR's intervention and assistance, the outstanding back fill problem was resolved. The complainant is currently living in his own apartment and receiving services through the home and community-based waiver program. (OCR Docket # 02013157)

New York State Department of Health
Allegation:
This complaint was filed on behalf of an individual diagnosed with a visual impairment and renal failure secondary to diabetes, a seizure disorder, and mild to moderate mental retardation. The complainant alleged that she is required to remain in an acute care hospital against her will. Complainant stated that prior to her hospitalization, she lived in an apartment and received home health aide services as well as residential habilitation and day habilitation under the State waiver program. Complainant 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 complainant to her own home. The complainant is also receiving adequate supportive services to maintain her in the community in her own home. (OCR Docket # 02013190)

New York State Department of Health/ Home Health Care Agency, Kings Park, New York
Allegation:
This complaint was filed on behalf of a woman who has arthritis and requires assistance with ambulation. The complainant alleged that the State reduced the number of hours of home health care assistance from 22 hours a week to 152 hours resulting in less time to assist in household chores. Additionally, the complainant alleged that the State is refusing to allow a home health aide to accompany her to medical appointments. The complainant believed that without adequate Medicaid home care services she was at risk of being unnecessarily institutionalized.

Disposition:
With OCR's intervention and assistance, the complainant was accepted into a new State personal aide program and is now receiving adequate personal care services. (OCR Docket # 02013197)

New York 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 complainant remained institutionalized. The complainant 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 complainant was placed into a permanent transition home consisting of habilitation services, social worker services, registered nurse habilitation specialist services, psychiatric services and other services. (OCR Docket # 02023050)

New York State Department of Health/Westchester County N.Y. Department of Social Services/New York 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 the complainant's institutionalization, she lived with her elderly mother in a private home. The complainant 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 complainant to live in the community. (OCR Docket # 02023093)

New York State Department of Health/Nursing Home, New Hartford, New York
Allegation:
This complaint was filed on behalf of an individual with multiple sclerosis who lived in an institution. The complainant believed that with proper supports she is fully capable of living in the community. The complainant 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 complainant moved into her own apartment and is receiving adequate supportive services. (OCR Docket # 02023100)

New York State Department of Health
Allegation:
This complaint was filed on behalf of a 50-year-old woman who has multiple sclerosis. The complainant was hospitalized due to a burn and was subsequently transferred to an institution. Prior to her institutionalization, the complainant had lived in her own home with her two children. The complainant wants to return to the community.

Disposition:
As a result of OCR's intervention, the complainant was discharged from the institution. OCR also helped secure a private apartment for the complainant and 18 hours per day of personal care services provided through the Consumer Directed Personal Assistance Program. (OCR Docket # 02023118)

OKLAHOMA

Oklahoma Department of Human Services (ODHS)
Allegation:
The complainant 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 has quadriplegia and uses a wheelchair. The complainant alleged that ODHS allowed contractors to endanger his well being by providing no back-up services for providers who fail to show for work and by failing to provide enough hours to let him live independently (a minimum of 42 hours a week). The complainant lived on his own in an apartment on his mother's property. His mother provided additional care in the evening. However, his dependency on his mother strained their relationship, and the complainant paid for his own aides for about 15 months. The complainant's aide could not be certified to provide the service through a Medicaid home health agency due to felony convictions. The complainant had his services terminated by several home health agencies due to his reportedly uncooperative and inappropriate behaviors.

Disposition:
OCR and ODHS worked together to resolve the complainant's individual issues. He now lives in his own Section 8 apartment and is receiving 42 hours (AM and PM) of home visits 7 days a week to provide personal care and homemaking chores; skilled nursing visits; medication; and medical supplies and equipment. (OCR Docket # 06993068)

Oklahoma 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 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 which was alleged to be the most integrated setting appropriate to the complainant's needs.

Disposition:
OCR and ODHS worked together to resolve the issues raised by this complainant through an informal resolution process. The complainant now receives 45 hours a week of home health services to provide her daily personal care and housekeeping services; skilled nursing visits; medication; medical supplies and equipment; and a mechanical lift. The complainant is able to live in on-campus housing and continue her education. (OCR Docket # 06003161)

Oklahoma Department of Human Services (ODHS)
Allegation:
This complaint was filed on behalf of a 47-year-old man who has quadraplegia and who lives in his own apartment. The complainant alleged that ODHS discriminated by failing to provide continuous services, in the least restrictive and most appropriate integrated environment. Also, the complaint alleged that the State is forcing people with disabilities into nursing homes because they cannot receive the necessary services to live independently.

Disposition:
This complaint was resolved through the informal resolution process. The complainant 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 homemaking chores; 2) total assistance to transfer from bed to wheelchair; 3) skilled nursing visits; and 4) medical supplies and equipment. Additionally, the Veterans Administration provides all medications and wheelchair repairs. (OCR Docket # 06013139)

RHODE ISLAND

Rhode Island 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 and had multiple hospitalizations. He 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. (OCR Docket # 01013012)

Rhode Island 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. (OCR Docket # 01023021)

TEXAS

Texas 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 full home and community-based services when he was found ineligible for Primary Home Care Medicaid Waiver services.

Disposition:
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. Since application for these services had not been received, the State, at the behest of OCR, is working closely with the complainant to ensure that the child receives all services for which he is eligible. The child continues to live in the community. (OCR Docket # 06003082)

Texas Department Mental Health and Mental Retardation
Allegation:
This complaint was filed on behalf of a person with a mobility impairment and mild mental retardation. The complainant alleged that he was in danger of unnecessary institutionalization due to recommendations from his health care provider that he immediately be moved to a nursing home.

Disposition:
As a result of OCR intervention and assistance, institutionalization was averted. OCR also ensured that the complainant received adequate community-based services and assessment for continued community living. (OCR Docket # 06023022)

Mental Health and Mental Retardation Services of Tarrant County (MHMRTC), Texas
Allegation:
The complainant alleged that the County discriminated against him based on disability by providing him with inadequate care and services. The complainant has a number of psychiatric and physical impairments. He uses a wheelchair in order to be mobile and requires oxygen 24 hours a day, seven days a week. 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 complainant 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:
OCR worked with the County and other parties to resolve the issues of this complaint. OCR initiated a meeting among the service providers, the complainant and the complainant's legal advocate to assess the situation. The meeting led to an agreement among the parties, which resolved all of the issues included in the complaint. (OCR Docket # 06023007)

UTAH

Utah Department of Health and Utah Department of Human Services
Allegation:
This complaint was filed on behalf of an individual with multiple physical impairments and mental retardation. The complainant alleged that although the State had approved him for residential services, he has remained on a waiting list for such services for more than eleven years. The complainant contends that the State informed him 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 of siblings are unable to care for him).

Disposition:
As a result of OCR intervention, the complainant was removed from the waiting list and placed in an apartment with two other persons. This placement has resulted in the complainant's receipt of increased community-based services, specifically residential services which permit him to live independently in the community. (OCR Docket # 08013098 and 08013099)

WASHINGTON

Washington Department of Social and Health Services
Allegation:
This complaint was filed on behalf of a person diagnosed with mental illness and unspecified physical disabilities who lived in a facility for people with mental illness. The complainant alleged that despite her 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 complainant with community placement, and the complainant moved to the community shortly after filing the complaint. (OCR Docket # 10013031)

Washington Department of Social and Health Services
Allegation:
OCR received a complaint filed by a patient at one of the public psychiatric hospitals in the State of Washington. The complainant, a person 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 complainant 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 complainant 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. (OCR Docket # 10013110 )

WEST VIRGINIA

West Virginia Department of Health and Human Resources
Allegation:
This complaint was filed on behalf of an individual with muscular dystrophy who is ventilator dependent and requires 24-hour nursing services. These services, which the complainant has been receiving for several years, allowed him to live in his own apartment. The complainant alleged that these services were scheduled to be discontinued in the near future. He alleged 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 complainant requires through the State's Developmental Disabilities waiver. (OCR Docket # 03023093)

WISCONSIN

Wisconsin Department of Health & Family Services
Allegation:
The complainant alleged that the State failed to provide a person with cerebral palsy with an opportunity to live in the most integrated setting appropriate to his needs. The complainant had been living at home with his parents but was not receiving Medicaid waiver services due to 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 intervention and assistance, the complainant was approved for Community Integration Program services. Among the services provided to the complainant via this Medicaid waiver program are workshops, day programming and respite care. Transportation was also authorized but was on hold until the provider had an opening. (OCR Docket # 05003215)

Wisconsin 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 complainant alleged that the State failed to provide him 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 5 years and was told that his name would not come up to the top of the list for 1 or 2 more years.

Disposition:
With OCR intervention and assistance, the complainant moved from the nursing home to an apartment. The move was facilitated by COP (Community Option Program) Waiver Funding for Nursing Home Relocations for one year. The County will receive funding annually in its COP-Waiver allocation to continue the placement. (OCR Docket # 05003216)

Wisconsin Department of Health & Family Services
Allegation:
The complaint alleged that the State failed to provide the complainant, 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 complainant's move from the nursing home to an adult family group home. Funding for the relocation became available when the complainant, with OCR assistance, was placed in the County's family care management program. (OCR Docket # 05003293)

Wisconsin Department of Health & Family Services/Sheboygan County, Wisconsin Department of Human Services
Allegation:
The 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 5 years. As a result, the complainant alleged he was at risk of unnecessary institutionalization.

Disposition:
Working with the State, OCR helped secure 7 hours per month of Supported Employment job coaching for the complainant; 3 hours of support per week for housekeeping, shopping, and other tasks the complainant cannot perform on his own; and 2 hours of support 2 days per week to help the complainant develop additional self-help skills. In addition, the State bore the cost for the complainant's specialized transportation service. (OCR Docket # 05023004)

Wisconsin Department of Health & Family Services/Milwaukee County, Wisconsin Department of Human Services
Allegation:
The complainant, a person 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 and by placing her on a waiting list, thus failing to place her in the most integrated setting appropriate to her needs.

Disposition:
OCR worked with the State for nearly a year to provide a placement in a group home or an apartment with community services. However, the complainant chose to move out of state to live with her extended family. The State assisted the complainant with moving expenses. (OCR Docket # 05023024)

Wisconsin Department of Health & Family Services/Dunn County, Wisconsin Department of Human Services Allegation:
The complaint alleged that the State failed to find an appropriate community placement for a person with neurological and physical disorders , therefore, the complainant had no choice other than to reside in a nursing home.

Disposition:
As a result of OCR intervention, the complainant 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 COP (Community Option Program)Waiver Funding for Nursing Home Relocations. (OCR Docket # 05013127)

Wisconsin Department of Health and Family Services/Dane County, Wisconsin Department of 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. As a consequence, a complaint was filed alleging that the State had failed to provide the necessary resources to permit her to live in the least restrictive setting.

Disposition:
Working with the State and other stakeholders, OCR helped secure Community Options Program (COP) funds which allowed the complainant to remain in the community.(OCR Docket # 05013233)

Wisconsin Department of Health & Family Services/Dunn County, Wisconsin Department of Human Services
Allegation:
The 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:
OCR worked with the State for a year to secure the State provided-services sought by the complainant. The State purchased a lift chair and installed a hand railing on the stairs of the complainant's mobile home. In addition, the complainant is currently participating in the Senior Citizen Center's Meals on Wheels program. (OCR Docket # 05013249)

Wisconsin Department of Health & Family Services/Milwaukee County, Wisconsin
Allegation:
Seven complaints were filed with OCR by the Wisconsin Coalition for Advocacy (the State Protection and Advocacy agency) alleging that the State discriminated against the complainants on the basis of disability by failing to place them in the most integrated setting appropriate to their needs. All complainants 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:
OCR worked with the State to resolve these complaints. Due to financial and programmatic concerns, the State took over receivership of the facility and adopted a plan to move 90% of the residents to community settings and close the facility. All seven complainants moved into the community. (OCR Docket #s 05023025, 26, 27, 31, 40, 41, and 56

Wisconsin Department of Health & Family Services/Grant County, Wisconsin Department of Human Services/Iowa County, Wisconsin Unified Board
Allegation:
The complainant, a woman with cerebral palsy, alleged that the State failed to provided a community placement that would enable her to leave a nursing home and live in the community.

Disposition:
Working with the State, OCR helped secure community placement for the complainant. (OCR Docket # 05023036)

Wisconsin Department of Health and Family Services/Sauk County, Wisconsin Department of Human Services
Allegation:
The complaint alleged that the State failed to provide assistance to enable a man with a neurological and cognitive impairments to remain at home, thus putting him at risk of unnecessary institutionalization.

Disposition:
As a result of OCR intervention and assistance, the State conducted a comprehensive review to determine appropriate services for the complainant. The State assigned a new case manager to ensure that the programs for which the complainant was eligible were made available. In addition, an independent team of stakeholders was put in place to assist the case manager in overseeing service delivery. (OCR Docket # 05013073)

Note 1: "In Olmstead v. L.C., 527 U.S. 581 (1999), the Supreme Court held that the unnecessary institutionalization of qualified individuals with disabilities in institutions is a form of discrimination prohibited by the ADA. The Court held that states are required to provide community-based services for people with disabilities who would otherwise be entitled to institutional services when: (a) treatment professionals reasonably determine that such placement is appropriate; (b) the affected person does not oppose such treatment; and (c) the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others who are receiving state-supported disability services."

Last revised: May 14, 2003

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