Olmstead v. L.C. & the US’ Delayed Shift to Community-Based Services for People with Disabilities

By 1999, Lois Curtis and Elaine Wilson had been isolated from the rest of society since their early adolescent years. Both women had been voluntarily admitted to the psychiatric unit of the state-run Georgia Regional Hospital in Atlanta on account of their cognitive and developmental disabilities. However, when doctors eventually decided that the women should transfer to a community-based program that would allow them more independence, the state of Georgia prevented the women from leaving. This prompted the women to file a lawsuit, Olmstead v. L.C. (1999), for release from Georgia Regional. Arguing that Georgia’s preventing the women from entering community-based programs violated Title II of the Americans with Disabilities Act (ADA) and the US Civil Action for Deprivation of Rights code, their case advanced to the Supreme Court. In a landmark decision for people with cognitive and developmental disabilities, the Court ruled that states must place individuals in community programs when treatment professionals have deemed it appropriate, given that the individual does not oppose this course of action and that the state is able to do so.

At the District Court level, Curtis and Wilson were initially granted partial summary judgment, with the Court ordering that they be transferred to community-based programs and rejecting Georgia’s argument that inadequate funding, not discrimination, caused the state to prevent the women from leaving Georgia Regional. Upon appeal, the Eleventh Circuit affirmed this judgment, though it remanded Georgia’s cost-based defense, instructing the District Court to assess how transfering the plaintiffs to community-based care programs would affect Georgia’s mental health budget. Reaching the Supreme Court, the appeals judgment was largely affirmed; the Court highlighted that the Eleventh Circuit decision essentially upheld the ADA. It concluded that states must place an individual with disabilities in community-based programs in accordance with the recommendation of medical professionals, provided that the individual accepts this placement and the placement is not a burden on the state. Though the Court remanded the case to the Eleventh Circuit for further consideration of how Georgia should accommodate the plaintiffs given its resources, the opinion’s broad implications for the services available to people with disabilities would spark debates and reforms for years to come. 

One such debate has focused on the nation-wide movement to meet more individuals’ needs through community-based programs. Despite the Olmstead v. L.C. ruling, there has been a national lag in transitioning to community-based programs for people with disabilities. Beyond psychiatric units, states segregate people with disabilities from the general public through a number of programs, such as sheltered workshops, enclave employment, and facility-based day programs. While these programs serve varying purposes, with some intended to provide work opportunities for people with disabilities and others to keep them occupied with non-work social and educational activities, they are similar in that they isolate people with disabilities from people without disabilities. Sheltered workshops, for example, offer “employment opportunities for individuals who are developmentally, physically, or mentally impaired, to prepare for gainful work in the general economy,” according to the Social Security Administration. The Department of Justice adds that people employed by these workshops have “little or no contact with non-disabled people besides paid staff” and that the wages they receive are “extremely low compared to wages paid to people with disabilities in integrated employment,” in some cases less than one dollar an hour.

In light of Olmstead v. L.C., many disability rights advocates have argued that sheltered workshops should be closed. Some states have phased out workshops altogether or created plans to do so. New York was one such state, but following the governor’s announcement that sheltered workshops would be discontinued, numerous constituent complaints reached the state’s Assembly Minority Conference. Consequently, the Conference convened a series of statewide hearings, at which parents, service providers, and people with developmental disabilities were invited to weigh in on the question of sheltered workshops. Following the hearings, rather than shut down sheltered workshops, New York opted to incorporate individuals without disabilities into the sheltered workshop workforce, keeping workshops operational while complying with the Department of Justice’s interpretation of Olmstead v. L.C. Between 2016 and 2022, New York also reduced the number of workers receiving subminimum wages by nearly 90%; however, there remain some workers who make wages below the federal minimum. 

Across the nation, sheltered workshops have been the subject of similar disagreements, with disability rights advocates pushing for their closing while those directly impacted express dismay over the effects thereof. A 2022 investigation by ProPublica and The Kansas City Beacon explores this dynamic, seeking to understand why people with disabilities and those close to them would resist the shutdown of entities that often pay them poorly and fail to facilitate their transition to the unsheltered workforce, as intended. The investigation details Missouri’s refusal of federal funding for its workshops, which enables it to avoid federal requirements aimed at increasing rates of “graduation”— only 2.3% in Missouri between January 2017 and June 2022 — into the regular workforce. Missouri, the investigation suggests, does not provide people with disabilities with the support they need to envision themselves as employees beyond sheltered workshops. As the authors write, “The state’s failure to help remove the employment barriers has left [people with disabilities] with little choice: They believe that the best option they have is to work at a sheltered workshop.” 

Sheltered workshops are not the only isolating arrangement that persists for people with disabilities. More traditionally, state-run facilities, also called institutions, continue to operate, keeping mental health patients and residents with intellectual and/or developmental disabilities separate from society, not only during the workday but around the clock. Unlike sheltered workshops, these facilities serve populations admitted involuntarily at the order of a medical professional in addition to those admitted voluntarily. Still, following Olmstead v. L.C., institutions began to shutter at a faster rate. Though they had been in decline since the Mental Health Systems Act of 1980 provided federal grants to community mental health centers across the country, much of the act had been repealed under the Reagan administration, allowing Olmstead v. L.C. to serve as a second catalyst for the deinstitutionalization movement. 

Although some states have phased out institutions altogether, others have been slower to reduce their institutionalized populations. According to a study by the University of Minnesota, the capacity of institutions nationwide was reduced by 90% within the 50-year period preceding 2022, with only four states retaining more than 1,000 beds at the time of the study. However, in these four states, the process of deinstitutionalization has dragged on while bringing to light many troubling details of institutional history. In Illinois, for example, following a spate of lawsuits and reporting on patient abuse and employee intimidation, the state has announced plans to “repurpose and restructure” its Choate Mental Health and Development Center. These plans will entail relocating 123 of its voluntarily admitted residents — roughly half of its population — to others of the state’s seven institutions or to community-based programs. Many of the 112 residents in Choate’s “specialty units,” including people who were admitted to the facility at the order of a criminal court judge, will be moved as well, but their destination remains a subject of debate. Still, following the two-to-three-year transitional period, the facility will not shut down entirely; its 49-bed psychiatric hospital will continue to operate and, according to the Illinois Department of Human Services secretary, may expand.

While Illinois may have initiated the process of transferring people from Choate to other arrangements, many Choate residents feel anxious about the potential alternatives. Equip for Equality, an advocacy organization tasked with monitoring Choate, notes that, as with Missouri’s sheltered workshops, a significant number of workers “do not have access to the services they need to achieve their goals, both due to treatment failures at Choate and a shortage of federally required community options.” As such, Equip for Equality’s president and CEO, Zena Naiditch, argues that Illinois’ plan for Choate must go further. Citing Choate’s history of patient abuse, she says that “moving more than half of the individuals at Choate Developmental Center to other settings is an important first step, but Equip for Equality urges Governor Pritzker to take the necessary measures to help all residents leave this facility.” 

In New York, the Midwest, and the broader US, the movement to integrate people with disabilities into communities was bolstered by the Supreme Court’s 1999 Olmstead v. L.C. decision. Plaintiffs Lois Curtis and Elaine Wilson drew attention to the isolation and mistreatment faced by many people with disabilities, forcing service providers to consider the failings of the then-current system. However, while Olmstead v. L.C. has provided the impetus for progress regarding the work and living options available to people with disabilities, many states have found ways to work around improving their care offerings or dragged their feet in doing so. Further, as systems of services have been reconfigured, ugly histories of abuse have been brought into the open, compounding the need for reform. This is to say, the devaluation and dehumanization of people with disabilities — be it in terms of the subminimum wages they earn, their government-funded isolation from people without disabilities, or the treatment they receive from those entrusted with caring for and supporting them — continues into the present day. As states proceed to unveil new plans for community-based services for people with disabilities, it is their responsibility to abide by Olmstead v. L.C. and provide more respectful and inclusive opportunities for all of their residents, regardless of ability.  

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1 Sarah E. Cohen, “How Artist Lois Curtis Won Disability Rights,” Smithsonian Women’s History Museum (2023), https://womenshistory.si.edu/stories/how-artist-lois-curtis-won-disability-rights. 

2 “Olmstead: Community Integration for Everyone,” US Department of Justice Civil Rights Division (n.d.), https://archive.ada.gov/olmstead/olmstead_about.htm.

3 Olmstead v. L.C., 527 U.S. 581 (1999).

4 Americans with Disabilities Act of 1990, 42 U.S.C § 12101 (1990).

5 Civil Action for Deprivation of Rights Act of 1983, 42 U.S.C. § 1983.

6 “Questions and Answers on the Application of the ADA’s Integration Mandate and Olmstead v. L.C. to Employment and Day Services for People with Disabilities,” US Department of Justice Civil Rights Division (2023), https://www.ada.gov/resources/olmstead-employment-qa/.

7 “Program Operations Manual System (POMS): RS 02101.270 Services for Sheltered Workshops,” Social Security Administration (2017), https://secure.ssa.gov/poms.nsf/lnx/0302101270. 

8 “C.A.R.E.S. Plan: Championing Aid, Rights, Equality and Services,” Developmental Disabilities Alliance of Western New York (2017),  https://www.ddawny.org/wp-content/uploads/2017/04/FinalCARESPlan.pdf. 

9 “Meaningful Employment,” New York Developmental Disabilities Planning Council (n.d.), https://cdd.ny.gov/system/files/documents/2023/04/meaningful-employment-final.pdf. 

10 Madison Hopkins. “Missouri Allows Some Disabled Workers to Earn Less than $1 an Hour. The State Says It’s Fine If That Never Changes,” ProPublica (2022), https://www.propublica.org/article/missouri-sheltered-workshops-low-graduation-rate.

11 Mental Health Systems Act of 1980, 42 U.S.C. § 9501 (1980).

12 “Policy Research Brief: Are Large Institutions for People with Intellectual or Developmental Disabilities a Thing of the Past?” University of Minnesota Institute on Community Integration, (2022), https://publications.ici.umn.edu/community-living/prb/29-2/main.

13 Beth Hundsdorfer, “Illinois to Relocate at Least Half of Residents in Facility Plagued by Abuse and Cover-Ups,” ProPublica (2023), https://www.propublica.org/article/illinois-choate-mental-health-patient-relocation. 

14 “Equip for Equality Calls for Immediate End to Placements at Choate Developmental Center and Urges That All Individuals With Developmental Disabilities Be Moved Out,” Equip for Equality (2023), https://www.equipforequality.org/news-item/equip-for-equality-calls-for-immediate-end-to-placements-at-choate-developmental-center-and-urges-that-all-individuals-with-developmental-disabilities-be-moved-out/ .