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Senator Calls For Expansion Of Community-Based Services


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A new proposal in the U.S. Senate would eliminate a government bias toward placing people with disabilities in institutional rather than community-based settings.

U.S. Sen. Tom Harkin, D-Iowa, said Tuesday he is introducing a bill that would put an end to what’s known as the “institutional bias.”

Current law requires Medicaid to provide nursing home services to people with disabilities, but does not mandate that home and community-based options be offered. As a result, many states have long waiting lists for individuals wishing to obtain services in the community and a Senate report last year found that over 200,000 working-age Americans remain segregated in nursing homes.

Harkin’s proposal dubbed the Community Integration Act would change things by requiring that states deem all individuals who are considered eligible for institutional care to also be eligible for supports in home and community-based settings. What’s more, the bill would prohibit states from making people ineligible for services in the community based on their particular disability.

The bill introduction comes just days after the 15th anniversary of a landmark U.S. Supreme Court ruling on the issue. In the case known as Olmstead v. L.C., the court found that unnecessarily segregating individuals with disabilities in institutions is a violation of the Americans with Disabilities Act.

“Studies clearly show that home and community-based care is not only what most people want, but it is also more cost-effective,” Harkin said. “The Community Integration Act honors the Olmstead decision and ensures that states take the steps needed to ensure that all individuals with disabilities are given the opportunity to receive their services and supports in a community-based setting, where they can work, participate in community life and be an integral part of their communities.”

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Comments (13 Responses)

  1. Dadvocate says:

    At best, Harkin’s bill appears to be substituting one bias for another. Both usurp consumer choice and rights. Just because “most” want independent living arrangements (and I don’t challenge the notion that most do…and are entitled to them) it doesn’t follow that because the majority does, the many who prefer group settings and solutions should be bullied into moving to potentially isolating or dangerous situations “in the community” that they don’t want. Harkin doesn’t seem to understand that unstructured access to the community means that the community has unstructured access, too. For some of our most vulnerable citizens, or for folks who just don’t want to exercise the choice of independence for whatever reason, Harkin’s initiative is fundamentally unacceptable.

  2. KA101 says:

    Shame that he titled the bill that. I have having to vote for the CIA.


    Looking forward to it actually hitting the hopper and the text going online so we can read it!

  3. kathleen says:

    I am in support of Community based.

  4. Amanda Stufflebeam says:

    This is wonderful, no not really. Most states that provide community based services have huge wait list . Then there is Ohio. If you can work at all or use a microwave for that matter you do not qualify for services at all. When will someone step up and help get funding from the start?

  5. Whitney says:

    Yes, and dying on one of these waiting list is better. In Texas the waiting period is 15 years and person can die before the service is render. I think universal rights to all services should be nationwide not regulated by the sates.

  6. Nancy Mross says:

    Integration into the community is NOT a one size fits all. There are individuals who have been moved from institutions and have died in group homes because the level of care required could not be provided.
    We should also revisit our definition of “institution” For moderate individuals an assisted living type of facility (“institution”) or a group home of 6 individuals (instead of 4 for more impaired) would move the waitlist and encourage “appropriate” placement for all. Whereas those who require more medical supervision should have group homes of 4 or smaller facility (“institution”) with proper support staff. The current 3 Olmstead 1 from the waitlist composition of group home benefits no one. The Olmstead individuals more intense needs
    dictate the focus to overwhelmed staffing who are not trained for this population. The Senator’s concerns
    are Dollars and the current assisted living and 6 resident group homes for those with less intense needs would save Dollars as well without putting our most fragile at risk and totally ignoring the large moderate segment of disabled who will regress in such mixed settings.

  7. Whitney says:

    If the states and the communities did what they are supposed to do then Senator Harkin will not feel the need to step in. Not all states perform equally when it comes to services and sometimes the communities perform even worse. In Texas your lucky to have one choice and if the service is bad well too bad. There is no choice in some of the states now. Like I said all the states by law must follow the national standards for basic services of the most vulnerable communities. In Texas if you are disabled they don’t care. In all honesty the VA system works better at providing services for the disabled.,

  8. marie camp says:

    It sounds like this Senator is on our side, as a advocate for disabilities he is our man. I support his philosphy 100 percent. I hope he can convince all our Senators to do this wonderful, most meaningful proposal.

  9. J.R. Hardman says:

    I am an attorney and professional guardian in Washington State. I specialize in representing people with developmental disabilities.
    Sen. Harkin is ill informed if he believes the federal government has an “institutional bias” favoring intermediate care facilities and/or skilled nursing facilities licensed for treating those with developmental disabilities. In fact, the opposite has been true since at least the 1980s.
    My clients in what Washington terms Residential Habilitation Centers [RHCs] are doing well, getting appropriate treatments, and they under continual threat of eviction from their homes by people who claim to know better what is good for them than their families and guardians. Such people are the biggest threat my clients face. When Fircrest RHC was downsized at the behest of ‘advocates’ five of my clients were evicted and suffered as a result. Two of five did not recover until they were returned to their homes at Fircrest several years later following their lawsuit under the Abuse of Vulnerable Adults Act..
    I have been told by knowledgeable sources that six of sixty one of those “downsized” died as a result, I knew four of them. Their untimely deaths were avoidable. Most of those evicted suffered according to testimony of families and guardians, some grievously.
    The anti facility advocates mean well but their good intentions are paving the way to suffering to many and death to some.

  10. Margaret Titus says:

    I see the potential benefits of this approach but I am also seeing serious flaws. In Georgia, as institutions are defunded and closed, “to save money” vulnerable patients are being placed in unregulated, unsanitary, dangerous “personal care homes” — outside the easy scrutiny of others. We recently closed a regional hospital, killing professional jobs and displacing patients. We simultaneously made it perfectly legal to place loaded weapons in the hands of virtually anyone, anywhere. What happens next? We also recently saw a raid on a filthy, abusive “personal care home” where patients were being robber, and resorted to stealing and dumpster diving to get FOOD. Small government is not NO government. Vulnerable people need protection and eyes everywhere to assure they are not simply abandoned or worse– exploited and abused. I am more than a little worried about the long term dangers inherent this cost cutting strategy.

  11. vmgillen says:

    Note this pertains to “people with disabilities”, not specifically people with developmental disabilities. The bias is seen in cases where, for example, a person with quadriplegia requires physical assistance: medicare is set up to institutionalize these people rather than provide HHC service. I can confidently predict that whether this passes or not things will be screwed up…

  12. Nicole LeBlanc says:

    We need to eliminate the institutional bias in Medicaid and make home-community based waiver services an entitlement ! Community Service options are cheaper and people will have better outcomes ! Its time to STOP fearing people with disabilities.

  13. KA101 says:

    OK, it’s S.2515 should folks want to read the text. I’m thinking it looks pretty reasonable: providing choice/opportunity and the support to go with, not kicking people out.

    Implementation may be an issue, granted, but that works for just about any government program.

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