The states said,

"Congress must not be permitted to bury invisible land mines in legislation that later explode to the devastation of a state's fisc."

-- amicus brief of eight State Attorneys General in support of Olmstead in Olmstead v. L.C. and E.W.

The Olmstead petition argued that the Americans with Disabilities Act cannot require states to offer disability services in the most integrated setting. Olmstead lost that suit.

Winning it meant, for all but a few of us, that we could be assured of living in freedom with home- and community-based supports. Today 1.9 million law-abiding Americans are imprisoned by states in long-term "care" facilities for the crime of having a disability.


Mouth asks,

Is liberty
a land mine?

Does freedom
really cost


Woman protester with a sign that says
"There's a price on our heads."


This information first appeared in Mouth magazine #53, May 1999.
Photos are by Tom Olin.

The Supreme Court declined to hear the issue of cost in Olmstead v. L.C. and E.W. Even so, Olmstead and his amici continued to argue that home- and community-based services are costlier than services provided in nursing homes and other institutions.

Olmstead lost the case; advocates for home- and community-based services won. Even so, most states put up a mighty resistance to change, offering this same old institutions-are-cheaper argument.

Since taxpayers fund the majority of U.S. long-term care, they have a right to know which is cheaper. Here are the facts.







The American Health Care Association - A H C A - the nursing home lobby group, claims on its website that nursing home beds cost an average of "only $41,000 per year per resident."

Taxpayer dollars support 84 percent of all nursing home residents under Medicare, Medicaid, and other state, federal, and local government programs.
The National Conference of State Legislatures, which curiously enough filed an amicus in favor of Olmstead, reported in its January, 1999, State Legislative Report that "in 1996, institutional care cost an average of $94,348 per person, compared with $14,902 per person for community-based services.... States across the country have realized significant savings by offering services that allow people with disabilities [of all ages] to live in the community rather than in nursing homes or other institutions."
The University of Minnesota's Institute on Community Living publishes State of the States annually. That book compares Medicaid expenditures for people with disabilities who live in state "schools" and state mental institutions to Medicaid expenditures for community services.
Its figures for fiscal year 1998 show an average of $98,550 per person per year in institutions, $26,729 in the community. The figures vary from one study to the next because they measure expenditures in different institutions under varying accounting methods.

Medicaid is the primary source of income for nursing homes and for institutions housing people with the label of retardation. In the case of state services to people with mental illness labels, however, federal Medicaid reimbursement is available only for community services.
Georgia, where Tommy Olmstead [was] Commissioner of Human Resources, was eligible to receive federal reimbursement for nearly two-thirds of the cost of treating people labeled as retarded whether in institutions or community-based settings. That state was also eligible to receive nearly two-thirds the cost of providing services for people with psychiatric labels -- but only if those services were provided in community-based settings. Olmstead, however, prefers to continue his state's long tradition of institutionalizing both groups.

The U.S. Department of Justice amicus in support of L.C. and E. W. said this: "Virtually all of the relevant literature documents that segregating handicapped people in large, impersonal institutions is the most expensive means of care."
A woman who had been forced to live in a nursing home testified as follows at a 1995 Texas hearing on disability services:
"Medicaid pays for this cruelty. It's your taxpayer dollar at work. America should know what it's getting for that money."

"The sky is falling!" That's what L.C.'s and E.W.'s attorneys called Olmstead's contention that the ADA imposes a massive fiscal and administrative burden on states.
In their brief for the Court, they said, "... a handful of states, including Georgia, have dragged their heels. The reasons for that have nothing to do with the quality of treatment and/or the relative costs of providing it in institutions or the community. Instead, they have everything to do with politics."

On May 21, 1997, Mike (Mo) Oxford and Alene (A.J.) Jensen of TILRC, the Topeka Independent Living Resource Center, received The Health Care Financing Administration's (HCFA's) National Award of Merit for their work to re-invent and expand home health and personal assistance services for the people of Kansas.
The last time we'd seen the two of them near HCFA headquarters, they were among the Adapt activists who surrounded it and shut it down.
To read what Mike SAYS about your taxpayer dollar at work, click here.

Photo of hundreds of disability rights protesters stopping traffic.
One sign says, Home Health Care NOW.

But isn't it safer to keep those people in care facilities?


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Today, some genuine American patriots are at work, changing the system. They call themselves Freedom Clearinghouse, and you can learn more about them right now.