State’s ‘Olmstead Plan’ looks to overhaul disability services

Part I: Plan calls for ‘total reorientation for most services’  

Editor’s note: Part II of this story, examining the challenges of implementing Minnesota’s Olmstead Plan, will appear next week.

It’s been 14 years since the U.S. Supreme Court issued its ruling in the matter of Olmstead v. L.C. In that landmark case, named for Georgia Human Services Commissioner Tommy Olmstead, the high court found that states cannot continue to house disabled citizens in isolated, state-run institutions if those people are capable of thriving in a more independent setting.

The case was heralded as a major civil rights decision in favor of disabled persons. But progress on the part of U.S. states has been slow in coming, and Minnesota is no exception. Only a 2009 lawsuit against the state Department of Human Services spurred action on the issue of providing more options to individuals receiving services.

As part of the resolution of that case, Gov. Mark Dayton issued an executive order in January 2013 creating a subcabinet to craft Minnesota’s own “Olmstead Plan.” That group, chaired by Lt. Gov. Yvonne Prettner Solon, filed its plan with the U.S. District Court of Minnesota last week.

Advocates are broadly supportive of the plan, which they see as an ambitious, if somewhat vague, blueprint for overhauling the way the state handles its disabled residents.  But enacting Minnesota’s own Olmstead Plan will ultimately take years of fine-tuning to solve longstanding problems relating to the lack of housing and employment options, to name just two of the larger issues addressed in the report.

Even with progress being made in the abstract, the real issues that inspired the creation of the plan continue. An October court filing in the original lawsuit against DHS found that troubling practices — including the isolation of patients and the use of physical restraints — has continued at some public facilities that house the disabled.

Roberta Opheim, the State Ombudsman for Mental Health and Developmental Disabilities, said the news of continued mistreatment of patients should help spur the state toward faster and more comprehensive reforms. Opheim wishes the state had designed its own Olmstead Plan a decade ago and has grown tired of pleas for patience while reform takes shape.

“I’ve heard that too frequently,” said Opheim, who served as an ex officio member of the subcabinet. “So my job is kind of to keep pushing.”

A new paradigm

Thanks partly to state efforts at moving people out of institutional facilities, the majority of long-term care is now provided in home-based settings. A recent DHS report found that $3.6 billion was spent on long-term services and supports for people with disabilities and older adults during fiscal year 2012. Of that total, $945 million — or about one-quarter of the total expense – was dedicated to long-term care facilities, with the majority aimed at home and community-based settings.

Despite the deliberate movement away from institutionalizing the disabled, the state still provides services for many disabled residents at larger facilities like the Minnesota Security Hospital in St. Peter. That facility provides housing for about 380 people, many of whom have been civilly committed for mental illness. Hospital care allows for around-the-clock monitoring and services, but comes at a relatively high cost compared to letting individuals live on their own and receive only the services they need.

Prettner Solon hopes the state might ultimately find savings by moving more disabled people into independent living situations, arguing that many of the 2,000 Minnesotans now in larger, DHS-run hospital settings could determine that they need a lesser level of care than the state currently provides.

The broad goal of the state’s Olmstead Plan is to give the state’s disabled population more control over where they live, what they do and how they access state services. To that end, the proposal would give disabled people more say over housing placement and employment opportunities. Rather than consigning them to certain facilities and assuming they are incapable of working, the plan calls for the state to approach the subject by asking for input from disabled persons as well as their guardians or service providers.

“It starts with the individual, which is a total reorientation for most services,” Prettner Solon said.

Prettner Solon oversaw the discussion and drafting process, which incorporated input from commissioners or deputy commissioners from eight different state agencies, including the Department of Human Services (DHS), the Department of Employment and Economic Development (DEED) and the Minnesota Housing Finance Authority (MHFA). Within those agencies, smaller teams were tasked with addressing how the agencies could alleviate shortcomings in state treatment practices.

“It took a lot of talking and a lot of negotiating, and helping each other,” Prettner Solon said. “But I think it was really eye-opening because we did have eight different agencies talking to each other in that way.”

The relevant agencies are already beginning to reevaluate their internal budgeting and administrative approaches to conform to the plan. Ultimately, full implementation of the program over the coming years is expected to involve numerous legislative changes, including updates to state law and adjustments to how services are funded. Sen. Kathy Sheran, DFL-Mankato, chair of the Senate Health, Human Services and Housing Committee, admits that the plan’s goals are ambitious, but said she is encouraged to see so many facets of the state government working in concert.

“What’s interesting about this is the opportunity,” Sheran said. “They create more opportunity… with multiple funding sources, and everybody takes a funding role.”

Feedback stresses jobs, housing

When draft proposals of the Olmstead Plan were made public, an overwhelming amount of the public comments received in writing and at open listening sessions centered on better employment options and increased affordable housing. Both issues pose daunting problems for the state. A 2010 study found that 56 percent of Minnesota’s working-age disability population was unemployed, while many of those who did have jobs worked in sub-minimum wage programs that isolated disabled employees from others.

Under the plan, the state is charged with designing and adopting an “Employment First” policy by September 1, 2014; that plan is to be driven by the presumption that people with disabilities want to find competitive job opportunities with real wages.

The proposal similarly calls for a “Housing First” model that attempts to place people receiving services in housing that is agreeable to them, rather than routing them to whichever location is most convenient for the government entity in charge of providing services. The end goal is to allow disabled people to live as independently as possible, with options that include rental leases or home ownership, while still allowing for the providing of necessary services.

“[The disabled resident] is the person in charge of employment and housing decisions,” said Steve Larson, policy director at Arc of Minnesota. “That’s a fairly significant change in Minnesota.”

The employment strategy calls for continued inter-agency collaboration between the DHS, DEED, and the Department of Education, which would be tasked with helping the state’s disabled students with employment preparation before high school graduation. Addressing the housing situation, meanwhile, means ongoing work between DHS and MHFA, which must seek solutions to a chronic shortage in affordable housing in Minnesota.

Tackling these changes is no simple task, and the subcabinet has given itself an extended period to collect details and design remedies. As one example, the Olmstead Plan sets a January 30, 2015 deadline for the establishment of a timeframe “for completing individual assessments and facilitating moves into more integrated settings.” Prettner Solon said problems this complex do not have easy solutions.

“There’s no way that we can accomplish this much change instantly,” she said. “What we had to do was to prioritize and to set goals that we expect to meet.”

For her part, Opheim expressed some frustration with the delay in the implementation timeline. She said she senses a real commitment from the Department of Human Services to

enact changes in treatment of disabled people, but she said the many moving parts needed to improve state services make it difficult to establish momentum for reform.

“So,” she said, “we keep doing what we’ve always done, and there’s a lot of political and market forces to keep the status quo in place. That’s why it took a court case.”