
The Olmstead Decision at 27: Why Community-Based Care Still Matters for People With I/DD
This June marks 27 years since the United States Supreme Court handed down its decision in Olmstead v. L.C. — one of the most consequential disability rights rulings in American history.
If you're a family member of someone with an intellectual or developmental disability, or a person with I/DD yourself, you may not have heard the name Olmstead. But you have very likely lived inside the world it created. Every time someone with I/DD lives in their own apartment instead of an institution, attends a community-based day program instead of a sheltered workshop, joins a public school class instead of being segregated, or gets to choose where, how, and with whom they live — Olmstead is part of the reason that's possible.
As we approach the anniversary of this landmark ruling, we want to take a moment to share what Olmstead is, what it has changed, what it has not yet changed, and why it remains the legal and moral foundation of community-based services like the ones we provide at North Star Oregon.
A Brief History: Two Women in Georgia
The story of Olmstead begins not with policy but with two women — Lois Curtis and Elaine Wilson — who were living at Georgia Regional Hospital, a state-run psychiatric institution, in the mid-1990s.
Both women had intellectual disabilities and mental health diagnoses. Both had been institutionalized for years. And both had been told by their treatment teams that they no longer needed to be in the hospital — that they could live successfully in the community with appropriate supports.
But the community supports they needed weren't available, or weren't being offered. So they remained in the hospital, year after year, even though everyone agreed they didn't need to be there.
With the help of the Atlanta Legal Aid Society, they sued the state of Georgia, arguing that the unjustified institutionalization of people who could live in the community violated Title II of the Americans with Disabilities Act (ADA). Their case made its way to the U.S. Supreme Court.
In June 1999, the Court ruled in their favor.
What the Court Actually Said
The Olmstead decision is technically narrow but philosophically vast. In a 6-3 ruling, the Court held that under the ADA, states are required to provide community-based services to people with disabilities when:
- Such services are appropriate.
- The individuals affected do not oppose community-based treatment.
- The placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others receiving disability services.
In plain language: if a person with a disability can live and receive services in the community rather than in an institution, and they want to, the state must make that possible — except in narrow circumstances. Unjustified segregation, the Court ruled, is itself a form of discrimination prohibited by the ADA.
That last sentence is the heart of it. Unjustified segregation is a form of discrimination.
For decades before Olmstead, the default response to disability — particularly intellectual and developmental disability — was to separate people from the rest of society. Large state institutions warehoused tens of thousands of people with I/DD across the country. Children were taken from their families and placed in these settings, sometimes for life, often based on doctors' recommendations to parents that they should "let go" and "move on."
Olmstead didn't end that history overnight. But it did establish, in the highest court in the country, that the practice was wrong — and that doing the opposite (supporting people in their communities) wasn't just kind or progressive but legally required.
What Olmstead Has Changed
In the 27 years since the decision, the landscape of disability services has shifted dramatically.
Institutional populations have continued to decline. In 1967, there were nearly 200,000 people with I/DD living in state institutions in the United States. Today, that number is under 16,000 nationally and continues to drop. Oregon closed its last state institution for people with I/DD, Fairview Training Center, in 2000 — the year after Olmstead. The state has not built another one. People who previously would have lived in institutions now live in their own homes, with family, in foster care, or in small group homes — supported by community-based services.
Community-based service systems have grown. Medicaid Home and Community-Based Services (HCBS) waivers — like the ones Oregon uses to fund North Star's services — were expanded and strengthened in the years following Olmstead. The 1915(c) waivers and Oregon's K Plan are direct descendants of the Olmstead mandate. Without them, the kind of in-home attendant care and community-based DSA programs we provide simply wouldn't exist at this scale.
Person-centered planning has become the standard. The Individual Support Plan (ISP) process — where a person's preferences, goals, and choices drive the services they receive — owes its prominence to Olmstead's emphasis on integration and individual choice.
Sub-minimum wage and sheltered workshops have come under scrutiny. Oregon, in particular, has been a national leader in transitioning away from segregated employment settings toward integrated, community-based work. The state's Employment First initiative, formalized through executive orders and legal settlements in the 2010s, was driven in significant part by Olmstead obligations.
Day services have moved into the community. The North Star Oregon DSA model — community outings, volunteering, real workplaces, public libraries, museums, parks, neighborhoods — is itself an Olmstead-era model. Day services that take place primarily in segregated buildings, with the same group of people every day, doing activities that wouldn't be available to non-disabled adults in the same age range, are increasingly being phased out as inconsistent with the integration mandate.
What Olmstead Has Not Yet Changed
It would be inaccurate to say Olmstead has fully delivered on its promise. Twenty-seven years on, gaps remain.
Waiting lists for community-based services remain long. In many states, including Oregon at times, the demand for HCBS waivers has exceeded the supply. Oregon does not currently maintain a waiting list for I/DD waiver services, which is something the state should be commended for. But the workforce shortage in direct support — caused largely by stagnant wages — has created a different kind of access problem: services are authorized but providers can't be found to deliver them.
People in nursing homes are still under-served by Olmstead. A significant share of the Olmstead litigation in recent years has focused on people with disabilities living in nursing facilities who could be supported in the community but aren't, because the state's system is structured around institutional rather than community placements.
People with the most complex needs sometimes still struggle. The integration mandate is for everyone, but the rhetoric of community-based services can sometimes leave behind people whose support needs are intensive, especially when funding doesn't keep pace with the cost of high-quality community supports for those individuals.
Segregation can take subtler forms. A person can technically live "in the community" while still being functionally segregated — going from a group home to a sheltered workshop and back, with little real participation in community life. Olmstead requires not just physical placement in the community but meaningful integration. Living in a community is not the same as being part of one.
The work is not done.
Why Olmstead Matters at North Star Oregon
We think about Olmstead often, even when we're not naming it.
When a parent-caregiver chooses to be hired as a W-2 employee to care for their own adult son in a shared-home setting — that's Olmstead. The person isn't being moved into an institution; they're being supported at home with their family.
When a young woman in our Eugene DSA program decides she wants to spend her Tuesdays volunteering at the humane society and her Thursdays taking a community college painting class — that's Olmstead. Her day looks like the day of any other young adult in Eugene with similar interests, not a clinical setting.
When a man in our Salem program rides the bus to work, eats lunch at a downtown café where the staff know his name, and goes home to an apartment he shares with a friend — that's Olmstead. He is not in an institution. He is a member of a community.
When we reject the term "clients" in favor of "the individuals we support," that's a small linguistic choice rooted in a much larger philosophical one: the people we work with are people first, with their own preferences, dreams, and rights, not subjects of a service.
What This Means for Families
If you are a parent, sibling, spouse, or family member of someone with I/DD, the Olmstead decision gives you legal grounding for some of the things you instinctively want for the person you love:
- They have a right to live in the most integrated setting appropriate to their needs.
- They have a right to participate in planning their own services and lives.
- They have a right to refuse institutional placement when community-based services would meet their needs.
- They have a right to providers who treat them as members of the community, not as patients to be managed.
If you ever feel like you are being pushed toward a more segregated, more institutional, more restrictive setting than your loved one needs — you have legal and moral standing to push back. Olmstead is part of the bedrock you can stand on.
If a service system is not working for your family, you can advocate for change. You can contact your CDDP services coordinator. You can reach out to advocacy organizations like Disability Rights Oregon, which is Oregon's federally designated Protection and Advocacy agency. You can talk to your state legislator. You can connect with other families who have walked similar paths.
Looking Forward
A generation ago, the future for many people with I/DD was institutional. That future is no longer the default — and that is largely because of the women and men, like Lois Curtis and Elaine Wilson, who refused to accept it as inevitable, and the courts and legislatures that listened.
The next chapter of disability rights is being written now, by today's self-advocates, today's families, today's direct support professionals, and today's policymakers. The work is incomplete, but the direction is clear: more inclusion, more choice, more community.
At North Star Oregon, we consider it a privilege to be part of that work. The people we support are not "served" by us; they are walking through their own lives with us walking beside them, and we are better for the company.
To learn more about our community-based services — In-Home Attendant Care across Oregon and Day Support Activities in Albany, Corvallis, Eugene, Springfield, Salem, and Tangent — visit northstaroregon.com or reach out to our team. We'd be honored to be a part of your community.

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