In a 1999 case called Olmstead v. L.C., the Supreme Court wrote that the unnecessary segregation of people with disabilities is a form of discrimination. The Court said that a person with a disability must be served in the community when:

1. community-based services are appropriate to the person’s needs;
2. the person does not oppose community-based services; and
3. the state or local government entity can reasonably modify its programs and services to provide services in the community.

Community-based Services

Community-based services are funded by federal, state, or local dollars to support people with disabilities living at home or in other community-based settings. A few examples of community- based services are:

• Nursing services (like a nurse who comes to your house to help with ventilator or tracheostomy care)
• Personal care services (like help bathing or getting dressed)
• Mental health services (like counseling or an Assertive Community Treatment team)
• Medication management (like help taking medicine or providing reminders to take medicine at the same time every day)
• Peer mentorship (like help from a person with lived experience of disability who can model and support self-advocacy)
• Caregiver supports (like mentorship, training, and respite)
• Home modifications (like installing a ramp or widening a door)
• Housing services (like help finding, moving to, and remaining in community- based housing).

Community-based Settings

Community-based settings are places where people with disabilities are integrated into their community. These settings:

• make it possible for people with disabilities to interact with people without disabilities as much as possible;
• provide opportunities to live, work, and enjoy hobbies and other activities in the community whenever they want to; and
• make it possible for people with disabilities to choose their own activities and socialize with anyone they want to, as often as they want to.

Examples of community-based settings include a house or an apartment that the person with a disability owns or rents, or a family home, where they can—but are not required to—receive services.

Segregated Settings

Segregated settings are places where people with disabilities live, work, or spend most of their time with other people with disabilities, other than non-disabled paid staff. These settings:

• tend to limit a person’s ability to go out in the community and mainly offer group activities and community outings;
• lack privacy;
• limit when or how often a person can have visitors; or
• have a lot of rules, like about when a person can eat, bathe, groom, get dressed, or go out.

Examples of segregated settings include mental health facilities, nursing homes, and intermediate care facilities.

When are community-based services “appropriate”?

Community-based services are likely appropriate if people with similar service needs are living, working, and receiving services in the community.

There are lots of ways to tell whether community-based services are right for a particular person.

For example, providers that know about the range of available services can evaluate the person’s needs and help identify services that would help them live in the community. Organizations that serve individuals with disabilities in the community can also provide helpful information about how to support someone to move to, or stay in, the community. An unbiased evaluation by an individual’s own health professional, or by a health professional associated with the local disability service system, can also help determine whether community-based services can help someone live in the community.

What does it mean to “not oppose” community-based services?

People with disabilities do not oppose receiving community-based services if they are willing to receive services at home or in the community instead of in a facility.

But many people with disabilities have spent years in segregated settings. They may have been told repeatedly that they cannot live at home, or that they are not safe in the community. Many have never heard about services that could help them live and, if they wanted, to work in the community. So, some institutionalized people with disabilities may be nervous about the idea of moving to the community.

To address this problem, state/local governments must provide people with disabilities with the full, accurate, and accessible information they need to make an informed choice of where to live and receive services. For example, a counselor could meet with an institutionalized person with a disability to talk about the services that are available in the community. The counselor could also set-up visits with other people with disabilities who are getting services at home or in the community, and with providers who offer services in the community. These visits can help people start to see what is possible for their own lives.

What is a reasonable modification?

A reasonable modification refers to the way a state/local government changes how it operates to stop discriminating against people with disabilities. The ADA requires these changes when they are necessary to stop discrimination—as long as the changes do not “fundamentally alter” the services, programs, or activities offered.

A “fundamental alteration” is a change that would be unfair to other people with disabilities that that the government also serves, given available resources. To determine whether a change would be a “fundamental alteration,” the state/local government must look at the costs and resources available to it as a whole—not just those of the agency operating or funding the segregated setting.

Who has a right to community integration?

If you have a disability and you receive services from a State/local government to support your disability-related needs, then you have a right to receive those services at home or in your community, unless it would result in a fundamental alteration.

The ADA’s “integration mandate” applies to you whether you’re currently institutionalized, or you’re at serious risk of institutionalization because you aren’t getting the services you need to stay in the community.

Every state has organizations called “Aging and Disability Resource Centers” (ADRCs). They can give you information about services that can help you live at home and be in the community, if that is what you want. Every state also has disability advocacy organizations, called “Centers for Independent Living” (CILs), which can also help people with disabilities learn about their options for living in the community and connect people to community-based services. Finally, every state has a “Protection and Advocacy” (P&A) organization that provides legal advocacy, information, and referrals to people with disabilities.

• If you are receiving services in a segregated setting:

  • Your local ADRC, CIL, or P&A may be able to provide you with information and connect you to services in your home and in the community. These services may include helping you find a place to live or help paying rent.
  • If you are having a hard time finding information about community-based alternatives to institutional care, your local Long-Term Care Ombudsperson should be able to point you in the right direction.

• If you live in the community and prefer to stay there, but need more help:

  • Your local ADRC, CIL, or P&A may be able to provide you with information and connect you to the services you need to stay in the community. These services may include helping you find a place to live or help paying rent.

Learn more about the ADA and Community Integration:

The following documents provide more detailed information about the ADA and community integration:

• Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.
• 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