A new notice by the Department of Justice (DOJ) is calling the landmark Supreme Court Olmstead v. L.C. decision “unenforceable,” even as data consistently shows that the vast majority of Americans — even those with significant medical needs — want to continue to live in their homes as they age.
The DOJ published the notice in the July 20 Federal Register, saying it “is issuing this document to clarify that the guidance issued by the Department on June 22, 2011, and last updated February 28, 2020, titled ‘Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act [ADA] and Olmstead v. L.C.’ (Olmstead Guidance), and similar guidance documents are not enforceable.”
The U.S. Supreme Court handed down the Olmstead decision in June 1999, remarking that “unjustified segregation of persons with disabilities constitutes discrimination in violation of title II of the Americans with Disabilities Act,” according to the DOJ’s civil rights division’s website.
Providing community-based services, support
The case centered on Lois Curtis — called “L.C.” in the court case’s title — and Elaine Wilson, “who had mental illness and developmental disabilities, and were voluntarily admitted to the psychiatric unit in the state-run Georgia Regional Hospital,” the DOJ said. After Curtis and Wilson were treated, their mental health teams “stated that each was ready to move to a community-based program. However, the women remained confined in the institution, each for several years after the initial treatment was concluded.”
Curtis and Wilson eventually sued under the ADA to be released from the hospital. Tommy Olmstead, commissioner of the Georgia Department of Human Resources at the time, was the defendant in the case.
In its decision, the U.S. Supreme Court ruled “that public entities must provide community-based services to persons with disabilities when (1) such services are appropriate; (2) the affected persons do not oppose community-based treatment; and (3) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity.”
The Court’s decision added that requiring people “who can handle and benefit from community settings” to remain in institutional settings “perpetuates unwarranted assumptions that persons so isolated are incapable of or untrustworthy of participating in community life.”
Confining people to institutions also “severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement and cultural enrichment,” the Court said.
A DME pillar
The Olmstead decision and its stance of inclusion has been foundational to the durable medical equipment (DME) industry, which provides the medically necessary equipment and services needed for patients to live in their homes.
In July comments, the American Bar Association (ABA) described the DOJ’s notice as a “narrowing” of the ADA, Section 504 of the Rehabilitation Act, and the Olmstead decision, and said the June memo “concludes that neither the ADA nor Section 504 requires states to provide services in the ‘most integrated setting appropriate’ or creates a broad legal obligation to offer home- and community-based services … and that the decision did not establish a general ‘integration mandate.’”
The ABA said that although the notice is “not binding on courts,” it’s “likely to guide executive branch agencies, shaping federal enforcement priorities and substantially narrowing the government’s approach to investigations, compliance and litigation under the ADA and Section 504.”
LeadingAge, which describes itself as “a community of nonprofit aging services providers and other mission-driven organizations serving older adults,” said the OLC opinion demonstrated that the DOJ “no longer recognized the integration mandate under both the ADA and Section 504 of the Rehabilitation [Act] as a legal requirement within the executive branch of the government,” and said the change “could further jeopardize services and supports for people with disabilities in community-based settings.”
AARP’s most recent Home and Community Preferences Survey of adults 50 years and older, released in December 2024, showed that 75% of the responding adults wanted to stay in their homes, and 73% wanted to stay in their communities “for as long as possible.”
The 2022 Delaware Academy of Medicine/Delaware Public Health Association study called “Aging in Place: Are We Prepared?” said, “While the costs of all forms of long-term care are undeniably increasing, research does suggest that providing care at home to those aging in place may be a more cost-effective option.”
That report added that research has counted “millions of healthcare-associated infections” occurring at American long-term care facilities each year, and said, “Aging in one’s home can provide an alternative to nursing homes or long-term care facilities, therefore protecting older adults from healthcare-associated infections that could negatively impact their health and/or shorten their lifespan.”
