WASHINGTON — Five years after the Supreme Court ruled that segregating individuals with physical and mental disabilities can be a form of discrimination, experts said that the effort to move people out of large institutions and into small community homes had been sluggish and uneven.
"About three-fifths of the states have made progress," said Timothy M. Westmoreland, a law professor with Georgetown University's health policy institute. "But that means the other two-fifths haven't even put together a plan -- no timeline, no budget. Few have significantly improved services."
Westmoreland spoke this week at a forum assessing the impact of Olmstead vs. L.C., a decision that has been called the Brown vs. Board of Education of the disability rights movement.
In that 1999 ruling, the Supreme Court said that patients in state institutions had a right to be moved to community-based housing with doctors' consent.
The court also said that states could avoid discrimination lawsuits by drawing up a plan for moving people out of institutions at a "reasonable pace." That language reminded some experts of the phrase "with all deliberate speed" -- the timetable for action in the Brown decision. And the states' reaction, they said, has been similar.
"Some states are going to take it as a signal they should get cracking and move quickly; others are taking their time," said Michael Gottesman, the lawyer for the two Georgia women -- identified only as L.C. and E.W. -- who sued Tommy Olmstead, then that state's commissioner of human resources, for the right to live outside an institution.
As of February, 29 states had devised plans for beefing up support services and community care options. After advocacy groups threatened litigation, California finished its plan in May 2003, but the Legislature has not acted on it.
California's task force noted in the plan that without additional funding, implementing its recommendations would be a "significant challenge."
It's a challenge most states face.
In 2004, the states were looking at a combined $80-billion budget shortfall, according to the National Council of State Legislatures.
"I think states have been hesitant to draw up a plan they know they would not be able to implement anytime soon," said Joel Teitelbaum, a health policy professor at George Washington University who has studied Olmstead's impact.
