A federal judge in Texas stated in his 475-page Findings of Facts and Conclusions of Law filed on June 19, 2025: “Integration is fundamental to the purposes of the Americans with Disabilities Act. Provision of segregated accommodations and services relegates persons with disabilities to second-class status. The ADA’s integration mandate – to provide services “in the most integrated setting appropriate to the needs of qualified individuals with disabilities” – applies to all public entities. 28 C.F.R. § 35.130(d).”
In Olmstead, the Supreme Court unequivocally ruled that unjustified institutional isolation of people with disabilities is a form of unlawful discrimination: “Recognition that unjustified institutional isolation of persons with disabilities is a form of discrimination reflects two evident judgments. First, institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life. Second, confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.”
“One principle way to avoid segregation of individuals with disabilities in nursing facilities is to have an effective diversion process in place. If individuals with intellectual or developmental disabilities can be diverted from nursing facilities, they can avoid the segregation and isolation inherent in such facilities. Service systems that unnecessarily rely on segregated settings like nursing facilities produce greater isolation. Thus, effective diversion is an important part of the process that must not be overlooked. Preadmission screening is an integral part of the diversion process, and is mandated for all persons with intellectual or developmental disabilities. 42 U.S.C. §§ 1396r(b)(3)(F)(ii), 1396r(e)(7)(A); 42 C.F.R. § 483.112.7.”
The federal judge stated: “Most people with IDD [intellectual or developmental disabilities] in nursing facilities, or at serious risk of being admitted to nursing facilities, are qualified and appropriate for receiving services in the community, have not made an informed decision to enter or remain in nursing facilities, and do not oppose receiving services in the community. Although community programs are the most integrated setting appropriate to meet their needs, they remain unnecessarily institutionalized in nursing facilities, or at serious risk of such institutionalization. They are harmed by such institutionalization and deprived of living in a community setting and participating in integrated community programs.”
“It is reasonable for Texas to modify its policies, procedures, and practices to enable people to make an informed choice about whether to enter, or remain in, a nursing facility in order to avoid unnecessary segregation. Texas is required by CMS to provide information and opportunities to beneficiaries in its Medicaid-funded institutional and community programs through person-centered planning processes that “[p]rovide[] necessary information and support to ensure that the individual directs the process to the maximum extent possible, and is enabled to make informed choices and decisions.” 42 C.F.R. § 441.725. Conforming the State’s practices to its existing obligations is inherently reasonable. Regardless of setting, the requirements for informed choice in the person-centered planning processes ensure that people are provided with individualized information, opportunities, and support necessary to allow people with IDD to make an informed choice.”
“National standards and Texas’ own policies underscore the importance of providing informed choice to people with IDD and indicate that providing such choice is a reasonable modification and would not fundamentally alter Texas’ system. These reasonable modifications to Texas’ program, which are necessary to comply with the ADA and reflect accepted professional standards for allowing people with IDD and their guardians to make an informed choice whether to enter or remain in a segregated setting would include ensuring that persons with IDD receive individualized information about community living and opportunities to experience community settings: a. that are tailored to their ability to understand and to their cognitive and other disabilities, see 28 C.F.R. § 35.160(a) (requiring public entities to “take appropriate steps to ensure that communications with applicants, participants, members of the public, and companions with disabilities are as effective as communications with others”); b. that address their fears, concerns, prior experiences, or barriers to living in the community; c. that include individualized opportunities to engage in community activities, to spend time with non-disabled peers, to visit community programs, to meet providers of community services, and to hear from families and peers about community living; and d. that address the impact of institutionalization on the lives, experiences, and options of people with IDD who have been in nursing facilities for many years.”
“It is reasonable for Texas to modify its policies, procedures and practices to divert people with IDD from being segregated in nursing facilities. National standards and Texas policy and planning documents underscore the importance of diversion in preventing unnecessary segregation. Because Texas can reasonably modify its system to accommodate the relief being sought, Plaintiffs and the United States have met their burden in proving a violation of Title II of the ADA. It is reasonable for Texas to modify its policies, procedures, and practices to ensure an appropriate service array and system capacity, in order to provide sufficient community services and timely access to those services to enable people with IDD to live in the most integrated setting appropriate to their needs. It is reasonable for Texas to modify its policies, procedures, and practices to conduct effective monitoring, oversight, and training to ensure that its IDD system meets its intended goals … People with IDD in nursing facilities could reside in integrated, community settings if they were able to access the full array of community programs, services, treatment, and supports that Defendants provide for other people with IDD and if Texas revised its diversion and transition policies and practices.”
The federal judge determined: “Most people with IDD in nursing facilities, or at serious risk of being admitted to nursing facilities, are qualified and appropriate for receiving services in the community, have not made an informed decision to enter or remain in nursing facilities, and do not oppose receiving services in the community. Although community programs are the most integrated setting appropriate to meet their needs, they remain unnecessarily institutionalized in nursing facilities, or at serious risk of such institutionalization. They are harmed by such institutionalization and deprived of living in a community setting and participating in integrated community programs … Systemic injunctive relief is warranted for failure to comply with Section 504, Title II of the ADA and Olmstead where, as in myriad other types of civil rights cases, a public entity’s conduct, such as its failure to provide services in the most integrated setting, is generally applicable to a group of people.”
“Based on the evidence and the findings and conclusions herein, declaratory and injunctive relief as requested by Plaintiffs is warranted here to ensure that Texas provides individuals with IDD with accurate and appropriate PASRR screenings, evaluations of alternative placements, and the need for specialized services prior to admission to a nursing facility; and comprehensive functional assessments and all needed specialized services that meet the federal standard for active treatment as set forth in 42 C.F.R. § 483.440(a)-(f) for people with IDD in a nursing facility, consistent with the NHRA and Medicaid Act.”
Source Steward v. Young, Case 5:10-cv-01025-OLG, United States District Court for the Western District of Texas San Antonio Division.
If you or a loved one suffered harm while a resident of a nursing home in Texas or in another U.S. state due to nursing home neglect, nursing home negligence, nursing home abuse, nursing home under-staffing, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home claim lawyer in Texas or a nursing home claim lawyer in your state who may investigate your nursing home claim for you and file a nursing home claim on your behalf or behalf of your loved one, if appropriate.
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