Fifteen years after the state of Georgia settled a lawsuit with the Department of Justice (DOJ) over its policies regarding care for those with intellectual and developmental disabilities (IDD) and mental illnesses, its promised overhaul remains behind schedule. The state had committed resources to transitioning to community based healthcare as part of the national deinstitutionalization initiative set in motion by the Americans with Disabilities Act (ADA). Despite these substantial investments and notable improvements in the care continuum, the program overshot the original five-year integration plan. As such, systemic gaps often confine these individuals to institutional settings, violating their rights under the ADA. Patient advocates note that certain individuals frequently cycle through disconnected, understaffed support programs, recurring hospitalizations, and often return to institutions in light of community based services scarcity.
Key Findings:
- Institutional Reliance Persists: Despite the settlement’s mandate to expand community based services, many remain confined to hospitals or group homes without timely placement options.
- Incomplete Reforms: While Georgia has spent over $521 million on community services since 2010, the DOJ and advocates argue that critical goals, such as expanding crisis response and housing programs, remain unmet.
- Housing Shortages: Georgia’s 2010 housing voucher program aimed to assist 9,000 individuals by 2015. Today, fewer than 2,300 individuals benefit from this program.
- Workforce Strain: A lack of competitive Medicaid reimbursement rates has contributed to a caregiver shortage, forcing some service providers to close and limiting community care options.
- Recurring Hospitalizations: Individuals may cycle between hospitals and temporary placements, highlighting systemic challenges in providing long-term, community-based solutions supporting safe and appropriate housing.
The DOJ Settlement: Progress and Limitations
The DOJ’s 2010 lawsuit against Georgia emphasized the need for the state to stop unnecessary institutionalization and create robust community based care options. Although the state has implemented some initiatives, such as opening new crisis homes for individuals in need, major gaps persist:
- Delayed Compliance: Georgia was expected to comply with the settlement by 2015 fully. As of late 2024, several key provisions remain unfulfilled.
- Case Management Challenges: Advocates argue that improved case management is essential for individuals with complex care needs to transition successfully into the community.
- Funding Concerns: While lawmakers recently increased Medicaid reimbursement rates for providers, many argue that the changes come too late to reverse years of underfunding in combination with accounting for inflation.
Systemic Barriers and Ethical Concerns
Georgia’s challenges reflect broader national issues in disability rights and mental health care:
- Housing is the Foundation: Stable, supported housing is crucial to transitioning individuals out of institutions. However, the shortage of housing options continues to hinder progress.
- Workforce Limitations: Many caregivers leave the field for higher-paying jobs in other industries, contributing to an unstable care network.
- Rights Under the ADA: The 1999 Supreme Court decision in Olmstead v. L.C. established the legal right of individuals with disabilities to live in community based settings. Advocates have stressed that Georgia’s reliance on institutional care violates these protections.
Advancing Toward Community Based Care
Georgia’s journey toward community based care underscores the complexity of achieving systemic change. While progress has been made over the last 15 years, further action is needed to address the persistent barriers that keep individuals in institutional settings.
- Prioritize Housing Initiatives: Expanding housing options with mental health supports is essential to fulfilling the settlement’s terms and improving outcomes for individuals with IDD and mental illness.
- Enhance Workforce Retention: Competitive wages and targeted recruitment efforts can help stabilize the caregiver workforce and ensure continuity of care.
- Increase Accountability: Clear benchmarks and sustained momentum are necessary to meet the obligations of the DOJ settlement and honor the rights of individuals with disabilities.
Georgia’s ongoing efforts demonstrate the challenges and opportunities in creating an inclusive care system. Addressing these gaps will require collaboration, sustained investment, and a commitment to ensuring individuals with IDD and mental illness can live integrated, community-based lives.