• This year is the eleventh anniversary of the Americans with Disabilities Act (the "ADA"). On July 26, 1990, Congress enacted the ADA, establishing the most important civil rights laws for persons with disabilities in our nation's history.

• Olmstead v. L.C. is a historic United States Supreme Court decision issued in June 1999. The case involved two Georgia women who had been confined to a state institution for years, even though doctors had said they could receive appropriate care for their conditions — mental retardation and mental illnesses — in their community. The Supreme Court stated that the denial of community placements to individuals with disabilities is precisely the kind of segregation that Congress sought to eliminate in passing the ADA.

• Olmstead v. L.C. "forces states to reevaluate how they deliver publicly funded long-term care services to people with disabilities." (National Conference of State Legislatures, 2001)

• In 1981, the Oregon legislature reorganized the state's LTC system, creating the "Senior and Disabled Services Division" to centralize the state's LTC efforts. The division centralized funding sources and administration of LTC services to provide an all-encompassing system. Since the 1981 reorganization, Oregon has worked to provide LTC services in home and community settings, with nursing home placement as a last resort. As a result of that policy, there has been a decrease in overall nursing home caseloads, and in length of stay, as well. Nursing homes in Oregon now are primarily used for rehabilitative periods or end-of-life care.

• A recent Congressional report on nursing home abuse noted that 35% of nursing homes — more than one out of every three — in the United States were cited for more than 10,000 instances of abuse over a two-year period. The report, released by the House Government Committee, was requested by Congressman Henry Waxman (D-Los Angeles). For a copy of the report, see the Committee On Government Reform, Minority Office website (http://www.house.gov/reform/min/nursinghomesabuse.html).

• California is one of nine states that spends less than 20% of its Medicaid funding on home and community-based care, and over 80% on institutional care. It ranks 49^th in its per capita expenditures for the provision of home and community-based "waiver" services (for persons who would otherwise be institutionalized) and 48^th in its total provision of home care. (Memorandum by Brian Burwell, The MEDSTAT Group, April 25, 2000 re: Medicaid Long Term Care ( LTC) Expenditures in FY 1999) Also: Nat'l Conference of State Legislatures website (ncsl.org) "Medicaid LTC Spending for Community-Based Care, FY 1999"

• Recently, the federal government approved more than 650 proposed amendments and waivers to state Medicaid and CHIP programs this year. "Eliminating the backlog has been one of more major goals this year," according to HHS Secretary Tommy Thompson, adding, "Through these state plan amendments and waivers, states have?improved access to quality care and assisted individuals who are elderly or have disabilities to live in their own homes and communities."

(HHS release, 10/9/01) http://www.hhs.gov/news/press/2001pres/20011009a.html

• Persons in the U.S. who require long-term care are persons with disabilities and elderly persons. Approximately 57% are adults age 65 and over, and 40% are adults age 18 to 64. Approximately 3% are children under age 18. About 12.8 million Americans need assistance with everyday activities. (Concept Paper for San Francisco's Long-Term Care Integration Pilot Project: Main Report, by the Long-Term Care Pilot Project Task Force, DRAFT: 8/26/98)

• In the United States, approximately 85% of seniors prefer home and community-based care over nursing facilities. (McAuley, W.J., and Blieszner, R., "Selection of Long Term Arrangements by Older Community Residents", The Gerontologist, Volume 25, pp 188-193, 1985)

• In 1998 approximately 150,000 Medi-Cal recipients in the state of California lived in nursing facilities while only 13,964 persons statewide participated in in-home and community based waiver programs (excluding the waiver for developmentally disabled persons) (Charlene Harrington, The Role of Medi-Cal in California's Long Term Care System, July, 2000).