Toolkit for Legislators

Legislator Toolkit

This site aims to provide State and Federal Legislators, Officials and their staff with the information needed to make informed law and policy decisions on behalf of citizens with mental retardation and developomental disabilities. Resources which relating to lack of quality in some community settings, information about community versus facility costs, Olmstead and more are available through links within this summary, as well as in the articles to follow.

Given the diversity of persons within the developmental disability community, VOR strongly supports community expansion AND strongly objects to deinstitutionalization. We do not believe expanding desperately needed quality community options must or should come at the expense of individuals whose profound cognitive disabilities, medical needs, and behavioral challenges are best served in facility based settings (a/kl/a Intermediate Care Facilities for Persons with Mental Retardation; ICFs/MR; "institutions").

Seeing is believing: Tour an ICFs/MR

To fully appreciate the people served, their extreme needs, and the professional and compassionate care and training they receive, we encourage Members of Congress, State Legislators, their staffs, andothers to visit an Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) in your area. Nearly every state has state and/or private ICFs/MR. For contact information for an ICFs/MR in your area, please contact Tamie Hopp at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Only Providing Community-Based Care May Not Save States Money

A 1993 peer-reviewed study of existing cost comparison literature on found that community settings for persons with developmental disabilities are not always less expensive than facilities, as some advocates claim. (Walsh, et al., "Cost Comparisons of Community and Institutional Residential Settings: Historical Review of Selected Research, Mental Retardation, Volume 41, Number 2: 103-122, April 2003). A 2009 update by lead researcher, Kevin Walsh, confirmed that the 2003 conclusions remain valid in 2009 and beyond.

Olmstead Does Not Support Deinstitutionalization

State officials and legislators often hear that Olmstead requires community placements. Such interpretation is not accurate.

In actuality, the Supreme Court, in its landmark Olmstead v. L.C. ruling, embraced the need for a range of services to respond to the varied and unique needs of the entire disability community: “We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings...Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it.” 119 S. Ct. 2176, 2187 (1999).

Abuse and Neglect in Community Settings

VOR's Abuse and Neglect in Community Settings document provides a bibliography of investigative media series, state audits and peer-reviewed research in more than half the states that detail systemic concerns with regard to quality of care in community-based settings for persons with developmental disabilities. Tragedies range from physical, emotional, and financial abuse, neglect and even death. Many of these outcomes are associated with a zest to move to a "community for all" vision people with developmental disabilities without adequately considering the ramifications of separating vulnerable people from specialized care and then doing away with a critical safety net (a/k/a deinstitutionalization). The lessons learned from more than 25 states should cause policymakers and lawmakers to take pause and recognize that a range of needs requires a range of service options.

Myth of a Medicaid Institutional Bias

The allegation of a Medicaid institutional bias for people with mental retardation and developmental disabilities (MR/DD) is simply not true. It is based on two false premises: (1) that all institutional services are mandatory and all home and community-based services (HCBS) are optional, and (2) that more dollars are spent on institutional services than on HCBS services.

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