“Home” and “community” represent a lot more than just words for most people who live in Nebraska. Many of us develop our learning, hobbies, friendships, employment, and families within the various settings we think of as home. However, not all people have the same opportunities to live and participate in the homes and communities of their choosing. Some Nebraskans with disabilities live in isolated, congregated, and segregated settings that limit their ability to live fully integrated and culturally valued lives. Homes and communities hold the same level of importance to the way people with disabilities experience life as they do for all Nebraskans.
What can be done to ensure that people with disabilities who want to live in the community are able to make that choice? First off, let’s begin by recognizing that all people are stakeholders of community inclusion and integration. Whether we’re neighbors, friends, family members, civic leaders, policy makers, employees, business owners, advocates, educators, service providers, or people with disabilities, our contribution to this issue matters; and one of the most important things all of us can do is educate ourselves.
Over the past few decades our nation has taken measures to ensure that all people have the same opportunities for community inclusion.
For example, as a result of Section 1915(c) of the Social Security Act, home and community-based services became available through Medicaid waivers in 1983. The intention of the waivers was to make it possible for people to move from institutional settings into their own home or community with the provision of long-term services, and supports.
Then, in 1999, the Olmstead decision, by the United States Supreme Court, determined that institutionalizing people unnecessarily was a violation of their civil rights. As a result, most states have taken some steps toward creating a plan to address this rights violation, but the process has been slow. In Nebraska, a collaborative effort has helped nudge the state toward the creation of an Olmstead Plan.
In addition, the Centers for Medicare and Medicaid Services (CMS) have provided technical assistance to states regarding the Medicaid Home and Community-Based Services Final Rule regulations that were first introduced in 2014. This Rule was designed to provide clarity, guidance, and ensure that people with disabilities can truly access community living in the most appropriate integrated setting and in a way that is faithful to the spirit of person-centered planning, which is a requirement of the regulations.
Unfairly, even when people with disabilities are eligible for home and community-based services and supports, community inclusion isn’t always possible because of factors outside their control. Communities, especially in rural and remote areas of Nebraska, lack an adequate capacity of appropriate services, supports, and residential settings. That’s where we as stakeholders have an opportunity and responsibility to do what we can to increase the capacity for community living in Nebraska.
Generally, when people live in the community they have access to natural supports that exist because of their day-to-day activities, relationships, and connections – through jobs and volunteering, friends, family, and other roles they have in the community. These supports increase a person’s level of safety, well-being, and self-satisfaction.
Imagine: by working together we could increase community inclusion through expanding the available settings, connections, relationships, opportunities, and choices for all people who want to live in the community. Embracing each of our strengths, interests, and differences makes our communities more powerful, culturally diverse, meaningful, and successful for all Nebraskans.
People with disabilities, especially those who live in institutional settings, often don’t have the same access to freely make choices about their friendships, transportation, healthcare, relationships, employment, advocacy, housing, education, and opportunities for hobbies, civics, faith, sports, or recreation. These elements of life represent the foundation of what it means to live in a community; and regulatory language should not define what community living means for people with disabilities. Do you have any ideas for progressive, resourceful, or collaborative ways to increase the capacity for community inclusion in all of Nebraska’s communities? What is one action step each of us could take?
Nebraska's Medicaid Home and Community-Based Services (HCBS) waivers for Developmental Disabilities services opened a 30-day public comment period for stakeholder feedback, it runs from December 10, 2018, through January 9, 2019. For more information, please visit the link below:
For additional information and resources on this topic, please visit the links listed below:
Karen has worked with Disability Rights Nebraska since October 1, 2015. She is part of our Legal Advocacy Team and conducts intakes, information and referral, case advocacy, and monitoring of facilities. In addition, she is an avid writer, photographer, and member of our Blog Team.