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Housing FIRST v. supportive housing --- and the importance of voluntary supports

2/18/2022

We are strong believers in HOUSING FIRST and the moral urgency of it ---- BUT ---

For many people with disabilities --- it is not clear that HOUSING ALONE would prevent unnecessary institutionalization or the great risk of institutionalization inherent in homelessness.
Additionally, while HOUSING FIRST is sometimes DEFINED by SERVICE PROVIDERS as HOUSING + SUPPORTS ---
- That tends NOT to be the COMMON UNDERSTANDING.
- When most people hear HOUSING FIRST --- they think JUST HOUSING.
So I think a request for SUPPORTIVE HOUSING will be CLEARER to Policymakers and the Community what we're asking for.
- And ultimately a COURT if necessary.

Further, the importance of primarily VOLUNTARY SUPPORTS, except under EXTREME CASES can't be overstated.

Most PEOPLE with NEURO-DEVELOPMENTAL and/or PSYCHIATRIC Differences or Disorders WANT HELP.

It's NOT JUST that the PEOPLE with NEURO-DEVELOPMENTAL and / or PSYCHIATRIC Differences or Disorders --- DON"T WANT the HELP that is being offered.

The HELP that is being offered is sometimes NOT VERY HELPFUL.
AND it is probably NOT WORTH what we're paying for it .
- That's NOT always true, but it's more true than we realize.

A BIG PART of that is the relationship between NEURO-DEVELOPMENTAL DISORDERS and PSYCHIATRIC DISORDERS.

Those RIGID CATEGORIES in the DSM 5 are not withstanding the weight of current research ---- and it is becoming more and more obvious that these CATEGORIES are BLURRED and we're MISSING people.

If the NEEDS related to that often UNDERLYING NEURO-DEVELOPMENTAL DIFFERENCE or DISORDER --- which often involve SENSORY PROCESSING and EXECUTIVE FUNCTIONING ISSUES ---

are not better understood or addressed --- we may be spinning our wheels or even making things worse.

Invisible People
Tour Shelter + Permanent Supportive Housing in Denver

Further, the University of San Francisco Study found that HOUSING paired with VOLUNTARY SUPPORTS for even people experiencing some of the most significant impairment was successful.
Especially when it comes to NEURO-DEVELOPMENTAL DISORDERS and PSYCHIATRIC DISORDERS --- a lot of the need is a result of needing to address EXECUTIVE FUNCTIONING issues in MULTIPLE SPHERES OF LIFE in an ENVIRONMENT which individuals themselves and the community may be largely ignorant of the different needs of NEURO-DIVERSE PEOPLE.
- Further, that IGNORANCE is leading to a quite UNCONSCIOUS HOSTILE ENVIRONMENT for people with Neuro-Developmental Disorders across a BLURRED SPECTRUM of AUTISM and ADHD.

Further, that UNCONSCIOUS HOSTILE ENVIRONMENT is putting UNHEALTHY PRESSURE and UNWITTING DISCRIMINATION on people who are quite vulnerable to PSYCHIATRIC DISORDERS.

The answer is NOT to put people who are NEURO-DIVERSE in a BUBBLE ---
It's to develop those STRENGTHS which tend be SUBJECT MATTER or ARTISTIC STRENGTHS that serve as OUTLET for an enormous SENSORY PROCESSING LOAD.
And make REASONABLE ACCOMMODATIONS for those Executive Functioning issues ---
- but as the NEURODIVERGENT REBEL pointed out --- it's people (and service providers, friends and family working together ) to better DEFINE what they NEED in terms of specifics to address ACCOMMODATIONS / WORK AROUNDS for Executive Functioning Differences / Deficits.
- Right now the "BOUNDARIES" of NEURO-DIVERSE PEOPLE are running head long into the "BOUNDARIES" of NEURO-TYPICAL PEOPLE (and for that matter other NEURO-DIVERSE PEOPLE) and we need to "CONSCIOUSLY" address that.

How Much will it cost States to bring DISABILITY HOUSING to SCALE? It depends

2/18/2022

When we think about the State's Obligation to Provide Supportive Housing / Disability Housing:

it is somewhat a PAYOR of LAST RESORT
- if the FEDS are covering it, or
- the Counties and Municipalities are covering it
- if Charitable Organizations are covering it
- THAT NON-STATE FUNDED DISABILITY HOUSING can be and should be included in the STATE'S OVERALL OLMSTEAD PLAN for people with disabilities.

If there is a SHORTAGE --- and there CURRENTLY is a SHORTAGE in COLORADO and STATES ACROSS THE COUNTRY --- then:

STATES are legally responsible for making up that SHORTAGE --- but there are a lot of ways they could do that --- so long as it got done.
- they might convince the FEDS to allocate more in the way of HOUSING VOUCHERS
- they might provide more support to Municipalities and Counties to address DISABILITY HOUSING
- they might provide more support to CHARITABLE ORGANIZATIONS that address DISABILITY HOUSING
- FUND more DISABILITY HOUSING OUTRIGHT.

BUT at the end of the day, the STATE is responsible for making up that SHORTAGE and they need a comprehensive and effectively working plan with MEAURABLE GOALS and REASONABLE TIME FRAMES to meet their legal obligations.

How much FUNDING the STATE needs to SUPPORT THE PLAN to bring DISABILITY HOUSING to SCALE depends mainly on how much FEDERAL & LOCAL efforts reduce the need.

In the case of DISABILITY HOUSING --- the LEGAL RESPONSIBLITY is on the STATES.

It is not such a bad thing that so many governmental and private organizations have a STAKE in DISABILITY HOUSING --- the MORAL RESPONSIBILITY is SHARED:

BUT the LEGAL RESPONSIBLITY is on the States for Disability Housing
- Everyone needs to help them fulfill that responsibility, and
- This is complicated because States through primarily the MEDICAID program are coordinating SERVICE PROVISION for the people who need or may at some time need SUPPORTIVE or DISABILITY HOUSING.

Olmstead & That "STATE PLAN"

2/18/2022

Why does the Olmstead Decision talk about the "STATE PLAN" (for people with disabilities)?

We often think of "Olmstead" as the Brown v. Board of Education for people with disabilities ---
BUT a lot of the US Supreme Court's Olmstead decision was a give to the States:
- The State of Georgia and subsequent States have said that ----
  - we can't make these changes overnight
  - these changes have MULTIPLE RAMIFICATIONS to our overall STATE PLAN for people with disabilities including institutions, housing, services, etc.
- The "Olmstead Plan" is really a STATE DEFENSE to a LAWSUIT under Title II of the ADA --- so if there is no lawsuit --- right now there's no independent requirement for an Olmstead Plan.
  - Others might view it differently -- BUT that's my take.
  - And it also goes a long way to explaining why ENFORCEMENT has been "CHALLENGING."

If States don't have an OLMSTEAD PLAN then the State cannot succeed on a "FUNDAMENTAL ALTERATION DEFENSE" if Housing & Services are not adequate to avoid the unnecessary institutionalization or risk of institutionalization for people with disabilities.

This has proven PROBLEMATIC for people with disabilities.
There is a NEED to provide PRACTICAL AVENUES for ENFORCEMENT:
- FEDERAL ADMINISTRATIVE ENFORCEMENT would be the most practical --- BUT
- Agencies are afraid of EXCEEDING THEIR LIMITS.

People with Disabilities generally need Protection & Advocacy Offices and Large Pro Bono Efforts to get these TITLE II matters into COURT.

It has tended to be a CLASS ACTION requesting DECLARATORY, INJUNCTIVE & PERMANENT RELIEF.

What we're trying to do by just seeking DECLARATORY JUDGMENT initially is to:

Make it easier for people with Disabilities to communicate a CREDIBLE LEGAL THREAT to STATES.
- Get States to either voluntarily comply or
- Get this into Court on a streamlined less expensive basis.
- NUDGE that "voluntary compliance," and
- if we can't get voluntary or semi voluntary compliance --- take the DECLARATORY JUDGMENT (IF WE CAN GET IT) to DOJ or appropriately resourced entities to seek INJUNCTIVE & PERMANENT RELIEF.
- After all is said and done we would prefer that INCLUSIVE STAKEHOLDER GROUP to a COURT MONITOR ---

We hope it doesn't take a COURT MONITOR to get us MEASURABLE GOALS and REASONABLE TIME FRAMES on SUPPORTIVE HOUSING, but if it does --- we need a more PRACTICAL PATH to get there.

Funding Supportive Housing --- States, the Feds, Counties & Municipalities

2/17/2022

The "LEGAL RESPONSIBLITY" for funding disability housing for those people with disabilities that are institutionalized or at great risk of institutionalization ---- rests with the STATE under Olmstead.
Why are the COUNTIES & MUNICPALITIES --- willing to fund SUPPORTIVE HOUSING ?
- The Counties and Municipalities are often bearing the BRUNT of the cost of HOMELESS people in their communities and people who are JUSTICE-INVOLVED.
- This goes a long way towards explaining why STATES have been so slow to fund SUPPORTIVE HOUSING TO SCALE ---
  - By and large, it's NOT the STATES that are bearing the COST of FAILURE to fund SUPPORTIVE HOUSING ---it's COUNTIES and MUNICIPALITIES.
  - That's why it's the NATIONAL ASSOCIATION OF COUNTIES that is behind the STEPPING UP INITIATIVE to get people with MENTAL ILLNESS out of COUNTY JAILS.

The TRUTH is a lot of funding for DISABILITY HOUSING comes from the FEDS --- BUT ---
- it is NOT an ENTITLEMENT like MEDICAID and it doesn't cover the NEED.
- the STATE provides some funding to SUPPLEMENT the FEDS --- BUT THAT DOESN'T COVER THE NEED --
  - And it's the STATES with the LEGAL RESPONSIBILITY to COVER the NEED for DISABILTY HOUSING & SERVICES or have a COMPREHENSIVE, EFFECTIVELY WORKING PLAN TO SO.

Further, these CONVOLUTED FUNDING SCHEMES and MISMATCHED INCENTIVES are not providing ACCOUNTABILITY to people with DISABILITIES who are institutionalized or at great risk of institutionalization.
- I'm not saying that Counties and Municipalities shouldn't fund SUPPORTIVE HOUSING, BUT
- When people with DISABILITIES start insisting on SUPPORTIVE HOUSING as their right --- it also brings to a head these MESSY FUNDING SCHEMES.

Most people with disabilities don't care who FUNDS SUPPORTIVE HOUSING so long as it is there when they need it --- BUT that is just not the case for THOUSANDS of COLORADANS --- it's also true for approximately 1 MILLION AMERICANS with disabilities across the country.
If we start moving those HOMELESS & JUSTICE-INVOLVED PEOPLE to Medicaid Nursing Homes --- I bet the FEDS & STATES will find some HOUSING VOUCHERS.

Examples of Olmstead Complaints with a Request for Declaratory Judgment

2/7/2022

NEXT THURSDAY --- UPDATED:

We're going to provide a DRAFT generic Demand Letter that could be used for any State.
With respect to Colorado --- we're going to be asking that the State communicate to STAKEHOLDERS directly in writing regarding the Budget request regarding some type of "OLMSTEAD COMPLIANT" effort.
- We've heard this is going to involve some housing vouchers and is going to be led by the Colorado Department of Health Care Policy & Financing & the Division of Housing
- We'd like to get specifics and we're sure that others would as well.
- We're going to be looking for commitments to:
  - Meausurable Goals
  - Reasonable Time Frames, and
  - Funding to Support the Plan --- PLUS
  - INCLUSION

Draft Demand Letter to a State on Disability Housing --- requesting a INCLUSIVE STAKEHOLDER GROUP to Develop:

Measurable Goals
Reasonable Time Frames, and
Funding Strategies

to bring DISABILITY HOUSING to SCALE. This includes issues of ACCESSIBILITY, HOMELESSNESS, INSTITUTIONS including Nursing Homes, Mental Institutes and people with DISABILITIES being released from Jails and Prisons.

In the alternative, seeking a DECLARATORY JUDGMENT that Colorado's current provision of DISABILITY HOUSING violates Title II of the AMERICANS with DISABILITIES ACT.

Ideally, such a letter would come from a wide range of Stakeholders. Further, the LEGAL FRAMEWORK and RESOURCES for such a DECLARATORY JUDGMENT ACTION need to be FIRMLY ESTABLISHED.

Georgia: Georgia Network for Educational Support & Therapeutic Support Program

Issue a declaratory judgment that Defendant has violated Title II of the ADA by

(1) failing to make reasonable modifications to the GNETS Program to provide students with disabilities access to necessary mental health and therapeutic educational services and supports in the most integrated setting appropriate to their needs, and

(2) providing students with disabilities services, programs, and benefits that are inferior and unequal to those provided to other students served in the general education environment.

US Dept. of Justice Complaint against the State of Georgia regarding Georgia's Network for Educational and Therapeutic Support Program.

New York: Adult Care Homes

DOJ Complaint against the State of New York regarding "Adult Homes"

C. Issue a declaratory judgment declaring that:
1. Defendant has violated title II of the ADA and Section 504 of the Rehabilitation Act by failing to make reasonable modifications to services, programs, and supports for persons with mental illness residing in, and at risk of entry into, Adult Homes to enable them to receive services in the most integrated setting appropriate to their needs;

MISSISSIPPI --- Programs & Services for Adults with Mental Illness

DOJ Complaint against the State of Mississippi to enforce the rights of adults with mental illness to receive services in the most integrated setting appropriate to their needs.

C. Issue a declaratory judgment that Defendant has violated Title II of the ADA by failing to make reasonable modifications to services, programs, or activities for adults with mental illness to enable them to obtain the services, programs, and activities they require to reside in the most integrated setting appropriate to their needs;

1. The United States brings this action against the State to enforce the rights of adults with mental illness to receive services in the most integrated setting appropriate to their needs.

The State discriminates against adults with mental illness by administering and funding its programs and services for these individuals in a manner that has resulted in their repeated, prolonged, and unnecessary institutionalization in state-run psychiatric hospitals, and placed them at serious risk of such institutionalization, in violation of Title II of the Americans with Disabilities Act of 1990 (the “ADA”), 42 U.S.C. §§ 12131-12134

Housing FIRST v. supportive housing --- and the importance of voluntary supports

How Much will it cost States to bring DISABILITY HOUSING to SCALE? It depends

Olmstead & That "STATE PLAN"

Funding Supportive Housing --- States, the Feds, Counties & Municipalities

Examples of Olmstead Complaints with a Request for Declaratory Judgment

Olmstead Law & Order Thursday

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