Blog Posts

A Strict Constructionist Supreme Court and Olmstead

12/10/2023

Val's Take

In the US Supreme Court's decision denying VETERAN'S DISABILITY BENEFITS due to late filing even under extremely compelling facts involving schizophrenia, bipolar disorder and tardive dyskinesia ---

The Supreme Court may be signaling that they are not going to play favorites --- or they at least want to be perceived that way;
"Dobbs" (the Supreme Court's 2022 decision overturning Roe v. Wade) was not an anomaly --
and strict constructionist views (both Constitutional and Statutory) are going beyond "THE RIGHT TO PRIVACY."

I could be WRONG --- but I don't see the current Supreme Court overturning Olmstead. YET.

BUT the little dance that advocates and states are required to do under OLMSTEAD is PROBLEMATIC.
Further, it is NOT CLEAR what the current Court would do with current US Department of Justice Guidance on OLMSTEAD.

I think most everyone likes OLMSTEAD IN PRINCIPLE --- just ask STATE OFFICIALS ---

BUT I think People with Disabilities Need MORE ACCESSIBLE ACCOUNTABILITY and
STATES need MORE MONEY and TECHNICAL SUPPORT from the FEDS even as we're maintaining FLEXIBILITY.

Back in 1999 when Olmstead was decided --- I don't think people were necessarily ready to get rid of the Medicaid Rule Prohibiting Medicaid Funding of "Institutes of Mental Disease."

BUT they also often hadn't been ready to acknowledge the numbers of people with brain injury, neuro-developmental disorders and psychiatric disorders in Jails and Prisons.
- That has changed a lot, especially in the last 10 years.

Further, PERMANENT SCATTERED SITE SUPPORTIVE HOUSING is widely recognized as a VIABLE HOUSING & SERVICE MODEL for many people in a way that it wasn't 20 years ago even if some professionals knew about it.

SCOTUS’ First Decision of the Term Is a Unanimous Blow to Disabled Veterans (2023)

Why did the liberals co-sign Justice Amy Coney Barrett’s harsh opinion?

The Supreme Court's opinion in Arellano v. McDonough

What are some POTENTIAL OUTCOMES of INDIVIDUAL OLMSTEAD COMPLAINTS in the NEAR TERM?

Making A Record
Public Education
CREATIVE PROBLEM SOLVING

I think if the FEDS were to get rid of the IMD Rule -- they need to STATUTORILY require States to develop Comprehensive Plans of Care, Placement and Housing for People with Disabilities who are Institutionalized or at Risk of Unnecessary Institutionalization with:

Measurable Goals
Reasonable Time Frames
and Funding to Support the Plan

Late Diagnosis of Developmental issues and Failure to Accommodate executive Functioning challenges raises risk of institutionalization

10/10/2023

Conjecture

CMS (the Centers for Medicare & Medicaid Services) and others have championed Physical and Mental Health Integration --- one of the other important components to that is DEVELOPMENTAL HEALTH.

We currently have a sizable number of people who are getting a LATE DIAGNOSIS of a NEURO-DEVELOPMENTAL DISORDER such as ADHD and/or AUTISM that come with significant EXECUTIVE FUNCTIONING CHALLENGES.

I would submit that LATE DIAGNOSIS of NEURO-DEVELOPMENTAL DISORDERS is INCREASING INSTITUTIONALIZATION of people with Neuro-Developmental & Psychiatric Disorders insofar as NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS appear to be on a CONTINUUM.

Further, CHRONIC STRESS resulting from UN-ACCOMMODATED EXECUTIVE FUNCTIONING CHALLENGES is increasing the burden on individuals, families and the communities in this country as well as other countries.

In some ways --- this may not be that new --- we just didn't recognize it.

In the 20th Century --- SMOKING EXPLODED --- and a population that had significant Neuro-Developmental Disorders was perceived calmer and more stable in some respects --- even as large numbers of people were dying of heart disease from smoking.

Further, smoking during pregnancy multiplies the risk of ADHD in the child and that appears to go to the 3rd Generation and maybe beyond.

We don't have the same level of smoking anymore --- but the current "Mental Health Crisis" is spiralling out of contol without better CONCEPTUALIZATIONS and TREATMENTS.

Further, this isn't just related to our "Mental Health Crisis" --- it also seems to be related to our CHRONIC DISEASE EPIDEMIC where people with ADHD and/or AUTISM seem more vulnerable to these diseases.

Additionally, our MODERN ALIENATED, INDIVIDUALIST WORLD VIEW has not always been helpful in understanding this --- if we think this is just about the "LIFESTYLE CHOICES" of the INDIVIDUAL --- IT'S NOT.

Further, it is not just about the LIFESTYLE CHOICES OF THE PARENT.

BUT LIFESTYLE CHOICES going forward do need to "ACCOMMODATE" and/or ADDRESS these DEVELOPMENTAL DIFFERENCES.

Our current go to of a MENTAL HEALTH PROFESSION that thought its mission was to help people change is a MIXED BAG --- it is BOTH HELPING AND HURTING.

Further, when I started as a mental health advocate in 2007 --- the Mental Health Centers didn't think it was their responsibility to deal with DEVELOPMENTAL DISORDERS.

On the other hand, individuals have been "UNCONSCIOUSLY MASKING" for as long as they could and many of these "HYPER-CONNECTED BRAINS" --- had a hard time understanding why they would have EXECUTIVE FUNCTIONING CHALLENGES and so did everybody else.

You can start to see why this isn't really working.

Now that is slowly changing, but people with these "DEVELOPMENTAL DIFFERENCES" have to be part of the process of constructing appropriate supports going forward.

The Impact of Systemic Inflammation on Neurodevelopment (2018)

Cytokines and neurodevelopment

In the past several decades, inflammation has been increasingly recognized as an important contributor to central nervous system (CNS) injury in both the developing and adult brain [1,2] (Table 1).

The brain is particularly vulnerable in utero as well as during infancy and early childhood, and insults that occur during these critical periods have the potential to cause long-term damage.

Several neurodevelopmental disorders have been linked to early life immune activation and inflammation, including autism spectrum disorders (ASD), schizophrenia, cerebral palsy, epilepsy, cognitive impairment, and depression

Looking to Collaborate with Atlantis

8/11/2023

Val's Take

So the first thing I should say is that Mike Oxford with Atlantis gave me a little TUTORIAL on OLMSTEAD in our conversation in late July.
"Hey, I already know a lot about Olmstead --- Buddy" (and actually I do know a lot --- But I don't know everything).

History of Using the ADA's "Integration Mandate" in the Context of LONG TERM CARE

Mike credits legendary Disability Rights Attorney Steve Gold with being the first to use the Integration mandate in the context of LONG TERM CARE --- to get some residents out of nursing homes back east.
That rationale was ultimately used in Olmstead which involved a Mental Health Institute in Georgia.

Further --- Steve Gold served as an attorney for Atlantis and ADAPT (begun in DENVER).

Interim Director of Atlantis --- Mike Oxford

As far as I know, the US Department of Justice (DOJ) was the first to use Olmstead in a LARGE WAY in the context of INCARCERATION.

This involved a 2010 Settlement Agreement with the State of Georgia to provide housing and services for THOUSANDS of GEORGIA INMATES with DEVELOPMENTAL DISABILITIES (DD) and/or SERIOUS MENTAL ILLNESS (SMI) upon release.

Attorney Steve Gold: A Leader in Fighting for Disability Rights

Supportive Housing is a big Key to keeping people with disabilities out of institutions

8/7/2023

Nebraska is one of the states that has incorporated the Supreme Court's Olmstead decision into State Statute.

Originally when I was thinking about a "STATE STATUTE" ---- I was thinking something very broad to reflect the broadness of the Olmstead decision itself.

I think the broad application of Olmstead can paralyze States and for that matter Advocates.

There is much more a realization in 2023 than there was in 1999 that SUPPORTIVE HOUSING is a BIG KEY to keeping people with disabilities out of INSTITUTIONS.

For some people that HOUSING needs to be PHYSICALLY ACCESSIBLE often for a wheelchair --- but potentially other issues as well.

For people with "COGNITIVE DISABILITIES" --- SUPPORTIVE HOUSING in "MENTAL HEALTH" ---

Is often SCATTERED SITE HOUSING + ASSERTIVE COMMUNITY TREATMENT (ACT).

One of the things that Mike Oxford -- Interim Director of Atlantis pointed out to me was that the Colorado Dept. of Healthcare Policy & Financing has beefed up CASE MANAGEMENT for people TRANSITIONING OUT OF NURSING HOMES.

THAT'S A GOOD THING
There had been some HORROR STORIES involving people transitioning from the Nursing Home to the Community without proper supports.

Horror Stories of Homelessness --- It Doesn't Have to be This Way

When we think about people who are HOMELESS or BEING RELEASED FROM INCARCERATION with "NEURO-DEVELOPMENTAL DISABILITIES" and/or "PSYCHIATRIC DISORDERS" who qualify for MEDICAID:

WE PROBABLY NEED BEEFED UP MEDICAID CASE MANAGEMENT.

We have FOCUSED on "MEDICATION ADHERENCE" for several decades now in Mental Health and that has not resolved our Mental Health Crisis.

Two BIG CHALLENGING REALITIES:

The medication is often not as good as we would like.
- Can have many NEGATIVE SIDE-EFFECTS --- especially the current generation of medications that WORK ON THE BRAIN GLOBALLY.
- Genetic Testing may be in order for some people as well as
- Paying for a Neuro-Pharmacologist
A lot of this is DEVELOPMENTAL and people have gotten WORSE by not ACCOMMODATING their DIFFERENCES in:
1. Executive Functioning, and
2. Energy

The FAILURE TO ACCOMMODATE has been on MULTIPLE LEVELS:

The Person,
The Family
The School
The Employer, and
The Society

Have not really been aware of these EXECUTIVE FUNCTIONING and ENERGY ISSUES nor how to accommodate them.

THAT IS CHANGING.

The NEED for "SUPPORTIVE HOUSING" does not exist in a vaccuum and is related to many other VARIABLES.

Translational Research & Medicine
Public Education regarding Neuro-Developmental Differences involving EXECUTIVE FUNCTIONING & ENERGY
ACCOMMODATIONS for EXECUTIVE FUNCTIONING & ENERGY DIFFERENCES/DISABILITIES that are available in:
- EDUCATION, and
- EMPLOYMENT

Additionally, many people with "HYPER-CONNECTED BRAINS" do have "SPECIAL TALENTS" that should be DEVELOPED to benefit the person as well as the community.

The Complicated Relationship Between the FEDS and the STATES under Olmstead

5/7/2023

It's very hard to see how we FUND the level of support needed for Cognitive Disability in the US (and for that matter around the World) ---

If we don't get some better understandings and treatments.
- There are ACCESS ISSUES --- BUT THAT IS HARDLY THE ONLY PROBLEM.

There has been a lot of cachet around the brain and all things neural ---

BUT the more we learn about "PSYCHIATRIC DISORDERS"
- The more they start to look like other disorders and diseases we're more familiar with.
  - It is the BRAIN -- but it's not just the brain.

Further, the more you look at other disorders and diseases --- the more you see that there are some "PSYCHIATRIC COMPONENTS."

Once you get to "DISABILITY" that is resulting in "UNNECESSARY INSTITUTIONALIZATION" ---

If you're in the US --- that's an OLMSTEAD ISSUE.

One of the reasons why COGNITIVE DISABILITY is such a HUGE PUBLIC POLICY ISSUE is because FAMILIES can often not afford the SUPPORT needed.

Further, if you've got a Health Care System that is arbitrarily focused on people with IQs below 70 and Neuro-Developmental DIFFERENCE/DISORDER/DISABILITY ---

What happens to those people with an IQ over 70 and a Neuro-Developmental "Disorder" -- ?

Well, they are often not identified.

RESEARCH and TRANSLATIONAL RESEARCH and MEDICINE are generally FEDERAL ISSUES.

The responsibilities for services for people with disabilities is generally a shared responsibility under Medicaid.

The responsibilities on the State to prevent UNNECESSARY INSTITUTIONALIZATION OF PEOPLE WITH DISABILITIES under Title II of the Americans with Disabilities Act and the Olmstead decision and subsequent caselaw and guidance run beyond Medicaid.

Under 504 of the Rehabilitation Act there is to be no discriminaton based on disability for programs receiving federal funding.

Disability Housing under HUD (the US Department of Housing & Urban Development is NOT an ENTITLEMENT.

The Medicaid's prohibition against FUNDING INSTITUTES of MENTAL DISEASE without MORE was well intentioned ---

Unfortunately, in many cases it gave people with "Mental Illness" and their advocates a PYRRHIC VICTORY --- rather than a TRUE VICTORY.

American Society for Biochemistry and Molecular Biology

PTSD Biomarkers Found in Blood

Neuroscience News
March 27, 2023

"A new study found that people who are currently suffering or face a high risk of post-traumatic stress disorder show particular patterns in four biomarkers measurable with a simple blood test.

"The findings suggest these biomarkers could be used to predict a person’s likelihood of developing PTSD, diagnose the disorder or monitor the response to treatment."

Kings College London

Study Maps Out Links Between Psychosis and Our Immune System

Neuroscience News
March 27, 2023

A victory in which the results of the casualties incurred are so devastating that calling it a victory is arguable.

Olmstead, Cognitive Disability and the Running of the Bulls in Spain

5/5/2023

It's easy to make fun of the video to the right --- especially when it comes to "PHYSICAL DISABILITIES."

When it comes to "COGNITIVE DISABILITIES" --- I think we're often talking a "MIDDLE OF THE ROAD" APPROACH when it comes to the "BIOLOGICAL BASIS OF BEHAVIOR"---
- And a lot of what I am proposing on this website --- is that the ROUGH MESSY APPROACH we've been taking is more and more obviously OUT-DATED.

I think the INTELLECTUAL EVIDENCE for this --- in some ways MATHEMATICAL, LOGICAL and even ALGEBRIAC --- is there ---
- Robert Sapolsky at Stanford has done an excellent job of collecting the EMPIRICAL EVIDENCE and making this case in his book "Behave: The Biology of Our Best & Worst Selves"
  - I think there is also a biology to our boring and meh selves --- but its not as interesting.

I've made this point before that some of those SOFT SOCIAL CONCERNS --- are turning into SOME HARD BIOMARKERS.

Further, those BIOMARKERS can be EXTREMELY HELPFUL to INDIVIDUAL TREATMENT.

Are we just talking about 4 BIOMARKERS for PTSD --- probably not.

Medical Dialogues
Markers of PTSD in the Blood (2023)

Channel 9 Next

CO Lawmaker Argues People with Disabilities "ASSUMED THE RISK"

When we start bringing in the Broad Categories of Factors that impact HUMAN BIOLOGY and in turn HUMAN BEHAVIOR --- that includes:

the Systems of the Body
the In Utero Environment
the Microbiome
the Physical Environment which can impact our biology, and
the Social Environment which can impact our biology

This should be greatly expanding what we mean by Mens Rea in the Criminal Law.

I think it could also greatly expand what we mean by "UNNECESSARY INSTITUTIONALIZATION" under Olmstead and Title II of the Americans with Disabilities Act (ADA).

There is already a LANDMARK OLMSTEAD SETTLEMENT AGREEMENT out of Georgia from 2010 that was intended to be a US Dept. of Justice TEMPLATE FOR THE NATION.

focused on providing appropriate housing and services for thousands of inmates with "Developmental Disability" and "Mental Illness" upon release from incarceration.

In 2023, "Mental Illness" in many cases is looking like "DEVELOPMENTAL DISABILITY" with an IQ over 70.

The Face of Madness in Neuro-Diversity & What We Can Do About It

5/4/2023

Conjecture

First, I would say that the FACE OF MADNESS is not unrelated to the FACE OF OUR CHRONIC DISEASE CRISIS.

It should not be surprising that more and more people are being born with SIGNIFICANT LEVELS of DEVELOPMENTAL INFLAMMATION and that in turn DYSREGULATES MULTIPLE SYSTEMS OF THE BODY:

it does include the CENTRAL NERVOUS SYSTEM, but it also includes
the IMMUNE SYSTEM
the ENDOCRINE SYSTEM
the MICROBIOME
the METABOLISM
and the CIRCULATORY SYSTEM --- where we are slowly starting to find BIOMARKERS IN THE BLOOD for depression and even suicidality.
- Ultimately, we may find "psychiatric" biomarkers in most of the systems of the body.

THIS DOES NOT ALWAYS IMPACT "IQ" NEGATIVELY --- IN FACT -- IT MAY IMPACT "IQ" POSITIVELY.

SENSORY PROCESSING DISORDERS are identified significantly more in the "GIFTED" population.
SENSORY PROCESSING ISSUES are common among people with NEURO-DEVELOPMENTAL ISSUES such as ADHD, AUTISM, and DYSLEXIA.
NEURO-DEVELOPMENTAL ISSUES are more and more seen as part of a CONTINUUM with PSYCHIATRIC DISORDERS.

Understanding this RELATIONSHIP between NEURO-DEVELOPMENTAL DIFFERENCES/DISORDERS and PSYCHIATRIC DISORDERS is a MAJOR BREAK-THROUGH in our understanding of these issues.

With regard to Neuro-Developmental Disorders and Psychiatric Disorders ----
- "Rejection Sensitive Dysphoria" which is now associated with ADHD and more and more Autism and other issues ----
  - Is really about EMOTIONS THAT ARE NORMAL IN EVERY WAY --- EXCEPT INTENSITY.

I think that Difference in "INTENSITY" is related to Sensory Processing Differences and other Dysregulations of the Body.

Further, the IMMUNE SYSTEM is associated with SENSORY PROCESSING and is a critical part of the BRAIN-IMMUNE-GUT Triad. The IMMUNE SYSTEM also seems to be "SCULPTING" the Brain

"NDDs (Neuro-Developmental Disorders) are one of the chapters of psychiatric nosology most likely to benefit from the approach advocated by the National Institute of Mental Health’s Research Domain Criteria project.

"Genetic research supports the hypothesis that ID (Intellectual Disability), ASD (Autism Spectrum Disorder), ADHD, schizophrenia, and bipolar disorder lie on a neurodevelopmental continuum."

Neurodevelopmental disorders—the history and futur…

www.tandfonline.com/doi/full/10.31887/DCNS.2020.22.1/macrocq

The ROLE or ROLES of the IMMUNE SYSTEM seem to be EXPANDING to SURPRISINGLY---
SOCIAL BEHAVIOR

So I would say the FACE OF MADNESS is often--

The FACE of Developmental Difference
That is HIGHLY REACTIVE
Likely has average or above average intelligence
Likely has below average "EXECUTIVE FUNCTIONING"
- Often due to the demands of INCREASED SENSORY PROCESSING.
And is often dealing with idiosycratic METABOLISM and ENERGY FLOWS ---
- HYPER-FOCUS is often a STRENGTH.

So how does all this relate to Olmstead and the UNNECESSARY INSTITUTIONALIZATION of People with Developmental Differences/Disorders and Psychiatric Disorders?

If we don't have UP-TO-DATE and INTEGRATED understandings of even the INFORMATION --- WE ALREADY HAVE ----

A LOT OF MONEY IS WASTED, and
Many more people with DEVELOPMENTAL DIFFERENCES are in not just SUB-OPTIMAL PLACEMENTS ---
- But far too often HOMELESS or INCARCERATED.

Simplicity on the Near Side of Complexity --- PRISON BUDGETS

1/15/2023

Polis' $1 Billion State Prison Budget Isn't the Answer Anymore than A NARROW VIEW of "DE-INSTITUTIONALIZATION" was "THE ANSWER" for Mental Health

Olmstead is about preventing the "UNNECESSARY INSTITUTIONALIZATION" of people with Disabilities.

If we don't have any sense of a CONTINUUM --- you can end up where the DISABILITY COMMUNITY was 10 years ago --

We want people out of the Mental Institutes and
There are very few people with disabilities in the Criminal Justice System.

In the span of a DECADE --- that has CHANGED IN A BIG WAY.

Now most disability advocates would say the primary INSTITUTIONS for people with "MENTAL ILLNESS" are JAILS & PRISONS.

Our go to expert is often Former Director of the National Institute of Mental Health Thomas Insel who says Psychiatric Disorders are some of the most complicated problems in Medicine.

RAISING THE COMPLEXITY ANTE IN CRIMINAL JUSTICE

One of the other things that happened in the last decade was --- we started to realize how many people with BRAIN INJURY are in the Criminal Justice System
Statistics on BRAIN INJURY in CRIMINAL JUSTICE often run higher than PSYCHIATRIC DISORDERS --

RAISING THE COMPLEXITY ANTE EXPONENTIALLY in CRIMINAL JUSTICE

Developmental Disability (sometimes with IQ under 70, often with an IQ over 70),
Psychiatric Disorders
Brain Injury, and
Substance Issues

Well -- that sounds really complicated --- BUT these are often DISTINCT ISSUES that are well understood and we have great treatments for:

NOT SO MUCH
These are often BLURRED
Our TREATMENTS can be Medications that affect the BRAIN GLOBALLY --- and the precision medicine that's needed isn't there.

New Yorker: A New Hemingway Documentary Peeks Behind the Myth

One of the things that I appreciated about Ken Burns and Lynn Novick's documentary on Hemingway was Burns & Novick showed all the COMPLEXITY of Hemingway who was a talented guy AND who was often a NUT CASE ---He had mental illness, brain injury, substance issues (and I would say probably developmental issues)

Complex Patterns

Not an insignificant percentage of people in the Criminal Justice System are dealing with MULTIPLE COGNITIVE ISSUES.

So we're often dealing with the MOST COMPLEX ISSUES in MEDICINE in MULTIPLE in COMPLEX PATTERNS ---If we want to use $1 Billion Dollars to further the transition to a PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE --- that is probably not a bad thingBUT trying to placate a frustrated PUBLIC with more stuff that doesn't work isn't the way to go.

Jerry Lewis Telethon for Muscular Dystrophy

A lot of DISABILITY ADVOCACY is what to do when you DON'T HAVE THE "CURE" ---It's often an EXPLICIT REJECTION of the Jerry Lewis Telethon approach to DISABILITY ADVOCACY.

CNN: The AIDS activists of the past have more to teach us (2021)

Having said that --- AIDS ACTIVISTS did understand the importance of SCIENCE to their CAUSE and spent a lot of time ADVOCATING at the FEDERAL RESEARCH LEVEL.

When it comes to people with disabilities in the Criminal Justice System:

We need a Comprehensive Continuum of Care, and
- To me that is the States, Medicaid & HUD -- and we get rid of the well-intentioned Medicaid Institute of Mental Disease Exclusionary Rule that is making it hard for States to fund that Continuum of Care at higher levels of need.

UCHealth -- the picture is associated with a story on Covid --- but the University of Colorado and others are doing important work on PSYCHO-NEURO-IMMUNOLOGY

We need BETTER TREATMENTS ---

In a PBS Special funded by the American Psychiatric Foundation --- there was an acknowledgment that BETTER TREATMENTS are needed.
Research is probably primarily a FEDERAL ISSUE although Colorado has leading researchers and we should be CAPITALIZING on that to the MAXIMUM EXTENT POSSIBLE.

Making Society Neuro-Diversity FRIENDLY Is an OLMSTEAD ISSUE

1/15/2023

When we talk about Olmstead --- we're talking about:

Title II of the Americans with Disabilities Act and the ----- INTEGRATION MANDATE, and
The 1999 US Supreme Court Decision that the UNNECESSARY INSTITUTIONALIZATION of People with Disabilities VIOLATES THE INTEGRATION MANDATE.

Most people with Brain Injury, Neuro-Developmental Disorders, and classic PSYCHIATRIC DISORDERS who are "INSTITUTIONALIZED" (many are not) ----

Are Institutionalized in Jails and Prisons
At great risk of institutionalization as a result of "Criminal Justice Involvement"
Or at great risk of institutionalization as a result of HOMELESSNESS.

What many of the people with BRAIN INJURIES and PSYCHIATRIC DISORDERS have IN COMMON is some type of NEURO-DEVELOPMENTAL DIFFERENCE such as:

ADHD
Autism
Dyslexia
Etc.

Lived Experience Educator

In one sense, the Society is REFUSING or CAN'T BE BOTHERED to accommodate COMPLEX EXECUTIVE FUNCTIONING DIFFERENCES ----

On the other hand --- they really don't know HOW.

Further, the Society is in the PROCESS of LEARNING THIS ---

So there is going to be some TRIAL & ERROR.

The Criminal Justice System and Law Enforcement have to be a part of OLMSTEAD PLANNING.

AND Justice Involved and Homeless people with disabilities ---- HAVE TO BE PART OF THE OLMSTEAD PLANNING PROCESS --- TOO.

Cognitive Disability and Mobility

1/10/2023

I think this is an important issue because it highlights the POLICY CHALLENGES for the people with Cognitive Disabilities who are MOBILE.

There are care challenges for people with cognitive disabilities who are in some way physically incapacitated --- BUT the SAFETY CONCERNS for others often goes way down and we're often more concerned about the SAFETY of the PERSON -- pressure sores, neglect, abuse, etc.

Mobile people with Dementia can present challenges in care and they are sometimes placed on locked nursing home wards to prevent not only wandering --- but so-called "BEHAVIORS."

One of the points I want to make is that Cognitive Disability rising to a level of danger to self or others or gravely disabled can occur at any point in someone's life --- but when that occurs with MOBILITY -- the Society is often trying to get it's OXYGEN MASK ON before it can even think about this person with a COGNITIVE DISABILITY who is MOBILE and STRUGGLING.

That "SOCIETY" includes Family Members, Health Care Professionals, Law Enforcement and the Broader Community.

All of those STAKEHOLDERS have an interest in seeing COMPREHENSIVE and EFFECTIVE OLMSTEAD PLANNING for all people with disabilities and ESPECIALLY THOSE WITH THE GREATEST NEED.

This typically does not work out well for anyone if we haven't done the HARD PLANNING & IMPLEMENTATION -- before the crisis hits.

Further, if we do that PLANNING & IMPLEMENTATION --- we will likely see a lot fewer crises.

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