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Trapped 

Five years ago, a U.S. Supreme Court ruling on a Georgia discrimination case called for the desegregation of mental institutes and nursing homes nationwide. But today, few in Georgia have been granted that freedom.

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She wonders when she'll be able to escape the strange place that serves as her home. She wonders if she'll always live with two roommates in a stark room. She wonders if she'll ever get to play in a creek, buy a sweater at the mall or eat pancakes on a Saturday morning.

In December 2002, Rhonda's chances of leaving the institution seemed to have improved. Her doctor deemed her capable of living in the community, an evaluation that by law gives her the option to leave a state institution and live in a community-based setting. The law that granted Rhonda that right, an amendment to the Americans with Disabilities Act, was prompted by a 1999 U.S. Supreme Court decision. The case involved two mentally retarded women who fought for the right to leave Georgia Regional Hospital Atlanta in Decatur and move to a setting where they could interact with the outside world.

Called the Olmstead ruling, because the women's case began as an action against Georgia's then-commissioner of the state Department of Human Resources, Tommy Olmstead, the 6-3 opinion found that "unjustified institutional isolation of persons with disabilities is a form of discrimination."

The ruling affected everyone from the mentally ill to the mentally retarded, the physically disabled to the elderly, who lived in the nation's mental hospitals and nursing homes. It was hailed as the Brown vs. Board of Education for the institutionalized, and it ordered states to move at a reasonable pace to give people who could function outside institutions the opportunity to live in the real world.

Advocates thought Georgia -- the birthplace of the case -- would be among the first to implement the monumental change.

But it hasn't been.

More than five years have passed since the decision was handed down, and today Georgia ranks among the slowest states to de-institutionalize those capable of living outside institutions. More than 4,000 Georgians living in institutions and nursing homes have expressed a desire to live in the community, and that number only represents those people whom advocates have reached so far. During fiscal year 2004, however, Georgia officials identified just 145 people living in institutions who were eligible to live in community-based settings, according to the National Conference of State Legislatures.

Individuals like Rhonda have waited and waited -- some of them for two decades or more -- to leave a mental hospital or nursing home and enjoy the basic freedoms of average citizens. But they haven't been able to leave, even after filing lawsuit after lawsuit asking the state to comply with the Olmstead ruling. Jamieson has helped file dozens of complaints, including one federal suit on Rhonda's behalf. Still, the state drags its heels.

The state estimates that it's moved 2,000 people out of institutions and into community-based homes since 1999. That's low compared to states like Arizona and New York, which have so far moved more than 7,000 people out of institutions as part of the Olmstead mandate.

Georgia's snail-paced reaction to the Olmstead ruling raises fundamental questions about the systemic treatment of the disabled. Some experts claim five years is too soon to expect widespread change; after all, it took almost 10 years for the country to desegregate under the Brown vs. Board of Education ruling. Others say many states have been stumped as to how to best execute the reforms called for in the Olmstead ruling -- especially in times of budget constraints and Medicaid cuts.

Yet there are states, such as Oregon, that have overcome those hurdles. Oregon was the first state to spend a larger percentage of its Medicaid budget on community-based services than on institutions -- and officials there found that the shift saved the state money.

What's more, even when Georgia has moved people out of institutions and nursing homes, many patients ended up in personal care homes, which critics claim are cozy but nonetheless segregated settings. Disability advocates argue that the Supreme Court envisioned physically and mentally disabled people ultimately interacting harmoniously with nondisabled people in a setting where they'd receive services a few hours a day. But so far, a tiny fraction of Georgia's institutionalized have been given that opportunity.

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