Last month, West Virginia Governor Joe Manchin signed a state plan to comply with the 1999 U.S. Supreme Court decision in Olmstead v. L.C. and E.W. that requires states to support Americans with disabilities in the most integrated setting appropriate to their needs. Since then, states
accelerated efforts to move individuals out of institutions who wanted to leave and settled them into real homes in the community. The signing was a formal ceremony commemorating Governor Manchin's executive order issued in October to implement the Olmstead Plan. Right now, nearly 10,000 West Virginian elders and others with disabilities live in nursing homes; around 600 of them have developmental disabilities. About 18-20 percent of these nursing home residents said "yes" when asked if they'd prefer to live in community settings, said Tina Maher, Olmstead Coordinator for the state's Office of the Ombudsman for Behavioral Health. Much credit goes to self-advocates and other stakeholders for "keeping the pressure up to get the West Virginia Olmstead plan completed and signed by the governor," said Mountain State People's Alliance staff member Scott
Miller. (Mountain State People's Alliance is a new project funded by the West Virginia Developmental Disabilities Council.)

While the governor said he supports West Virginians with disabilities, he did not commit any funds to carry out the goals of the new Olmstead Plan. As soon as they heard about the official signing of the plan slated for December, "[b]oth the ADAPT coordinator [of West Virginia] and myself
started contacting our list of self-advocates and family members to start calling the Governor's office asking that funds be attached to the plan, "Miller said, "so it could be implemented and not just sit on a desk looking pretty."

In their phone calls, self-advocates throughout the state reminded the governor of his verbal commitments made in previous meetings with them to finance community-based services and supports. "It's a matter of being vigilant," said self-advocate Ken Ervin, "and reminding [the governor] of his own words."

Shortly before the ceremony, five self-advocates including Ervin, the state Olmstead Coordinator Tina Maher, two Independent Living staff and Miller, sat down with Brian Kastick, the Governor's Director of Public Policy and Federal Affairs, to discuss the possibility of including $500,000 in the
upcoming budget for Olmstead implementation. "Although he was aware of the request," Miller explained, The governor "had no information about it due to the fact that the Department of Health and Human Services had not made the budget request. It was our efforts that put this issue on the
governor's radar."

About 40 people attended the official signing ceremony; three in wheelchairs sat at the front of the room each holding a placard that together read, "We the people." Self-advocates wanted to make sure "the governor understood he was signing a document that was about real people and their lives in the community," Miller said. "Although we did not get a firm [financial] commitment at the meeting, we were left feeling relatively hopeful."

Then, in early January, Governor Manchin announced he was allocating $250,000 in his proposed 2007 fiscal year budget for the Office of Behavioral Health Services to implement the Olmstead Plan. The state is also receiving more than four million dollars through federal systems change grants to implement the Olmstead Plan.

The Plan. The Olmstead Advisory Council, whose members include self-advocates, family members, providers, and state agency representatives, prepared the state's Olmstead Plan.

"The West Virginia Olmstead Plan addresses several components of West Virginia's service delivery system for people with all disabilities, including developmental disabilities," said Frank Kirkland, Director of the state's Division of Developmental Disabilities.

"The plan looks at strengthening the community supports we have and identifying and assessing people with disabilities' desire to reside in the community who may now be in more restrictive settings such as nursing homes [or intermediate care facilities for mental retardation (ICFs/MR),] or
those who may need community supports to prevent them from going into more restrictive settings. It also looks at our wait lists for community-based programs such as the MR/DD and AD [aged and disabled] waivers.

In total, the plan spells out 189 specific activities or tasks that need to be fulfilled in order to implement the Olmstead decision in West Virginia. Of these tasks, 52 percent (99) can be put into action without fiscal impact and/or regulatory change; 30 percent (56) necessitate moderate
fiscal impact or regulatory change; and 18 percent (34) are major activities that would require legislative action for funding or changes in the laws.

These major activities and specific tasks are divided into 10 categories:

1) Informed Choice
Includes such goals as developing a resource guide and an interactive Website to educate individuals on making informed choices and finding community-based supports, resources, and providers.

2) Identification One task in this category is to require state-operated facilities, nursing homes, ICFs/MR, and assisted living residences to maintain a list of individuals who want to return to the community.

3) Transition
Transition tasks include developing a person-centered process to help individuals transition into the most integrated settings in the community.

4) Diversion
This primary goal for this category of tasks is to prevent or divert individuals from being institutionalized or segregated.

5) Reasonable Pace
Tasks include establishing policies so no one has to wait more than 90 days to receive home and community-based services once eligibility is determined.

6) Eliminating Institutional Bias
In order to provide community-based supports and services, institutional bias in funding long-term supports must be eliminated. Steps to accomplish this include analyzing alternative uses for nursing facilities and ICFs/MR as well as to educate mental health commissioners about the Olmstead
decision and alternatives to institutionalization.

7) Self-Direction
Providing individuals with choice and control over their services and supports underlies all self-direction tasks such as revising policies for licensing requirements to provide self-direction in all waiver programs.

8) Rights Protection
Goals for rights protection include amending child custody laws so that parents do not have to give up custody of their children to the state in order for the children to receive services.

9) Quality Assurance and Quality Improvement: QA/QI activities include preparing an annual Olmstead Plan implementation report for the governor and the general public.

10) Community-Based Services, Programs, and Activities: Tasks involved to develop, enhance, and maintain varied community-based self-directed supports include amending the Nurse Practice Act, seeking funds for programs that support un-served or under-served individuals, and implementing appropriate housing options in the community.

Next Steps. Now that the plan is approved, one of the first goals to tackle is to identify individuals in institutional settings and get some good data on their basic needs and which ones want to move back into the community, Maher said. The Olmstead Advisory Council will take on new roles by
advising Maher about fulfilling the Olmstead Plan; making recommendations for long-term care institutional and community-based support systems; issuing position papers to identify and resolve systemic issues; and monitoring, revising, and updating the Olmstead Plan and related work
plans.

FMI: To find out more about implementing the Olmstead decision in West Virginia, see http://www.wvdhhr.org/bhhf/olmstead/default.htm. To learn more about self-advocacy in West Virginia, visit the Mountain State People's Alliance's website at http://www.letsgetalifewv.org and ADAPT West Virginia's website at http://www.labs.net/adapt/ . For further questions, contact Tina Maher at (304) 558-2159 or tinamaher@wvdhhr.org.