Court Concludes Agreement That Prompted Important Reforms to the Nebraska Service System for People with Developmental Disabilities

Today, the U.S. District Court for the District of Nebraska approved the joint motion of the U. S. and the state of Nebraska to terminate a remedial consent decree that mandated improvements to the state’s system for people with developmental disabilities.  The Department of Justice recently determined that Nebraska had complied with the terms of the decree.  In 2008, the court approved the decree and entered it as a court order.  At the parties’ request, the court dismissed the case. 

The decree required the state to remedy health, safety, and welfare issues at Nebraska’s two state-owned and operated institutions—the Beatrice State Developmental Center (BSDC) and Bridges, a highly-restrictive facility that housed people with serious behavior problems.  The decree also required the state to significantly expand and enhance community capacity to ensure positive individual outcomes for people in integrated settings, as required by the Americans with Disabilities Act (ADA) and the Supreme Court’s Olmstead opinion. 

Over the past seven years, the state developed effective steps to comply with the terms of the decree.  The state has implemented reforms that have transformed its service-delivery system, greatly expanded and enhanced community capacity, minimized reliance on institutional services and improved outcomes for thousands of people with developmental disabilities. 

“Our agreement has prompted Nebraska to place a much greater emphasis on delivering needed services to people with developmental disabilities in integrated community settings,” said Principal Deputy Assistant Attorney General Vanita Gupta, head of the Civil Rights Division.  “We applaud the state for implementing important and sustainable reforms to help realize the promise of Olmstead.  Across the system, people with developmental disabilities in the state’s system are now more engaged with their communities, leading more meaningful and fulfilling lives.  We thank officials within the State’s Department of Developmental Disabilities for their hard work, leadership and commitment over the years in achieving positive change.” 

“As a society, we are judged by how we treat our citizens,” said U.S. Attorney Deborah R. Gilg of the District of Nebraska.  “This conclusion marks a lengthy overhaul of state services to individuals with developmental disabilities.  We are grateful to the state of Nebraska for its commitment to this process.” 

The state has made a sustained effort to expand community developmental disabilities services throughout Nebraska to ensure adequate service capacity exists to meet outstanding needs.

• Entry of the decree effectively “closed the front door” to state-run institutional developmental disabilities services in Nebraska; the last admission to BSDC was on June 9, 2009.  As of today, there are only 116 residents still living at BSDC, representing a 64 percent reduction in census size from the time of the United States’ investigation in 2007.  BSDC is the only state-run developmental disabilities institution left in Nebraska.

• The state closed the Bridges institution and placed all of the residents into community settings.  Since transition to the community, individual outcomes have greatly improved.

• State increased its expenditures on community developmental disabilities services and supports during the life of the decree.  The increased funding has expanded services, improved their quality, and provided more effective oversight of service-delivery.

• The state has shifted and increased funding to community-based services, allowing it to address the needs of nearly 1,700 additional people on its waitlist.

• The state has greatly expanded community capacity to address the needs of people with complex health conditions, as well as those with complex behavioral issues.  Prior to 2009, there were 25 specialized providers certified in Nebraska.  Since then, the state has certified an additional 35 such providers who operate a total of 87 certified community programs.  In addition, the state has implemented improved community behavioral services and crisis services.

• The state has implemented significant programs to improve health outcomes for people with developmental disabilities living in the community, including a screening tool, a traveling clinical review team, specialized training for provider staff, and a tele-health network. 

• In recent years, the state initiated a program to avoid unnecessary incarceration of individuals with developmental disabilities who come in contact with the judicial system, providing them instead with community homes and services in integrated settings.

• The state has significantly increased the number of people with developmental disabilities who are employed in integrated settings, as well as the number of hours they are working there. 

In addition to community initiatives, the state has implemented a number of important reforms at BSDC to better meet individual needs and to increase access to the community.

• The number and percentage of BSDC residents working in the community has increased from year to year.  In 2007, only one person (less than one percent) worked off campus.  Today, over 60 percent of eligible residents work in integrated settings.

• Nebraska has completely eliminated mechanical restraint usage throughout its entire system.     

• Nebraska now implements an effective “zero tolerance” policy for abuse and neglect.  As a result, substantiated abuse and neglect incidents at BSDC have declined steadily to only a handful of incidents per year. 

• The state has substantially improved health care and behavioral services at BSDC, resulting in substantial reductions in choking incidents, aspiration pneumonia, and use of polypharmacy.

The department initiated its investigation pursuant to the Civil Rights of Institutionalized Persons Act, putting a primary focus on obtaining reforms to address violations of the ADA, as interpreted in Olmstead v. L.C., requiring that individuals with disabilities receive services and supports in the most integrated setting appropriate to their needs.  On March 7, 2008, the United States issued a findings letter to the state that detailed systemic conditions and practices that violated the constitutional and statutory rights of individuals with developmental disabilities in the state’s system.  The findings letter, consent decree and papers related to the instant motion are available at: http://www.justice.gov/crt/about/spl.