Testimony of Celia S. Feinstein, Co-Executive Director
of the Institute on Disabilities at Temple University
Ms. Feinstein presented this testimony on March 31, 2104
before the Health and Welfare Committee of the Pennsylvania
House of Representatives
Topic: Pennsylvania’s progress on implementing the 1999 Supreme
Court “Olmstead” decision on the right to living in the least restrictive
appropriate setting.
Ms. Feinstein’s testimony:
Good morning Chairman Di’Girolamo and Sub Committee Chairman Murt. I thank you
for the opportunity to testify before you today. My name is Celia Feinstein and I am the
Co-Executive Director of the Institute on Disabilities at Temple University. The Institute
is one of 67 centers throughout the country, funded by the Federal Developmental
Disabilities Assistance and Bill of Rights Act. We are Pennsylvania’s only University
Center for Excellence, and although our primary location is on Temple’s main campus in
north Philadelphia, we are a statewide program and have a satellite office in Wexford,
PA just north of Pittsburgh.
Our charge through the Developmental Disabilities Act is to provide community training
and technical assistance, interdisciplinary training in order to prepare the next
generation of professionals, research and dissemination, all on behalf of people with
intellectual and developmental disabilities and their families. We have been PA’s
UCEDD since 1973 and celebrated our 40th anniversary last year.
One of the core functions of the University center is to be a resource to the disability
community in producing information and in interpreting information that exists. It is in
this capacity I stand before you today. I was asked to present the data describing how
Pennsylvania is faring with regard to its support for its citizens with intellectual
disabilities since the Olmstead decision of 1999.
In order to do this I have examined several resources. Dr. David Braddock and his
colleagues at the Coleman Institute at the University of Colorado at Boulder produce a
seminal work each year entitled, “The State of the States in Developmental Disabilities”.
“The State of the States in Developmental Disabilities" is a comparative nationwide
longitudinal study of public financial commitments and programmatic trends in
developmental disabilities services and supports. The project’s activities include:

Analyzing developmental disabilities financial and programmatic trends in each
state and the District of Columbia
The following data came from the most recent “State of the States in Developmental
Disabilities 2013: The great recession and its aftermath”.

With regard to public I/DD spending for community services from 2009-2011
o In PA, funding decreased by 5.1%
o Nationally, funding increased by 3.2%
o PA is 39th in funding growth from 2009-2011 (states +DC)

In terms of fiscal effort for I/DD services: Percent change from FY 2009-2011
o In PA, cash spent per $1,000 changed from $5.72 in 2009 to $5.43 in
2011, a 5% decrease in spending.
o Nationally, cash spent per $1,000 changed from $4.41 in 2009 to $4.47 in
2011, a 1% increase in spending.
o PA ranks 42nd in “fiscal effort” related to I/DD services from 2009-2011
(states+DC)

If we look at persons with I/DD in out-of-home residential settings by size of
setting and state, FY 2011:
o PA is ranked 28th nationally on percentage of total persons with I/DD in
out-of-home settings who reside in 1-6 person settings.
o PA is ranked 32nd nationally on percentage of total persons with I/DD in
out-of-home settings who reside in settings with 7+ people.
o Utilization rate, per 100,000 citizens of general population, for all I/DD outof-home placements in PA – 203; Nationally – 198

The average daily residents of state-operated 16+ I/DD institutions from FY
2009-2011
o PA – 6% decrease in individuals in institutions, 32nd nationally
(states+DC).
o Nationally – 12% decrease in individuals in institutions.

For residents with I/DD in nursing facilities: FY 2009-2011
o PA – 0% change from 2009-2011
o Nationally, 3% decrease from 2009-2011

PA ranks 38th among states+DC in spending for family support programs, and
14th in the percentage of families supported by these programs.
Also in 2013, U.S. Senator Tom Harkin, chairman of the Senate Health, Education,
Labor and Pensions Committee published a document entitled, Separate and unequal:
States fail to fulfill the community living promise of the Americans with disabilities act.
Specifically, Senator Harkin referred to the Olmstead Decision. The monograph begins,
“Following a hearing last year before this committee to assess the progress that has
been made to implement the Olmstead decision, Chairman Tom Harkin sent letters to
the Governors of all 50 states requesting information on Home and Community Based
Services. The purpose of the Chairman’s request was to clarify whether states are
ensuring that all populations of individuals with disabilities have the opportunity to live
independently, while also providing the necessary services and supports in a costeffective manner. To that end, the Chairman asked six specific questions to gather
information about different aspects of the Olmstead initiative:” (p.7)
The six questions were as follows:
1. From FY 2008 to present, number of people in all types of care facilities and housing
programs.
2. The amount of money that will be spent caring for individuals in all types of facilities
and housing programs
3. FY 2008 to present, the extent to which a state has expanded its capacity to serve
individuals with disabilities.
4. The contents of your state’s Olmstead plan and the extent to which it has been
implemented.
5. Policy recommendations you have for measures that would make it easier to
implement Olmstead
6. Successful strategies that your state has employed to implement Olmstead.
“Seventeen states did not respond in any way to the Chairman’s letter, despite repeated
requests to do so. These states are Florida, Georgia, Idaho, Indiana, Kansas,
Louisiana, Maine, Montana, Nevada, New Jersey, North Carolina, North Dakota, Ohio,
Oklahoma, Pennsylvania, South Carolina, and Utah. Their failure to respond
creates the impression that these states are not prioritizing the integration
mandate of the ADA” (p.8, emphasis added)
“With respect to the states that did not respond, the Chairman generally found that
many state leaders and Medicaid directors are working hard to provide more HCBS in
an era of rising costs and growing populations. However, most states continue to
approach community living as a social welfare issue and not as a civil rights issue. With
few exceptions, state leadership appears not to view the provision of HCBS as a means
to guarantee that individuals with disabilities are able to exercise their civil rights as
citizens by receiving supports that allow them to make their own decision and fully
participate in the life of their communities. Much of the problem appears to be based on
concerns about adopting options that require states to serve all individuals eligible for a
particular set of services. An additional problem is a continued focus on providing care
in settings that are “less institutional” but also are not the most integrated setting.
These setting do not fully realize the integration mandate of providing individuals with
disabilities the option to live at home. Finally it is very difficult to assess the states’
progress because of a lack of consistent classification, tracking, and reporting of both
eligible populations and populations served.” (p.8)
Although PA did not respond to the survey, there were some data that were available.
In a chart assessing the variation in state spending on Home and Community Based
Services as a percentage of Long-Term Services and Supports – Pennsylvania ranks
42nd out of states + DC
In a comparison of states changes in <65 nursing home population change from 20082012, PA had a 26.03% increase in that population during that period. The average
increase nationally was 15.97%. PA has the 19th highest percentage of individuals <65
in nursing homes.
Approximately 56% of all I/DD expenditures are for the more than 26,000 people
supported HCBS; 22% is expended for the approximately 1,000 people living in staterun ICFs/ID. In addition, of the more than 200,000 people with I/DD in PA, according to
Braddock et.al, 71% live at home with families.
I have attached some of the charts from the Braddock data for the U.S. and for PA to
my testimony. If you have any questions, please don’t hesitate to contact me. Thank
you for your time.