A crisis is the perfect time to chart a new course

We have all been touched by the impact of the COVID-19 pandemic. Sweeping illness, isolation, and economic devastation have taken a toll on our collective psyche. There are many lessons that can be learned from this pandemic, and perhaps most glaring is that it is time to deinstitutionalize our most vulnerable Rhode Islanders.


According to the Rhode Island Department of Health’s COVID-19 Response Data, as of early September, about 78% of COVID-19 related deaths occurred in long term care facilities and assisted living facilities. How many of these deaths could have been avoided had there been suitable alternatives to institutionalization? What are the alternatives? Who is responsible for ensuring such alternatives are accessible to everyone who needs them?


Obviously, states are in the best position to ensure that the demands of their changing population are being met, but money is tight. The pandemic has caused a national recession, and Rhode Island, like many other states, is facing an economic crisis. That is why we need to make a new plan—an Olmstead Plan.


Olmstead refers to the U.S. Supreme Court’s 1999 landmark ruling in Olmstead v. L.C., which found that segregation of people with disabilities is discrimination under the Americans with Disabilities Act (ADA). The court decided that states have a legal obligation to ensure that individuals with disabilities have the opportunity to live, work, and receive services in the community in the least restrictive setting permitted by their disabilities. They cannot be hidden away in institutions like prisons, hospitals, or nursing homes. The Court’s decision also noted that compliance with the ADA could be achieved if a state could show that it had a “comprehensive and effectively working plan” for moving people out of restrictive settings into the community. So far, 26 states have created “Olmstead Plans,” and 18 states have published alternative strategies. Seven states (RI, FL, TN, ID, NM, SD, and DC) have neither.


For too long in Rhode Island, people with disabilities have been needlessly institutionalized because we have not invested in community services and housing options needed to help them live full and integrated lives. Many have been educated in segregated schools and classrooms, lost their children when they could parent, spent their days in day programs instead of being gainfully employed, or have been arrested and incarcerated for behavior related to their mental illness or cognitive disability, especially people of color.  Others are homeless, continually cycling between emergency room departments, prison and shelters. In fact, Rhode Island’s Homeless Management and Information System (RI-HMIS) reports that people with behavioral health and/or physical disabilities account for 63% of our homeless population.


I applaud Governor Raimondo’s recent efforts to expand home based care options through workforce incentives and training. It’s a step in the right direction, but we need to do more. Our state’s decision to not provide housing and community supports despite the need may provide initial budgetary relief, but it raises human and monetary costs in the long run. It increases uncompensated health care and overreliance on costly emergency department visits, hospitalization, prison, police, and the child welfare system. Even if we can’t afford everything we need right now, we can begin planning. We will never arrive at our desired destination if we do not create a road map. Let’s chart a new course to build a healthier Rhode Island. Let’s create an Olmstead Plan.


To listen to a recording of community leaders at a virtual Town Hall discussing what an Olmstead Plan could do for Rhode Island, visit

Laurie-Marie Pisciotta is the Executive Director of the Mental Health Association of Rhode Island.



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