The case of Isabelle Jessich illustrates a system that lags the direction in which people -- and policy -- want to go.
According to the Star Tribune ("'I feel like I'm in jail,'"Aug. 23), Isabelle Jessich, nursing home resident and ward of the state, could not get permission to return to the community despite her strong preference and the opinions of her doctor and court-appointed guardian that she no longer needed to live in a nursing home. Once turned on, guardianship was almost impossible to turn off. Worse, the premises of the system were out of sync with the trends toward community-based long-term support services in the United States.
In its 1999 Olmstead decision, the U.S. Supreme Court ruled that keeping individuals in institutions just to meet their health needs violates the Americans with Disability Act. In 2001, the presidential New Freedom Initiative reinforced the goal that persons of all ages, with all types of disabilities, have the fullest range of life choices possible. Since then, the federal government has awarded more than $300 million in grants to help states implement community care. Most states, Minnesota among them, have developed extensive community programs, including consumer-directed community supports (a fancy way of saying the care recipient controls the money).
So given this background, what are the implications of the Jessich story?
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