Hidden in Plain Sight:
Texas’ Longstanding Crisis of Unlawful Institutionalization of People with Disabilities
For decades, Texas has quietly failed thousands of its most vulnerable residents, people with intellectual and developmental disabilities (IDD), by placing them in nursing homes that are neither equipped nor legally appropriate for their care. According to recent federal investigations and state data, approximately 4,500 people with IDD are living in these facilities today, a violation of their civil rights and a direct breach of federal law (Department of Justice, 2024; Klibanoff, 2024).
This systemic failure not only deprives these individuals of the specialized support they need but also raises troubling questions about Texas' long history of segregating people with disabilities instead of integrating them into community life (University of Houston Institute for Disability, 2024).
A Violation of Federal Law
The crisis centers on the Americans with Disabilities Act (ADA) of 1990, and a landmark 1999 Supreme Court decision, Olmstead v. L.C., which ruled that people with disabilities have the right to live in the most integrated setting appropriate to their needs (Olmstead v. L.C., 1999). Under Olmstead, unnecessarily institutionalizing people in nursing homes, when they could live in community-based settings with the proper support, is a form of unlawful discrimination (Department of Justice, 2024).
Federal law requires states to provide “community-based services” wherever possible: small group homes, assisted living with supports, or independent housing with wraparound care (National Council on Disability, 2020). Yet, in Texas, many people with IDD have remained trapped in nursing homes built primarily for the elderly, where their developmental, social, and behavioral needs go unmet (Klibanoff, 2024).
How Did This Happen?
The roots of this crisis stretch back decades. Texas has long prioritized institutional care over community services, creating long waitlists for programs like Medicaid waiver services, which would allow people with disabilities to live independently (Texas Health and Human Services Commission, 2023).
Several factors fueled the problem:
Funding priorities: Texas has consistently underfunded its community services while maintaining higher reimbursement rates for nursing homes (University of Houston Institute for Disability, 2024).
Lack of oversight: State agencies failed to track how many people with IDD were being admitted to nursing homes (Department of Justice, 2024).
Administrative neglect: Many families and individuals were simply steered toward nursing homes as the “default” option, even when better alternatives existed (Klibanoff, 2024).
Advocates have warned about this for years, but only recently has federal scrutiny forced the state to acknowledge the scope of the problem (Texas Tribune, 2024).
What the Federal Government Found
In May 2024, the U.S. Department of Justice (DOJ) released a blistering findings letter following a multi-year investigation. The report concluded that Texas is systematically violating the ADA and the Olmstead decision by warehousing people with disabilities in nursing homes without evaluating whether less restrictive, community-based placements were available (Department of Justice, 2024).
The DOJ found individuals in these nursing homes:
Lack appropriate habilitation services, such as speech therapy, life skills training, and behavioral support.
Face social isolation, with limited opportunities for work, education, or meaningful community participation.
Are over-medicated to manage behaviors that would be better addressed through supportive services.
Are subject to greater risk of abuse and neglect, a known risk in congregate care settings where oversight is minimal (Department of Justice, 2024).
Who Are the People Affected?
The 4,500 individuals impacted are mostly adults, though some are young adults aging out of childhood services. Many are non-verbal or have limited ability to advocate for themselves (ACL, 2022). Some were placed in nursing homes after a family member could no longer provide care, while others were directed there by case managers who had few other options (Klibanoff, 2024).
Critically, most of these individuals qualify for Home and Community-Based Services (HCBS) waivers, but they are stuck on waiting lists that can stretch 10–15 years (Texas Health and Human Services Commission, 2023).
The Human Cost
Beyond the legal violations, the human cost is profound. People with disabilities are being denied their autonomy, dignity, and the chance to lead full lives. Instead of participating in community activities, holding jobs, or forming relationships, they live in facilities designed for end-of-life care, surrounded by elderly residents who often have very different needs (University of Houston Institute for Disability, 2024).
Family members have reported feeling trapped, told that no other options were available or affordable (Klibanoff, 2024). Advocates argue that many individuals could thrive in small group homes or supported living arrangements for less money than it costs to institutionalize them (National Council on Disability, 2020).
What Happens Next?
The DOJ has strongly encouraged Texas to enter into a negotiated agreement to reform its system, but if the state refuses, the federal government could file a lawsuit, as it has done with other states such as Georgia and North Carolina (Department of Justice, 2024).
The reforms would likely require:
Dramatically expanding Medicaid waiver slots and community-based services (Texas Health and Human Services Commission, 2023).
Reducing the nursing home population by transitioning people into supported housing.
Providing training and pay increases for direct-support professionals, who help individuals live independently (ACL, 2022).
Enhancing oversight and accountability mechanisms (Department of Justice, 2024).
While Texas officials have acknowledged the report, they have so far resisted sweeping changes, citing concerns over costs and state autonomy (Texas Tribune, 2024).
A Pattern of Neglect
This situation is not isolated. Texas has a long history of litigation and federal oversight concerning disability rights, including over its state-supported living centers and school special education services (University of Houston Institute for Disability, 2024).
Nationally, states have faced similar Olmstead challenges, but Texas stands out for both the sheer number of people affected and the length of time the problem has persisted (Department of Justice, 2024).
The Broader Implications
At its heart, this case reflects an ongoing battle over how society treats people with disabilities: as full members of the community deserving independence and dignity, or as problems to be hidden away.
The 4,500 people warehoused in Texas nursing homes are a powerful reminder that federal civil rights laws mean little if state systems are allowed to ignore them without consequence.
Their fight for freedom is not over, but thanks to federal action, it may finally be heard.
Sources
Department of Justice, Civil Rights Division. (2024, May). Investigation of the State of Texas’ Compliance with the Americans with Disabilities Act and Olmstead v. L.C. Retrieved from https://www.justice.gov/crt/case/olmstead-texas-idd-nursing-homes
Census Bureau. (2023). Disability Characteristics: Texas. American Community Survey 1-Year Estimates. Retrieved from https://data.census.gov/
Klibanoff, E. (2024, May 21). Federal investigation finds Texas has unlawfully institutionalized thousands of people with disabilities in nursing homes. Texas Tribune. Retrieved from https://www.texastribune.org/2024/05/21/texas-nursing-homes-doj-investigation-disabilities/
National Council on Disability. (2020). HCBS Settings Rule Implementation Progress. Retrieved from https://ncd.gov/publications/2020/HCBS-Progress-Report
Olmstead v. L.C., 527 U.S. 581 (1999).
Texas Health and Human Services Commission. (2023). ID/DD Medicaid Waiver Waitlist Data, 2023 Annual Report. Retrieved from https://www.hhs.texas.gov/reports/2023/annual-id-dd-waiver-waitlist
U.S. Department of Health and Human Services, Administration for Community Living. (2022). Profile of Individuals with Intellectual and Developmental Disabilities Receiving Medicaid-Funded Services. Retrieved from https://acl.gov/data/idd-services
University of Houston Institute for Disability. (2024). The State of Disability Services in Texas: A Policy Review. Retrieved from https://uh.edu/disability-policy/texas-review-2024