## Facts

- Pennsylvania’s Department of Public Welfare (DPW) operated both (1) a nursing-home program and (2) a home-based attendant-care program providing personal care services to qualified individuals with disabilities.
- Idell S. had a physical disability and required personal care services.
- DPW funded Idell S.’s care in a nursing home, but she sought to receive comparable services through DPW’s attendant-care program so she could live at home with her children.
- The plaintiffs sought declaratory and injunctive relief, alleging DPW’s administration of its programs resulted in unnecessary institutionalization rather than service delivery in the most integrated setting appropriate.
- The district court entered summary judgment for DPW, concluding DPW was not discriminating under Title II of the Americans with Disabilities Act (ADA).
- The case reached the Third Circuit on appeal on a record that included stipulated facts; the United States participated as amicus curiae supporting the plaintiff.

## Issues

1. Whether DPW violated Title II of the ADA, 42 U.S.C. § 12132, by requiring Idell S. to receive services in a nursing home instead of through DPW’s attendant-care program.
2. Whether unjustified segregation in an institution, when an integrated community-based alternative is available and appropriate, constitutes discrimination “by reason of” disability under Title II and its implementing regulations, including 28 C.F.R. § 35.130(d).

## Decision

- The Third Circuit reversed the grant of summary judgment for DPW and remanded.
- The court held that DPW’s administration of its attendant-care and nursing-home programs violated Title II because it unnecessarily segregated qualified individuals with disabilities in nursing homes when attendant care in the community was appropriate and available.
- The court rejected the view that Title II requires proof of animus or intent; discriminatory effect and program structure can establish a violation.
- On the record presented, DPW lacked a supported justification that providing attendant care would be infeasible or would fundamentally alter the program.

## Legal Principles

- Title II prohibits a public entity from subjecting a qualified individual with a disability to discrimination in the entity’s services, programs, or activities. 42 U.S.C. § 12132.
- A public entity must administer its services in the “most integrated setting appropriate” to the needs of qualified individuals with disabilities. 28 C.F.R. § 35.130(d).
- Unnecessary institutionalization and segregation of persons with disabilities, when a suitable integrated alternative is available, can itself constitute discrimination under Title II.
- Discrimination under Title II is not limited to intentional exclusion; it includes policies and program designs that produce unjustified segregation.

## Conclusion

The Third Circuit held that DPW violated ADA Title II by confining a qualified person with a disability to a nursing home to receive services that could appropriately be provided through an existing attendant-care program in the community, and it reversed and remanded for relief consistent with the integration requirement.


Helen L. v. DiDario, 46 F.3d 325 (3d Cir. 1995)