Texas Ordered to Stop Illegal Disability Institutionalizations in Nursing Homes

A landmark federal court ruling has found that the State of Texas has been violating federal law for decades by unnecessarily institutionalizing thousands of people with intellectual and developmental disabilities (IDD) in nursing homes, depriving them of essential services and the chance to live in the community. The decision, issued June 17, 2025, by U.S. District Court Judge Orlando L. Garcia, has sweeping implications for nurses, long-term care staff, and disability advocates across the state and beyond.

The Case: Decades of Unlawful Institutionalization

The ruling stems from a class action lawsuit, Steward v. Young, originally filed in 2010 by individuals with IDD and disability rights organizations. The suit alleged that Texas officials violated the Americans with Disabilities Act (ADA), the Rehabilitation Act, and federal Medicaid law by segregating people with severe disabilities in nursing facilities and failing to provide them with the specialized services and community-based options required by law.

Judge Garcia’s 475-page opinion found that Texas’ actions have caused “irreparable injury” to people with IDD. He wrote: “Although community programs are the most integrated setting appropriate to meet their needs, they remain unnecessarily institutionalized in nursing facilities, or at serious risk of such institutionalization. They are harmed by such institutionalization and deprived of living in a community setting and participating in integrated community programs.”

Key Findings From the Court

• Over 4,000 Texans with IDD have been unnecessarily placed in nursing homes, often in poorly run facilities, without access to the specialized services or community living opportunities mandated by federal law.
• Many individuals were sent to nursing homes after hospitalization for unrelated illnesses and then became effectively trapped, lacking adequate preadmission screenings or the ability to advocate for themselves.
• The state failed to provide preadmission screenings, appropriate assessments, specialized services, and active treatment, as required by federal Medicaid law and the Nursing Home Reform Act.
• The harm is ongoing, with Judge Garcia noting that “the irreparable injury resulting from Defendants’ ongoing refusal and failure to provide people with IDD with preadmission screenings, professionally appropriate assessments of their habilitative needs, specialized services to meet those needs, and active treatment is severe and ongoing.”

Implications for Nurses and Long-Term Care Providers

This ruling is a call to action for nurses and healthcare professionals working in long-term care and disability services:

• Advocacy and Assessment: Nurses are often the first to recognize when a resident’s needs are not being met or when a less restrictive, community-based setting may be appropriate. This decision highlights the importance of thorough assessments and advocating for the least restrictive environment possible.
• Transition Planning: Facilities should prepare for increased efforts to transition eligible residents with IDD from nursing homes to community-based settings, in line with federal law and best practices.
• Person-Centered Care: The ruling reinforces the need for individualized, person-centered care plans that reflect each resident’s goals, preferences, and rights to community integration.
• Regulatory Compliance: Providers must ensure compliance with preadmission screening requirements and the provision of specialized services for people with disabilities, as failure to do so can result in significant legal and ethical consequences.

What’s Next?

The court’s decision directs Texas to halt its unlawful practices and develop a plan to remedy the violations. Disability advocates hailed the ruling as a major victory.

Garth Corbett, senior attorney for Disability Rights Texas, said: “It underscores the right of persons admitted to nursing facilities with IDD to be provided the necessary supports and services required by federal Medicaid law, so that those who want to live at home or in another community-based setting are able to do so safely.”

As Texas moves to comply with the court’s order, nurses and care teams will play a critical role in supporting residents’ transitions, ensuring informed choice, and upholding the rights of people with disabilities to live and thrive in the community.

For nurses, this case is a powerful reminder: Upholding the dignity, rights, and preferences of people with disabilities is not just best practice—it’s the law.

 

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