Out of Institutions - but Into What? What the U.S. Can Teach Nova Scotia About Disability Rights
Read about The Remedy in Nova Scotia and what we can learn from the implementation of the Olmstead decision in the US nearly 30 years later.
Written by Sean Landry and Mina Ali | 7 min read
Nova Scotia’s “Remedy”
Keeping disabled people housed in long-term care institutions has long been a matter of policy in both the US and Canada. But just because a government has done something a for a long time does not make it lawful. That is what the Nova Scotia Court of Appeal in Disability Rights Coalition v. Nova Scotia (Attorney General) (2021) found.
In that case, the court determined that the province of Nova Scotia systemically discriminated against people with disabilities in its delivery of services, particularly in relation to housing and community support. In response, “The Remedy” was enacted as part of an interim settlement agreement between the province and the Disability Rights Coalition. The court determined that the government was “warehousing” people with disabilities into facilities that weren’t suitable for them by not providing community living options. This affirmed that government failure to provide equitable, community-based services amounts to systemic discrimination.
The ultimate outcome of the Remedy is the remedying of discrimination for people with disabilities in Nova Scotia by 2028. Part of the plan is for the government to close large residential facilities for people living with disabilities and transition them to supported community living.
However, more than halfway through the implementation timeline of the remedy, Nova Scotia is still behind on several key milestones. On Friday, January 23rd, the Disability Rights Coalition issued a metrics report that highlights key areas where the province is still lagging behind as of December 31, 2025. Most importantly, 588 people remain in large institutions, meaning the province has only reduced institutional living by 43%, significantly below the 75% goal by the end of March 2026. Progress is even weaker on the development of community-living alternatives: only 12 of 90 shared services places have been created, only 149 of 600 additional ILS+/Flex places have been created, and no new Homeshare spaces have been opened.
The data also suggests that even where people are leaving large institutions, many do not appear to be moving to the province’s community living options. This is extremely concerning; If they are not moving into community living options, and the institutions that housed them previously are closing, where are they going? Are they finding private accommodations? Are they being essentially evicted into homelessness? The data is unclear.
The U.S. Approach: The “Integration Mandate”
The U.S. integration mandate offers a useful model for Nova Scotia to learn from. In Olmstead, the U.S. Supreme Courtheld that unjustified institutionalization violates the Americans with Disabilities Act’s “integration mandate”. This mandate requires public services to be delivered “in the most integrated setting appropriate to the individual (with a disability)”. Justice Ruth Bader Ginsberg, writing for the majority, recognized that needless segregation reinforces harmful assumptions about disabled people’s abilities and limits their housing opportunities.
The plaintiffs in the Olmstead case were Lois Curtis and Elaine Wilson, two women in Georgia with intellectual, developmental, and psychiatric disabilities who wanted to live in the community but remained caught in institutional settings. Georgia argued that moving them into community-based care would be too difficult and too costly. The Supreme Court rejected that logic. In doing so, it made clear that disabled people cannot be housed in institutions simply because community housing supports have not been properly developed.
Olmstead’s Effect on U.S. Community-Based Services
A new study, Olmstead’s Effects on Housing Affordability, Supportive Housing, and Home and Community-Based Services: A Three-State Study (2025), shows what happens when U.S. state governments take the integration mandate seriously. Looking at Georgia, North Carolina, and Virginia, the study found that Olmstead significantly reduced institutionalization and pushed states to fund community-based housing services.
In Georgia, the state agreed to stop admitting people with developmental disabilities to state institutions and, by 2024, had eliminated 1,037 of 1,142 institutional beds. Georgia also developed the Georgia Housing Voucher Program, which provided services for over 3,000 people, including rental vouchers, ongoing supportive services and bridge funding, that covered the first and last month’s rent, security deposits and move-in costs.
In North Carolina, the state created the Transitions to Community Living program, which, among other things, provided rental assistance including paying out the difference between the cost of a rental unit and the tenant portion of the rent. Moreover, participants who required live-in personal care could request a unit with an extra bed. As of 2023, the TCL reported more than 4,800 people had left or been diverted from institutionalization. To ensure compliance with the settlement terms, the agreement included a system for quality assurance monitoring, requiring that progress toward settlement goals be evaluated and monitored by an independent reviewer, as well as mechanisms for managing any compliance disputes.
In Virginia, the state created the State Rental Assistance Program and expanded Medicaid waiver services for people with intellectual and developmental disabilities. Virginia later eliminated the waitlist for “Priority One” waiver recipients and funded thousands of new waiver slots, reflecting a major long-term structural shift toward community living. In June 2025, the court approved a permanent injunction in the case, which was slated to last for seven years, ensuring that the state continued to be held responsible for implementing the remaining elements of the settlement. Virginia also agreed to a list of commitments in perpetuity, including the establishment of a quality and risk management system.
What Nova Scotia Can Learn from Olmstead and the “Integration Mandate”
Although the study lauds the progress made in the three states studied, it emphasized that major barriers remain, including:
chronic underfunding of community housing solutions;
severe affordable and accessible housing shortages;
an increasingly expensive renting market;
high rates of landlord discrimination; and
direct care workforce shortages and federal cuts to Medicaid which threaten to directly reduce states’ capacity to implement the integration mandate.
The problem is not only that there are inadequate resources or political will, although both play a major factor. Instead, it is all these interconnected systems that make it difficult for governments to rapidly create community housing opportunities, even with adequate funding and political will.
What the study shows is that progress requires a detailed, comprehensive and realistic plan that addresses all these issues. Governments cannot simply close institutions and expect results to follow. The states that made the most meaningful progress were the ones with concrete implementation mechanisms, enforceable targets, and adequate funding and political will.
If there is a hopeful takeaway, it is this: the U.S. example shows that delay does not mean the project is impossible. Despite missed timelines and major barriers, states still demonstrated the capacity to create effective pathways toward affordable housing and integrated community living. Nova Scotia can do the same.