With Idaho’s history, everyone should pay attention to evolving language of institutionalization

As an Idaho historian and a person with a disability, it is clear to me that whether or not you or a member of your family has personally experienced disability, whether or not you have a friend or colleague who is disabled, or you work in the field of direct care for people with disabilities, everyone should be paying attention to the evolving language of institutionalization.

Idaho has a long history with institutionalization and a shift back to overreliance on this practice by either federal or state policymakers presents the same constitutional and moral danger.

As federal protections fade, Americans with disabilities fear a return to institutions

Idaho statehood and the institutionalization of people with disabilities were entwined. The state of Idaho wasted no time getting into the business of institutionalizing people with disabilities whether those disabilities were intellectual or developmental, mental illness, verbal or non-verbal, in adults or adolescents. People with physical disabilities were not always immune from the practice.

The question of whether these Idahoans were better suited for living independently in their communities with appropriate supports wouldn’t be asked for nearly a century. 

The Idaho Insane Asylum, the original name for what is now State Hospital South, was established in 1886, four years prior to Idaho statehood. It had an original capacity of 300 beds. In 1889 at the state constitutional convention, language was included to formally establish the hospital in Blackfoot.

Idaho’s founders decided that institutionalizing people with disabilities was the only way to deal with the scourge of difference. Families were encouraged to lock away their family members with disabilities, and many did exactly that.

As the state grew, so did its institutions. The Northern Idaho Sanitarium at Orofino, now State Hospital North, would follow in 1905 with a 250-bed capacity. The Idaho Sanitarium for the Feeble-minded and Epileptic came in 1911 with an original capacity of 250 beds primarily for adolescent “inmates,” a term that was used for far too long in referring to Idahoans with disabilities residing in our state hospitals. It has had an array of names including the State School and Colony for the Feeble-minded, Idaho State School and Hospital and now the Southwestern Idaho Treatment Center. 

As slippery slope arguments go, the day the state opened these institutions was a slippery slope toward an expensive and morally dubious enterprise. While the state’s population grew, the population of these hospitals exploded.

In the 1930s to 1950s, the population to capacity issue abounded at each of the hospitals. By 1955, 1,221 Idahoans were institutionalized by the state in hospitals rife with overcrowding, abuse, neglect and doctor to patient ratios that are horrifying by today’s standards. In 1970, a report found the adolescent residents of the Idaho State School and Hospital to be living in substandard conditions.

It was the independent living movement that forced the question of whether institutionalization was constitutional and if it was the best way to care for people with disabilities who had been locked away from society since the 19th century. 

Section 504 of the Rehabilitation Act of 1973 required that people with disabilities be included in any program that receives federal funding. The Americans with Disabilities Act, signed into law in 1990, prohibited discrimination based on disability, similar to how prior civil rights legislation prevented discrimination based on race, religion and sex.

Then came a 1999 ruling by the United States Supreme Court in Olmstead v. L.C.

The court in Olmstead decided that under the ADA, people with disabilities have a right to receive government supports and services in their homes and communities utilizing a three-part test. That test asks that a healthcare provider determine that home and community placement is appropriate for the individual, that the individual is not opposed to living in their home and community, and the placement is a reasonable accommodation.

Of the third part of the test, it can be said unequivocally that placement in one’s home and community is more economical than permanent institutionalization in a specialized hospital run by the states.

A state institution is not the same as assisted living or a nursing home. It is beyond skilled nursing. Institutionalization is all-encompassing. Every way a person requires support in their physical, mental and behavioral health must be accessible within the halls of that institution. 

In June, the U.S. Department of Justice released a slip opinion — a legal memorandum for the Counsel of the President — on the application of the Rehabilitation Act and Americans with Disabilities Act in the states.

In that opinion, the DOJ submitted that neither Section 504 of the Rehabilitation Act nor the ADA “imposed an integration mandate on the states in their treatment of mentally disabled individuals. Nor does either statute authorize the responsible Executive Branch agencies to impose such a mandate.” It goes on to say more plainly that Olmstead did not hold that the Rehab Act or the ADA “require states to treat mentally disabled patients in the most integrated setting appropriate to their needs.”

The instruction they are offering the White House is that the Supreme Court’s interpretation of the laws that have preserved the rights of people with disabilities to live in their homes and communities for nearly three decades is incorrect and the federal government no longer needs to abide by the previous flawed interpretation.

The current number of Idahoans receiving home and community-based services is 33,000. In the years since deinstitutionalization, a process of getting people out of hospitals and into homes and communities triggered by good advocacy and the Rehab Act, not only have the numbers decreased dramatically in our state hospitals, the number of beds available in those facilities shrank.

If Idaho policymakers were to resume the practice of segregating people with disabilities, where would these Idahoans go? The state hospitals are no longer structured in a way to support this.

The cost to Idaho taxpayers would be exorbitant. This would tax the Department of Health and Welfare. The facilities would be costly. The price to staff expanded facilities in a field with high turnover would be huge.

These costs would be a pittance compared to the human costs. The mental and emotional cost to people with disabilities being ripped away from their communities, homes and families cannot be overstated. Families would be forced to travel to one of three locations in the state to see their family members.

Every Idahoan with a disability, with a family member with a disability, with a business that employs people with disabilities, with an organization that utilizes volunteers with disabilities, or pays taxes would be impacted by this state choosing to follow the DOJ’s interpretation of Olmstead. 

In 2025, Idaho was found to be in violation of section II of the Americans with Disabilities Act for unnecessarily segregating people with disabilities to nursing homes. Is it advisable for this state to expand that violation to include the Rehab Act and the Supreme Court’s ruling in Olmstead? And at what cost?

If the legal implications aren’t reason enough to avoid the segregation of people with disabilities, consider the risk of abuse, neglect and death. Is there a line policymakers are willing to walk up to and not cross when it comes to the denial of civil rights?

The abuse and neglect rampant in the first half of the 20th century in Idaho’s institutions did not go away with deinstitutionalization. An investigation of the state hospital in Nampa, SWITC, from 2017-2023 revealed systemic safety, abuse and neglect issues with danger to residents and staff.

We are not as far removed from these practices as we would like to believe.

And still, if policymakers can’t find it in themselves to act based on these legal, moral and ethical considerations, they must consider the cost. If there is a policymaker concerned about the cost of home and community-based services whose answer is to put the consumers of such services in state institutions, they are not a serious thinker. The slippery slope of institutionalization will explode the budget. 

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