By Paul Singer and Carrie Spencer
The Associated Press

AVON, Ohio - Tom Grant fiddles with the electronic controls on his wheelchair in the cramped space between his nursing home bed and a window that faces a brick wall.

"I refer to this place as a minimum security prison," the 53-year-old retired police officer says. "There's a number of people like myself who are disabled but still functioning from the shoulders up. We still could make a positive contribution to society."

The U.S. Supreme Court ruled in 1999 that states must provide alternatives to institutions for people who can reasonably be served in the community - but only if the state can afford it. The "Olmstead" decision said states should provide care in "the most integrated setting" possible, but set no deadline.

Ohio and many other states do not have enough disabled accessible housing to meet demand, enough caregivers to work in homes and enough state and federal money to pay for either.

A National Conference of State Legislatures report issued in March said budget problems have delayed many states' plans for expanding home and community-based services to the disabled.

Fewer than 20 states enacted laws related to their Olmstead plans last year, including nine with task forces studying the issue, the report said.

In Ohio, lawmakers considering a temporary sales tax increase and service cuts to balance the next two-year state budget say there isn't extra money.

"All of the other home and community-based services are optional. So, by federal law, we have to come up with the dollars to pay for the institution before we come up with the dollars to pay for home and community based care," said Greg Moody, Gov. Bob Taft's executive assistant for health and human services.