Improving Access to Home and Community-Based Services – Information Bulletin # 319 (8/2010).http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Nearly five years ago, Congress amended Medicaid by adding Section 1915 (i), intending to increase community-based services instead of institutional Medicaid services by permitting greater flexibility than Waivers permit. Unfortunately, only a few states took advantage of this.

In enacting the Affordable Care Act in 2010, Congress made a number of additional changes which are extremely important to the disability community. However, unless your State opts to take advantage of these changes, they will not happen. These amendments take away many excuses the States have used in the past.

On August 6, 2010, CMS wrote a “Dear State Medicaid Director” encouraging States to take advantage of the ACA 2010 amendments. Here are the changes:

1. The ACA strengthened Section 1915 ( i ) to remove the requirement that

individuals had to meet an institutional level of care in order to

qualify for home and community-based services. Unlike eligibility for

Medicaid Waivers which require a person meet an institutional level of

care, the 2010 amendments permit your state to provide community-based

services for people who are not otherwise eligible for institutional

care. Heh – makes sense to provide services before a person loses more

ADLs.

2. Another big change is that the Affordable Care Act amended this

Section to permit States to provide community-based services to persons

with chronic mental illnesses and/or substance use disorders.

Services for this population are defined extremely broadly. This is

long overdue and will help a portion of the disability community that

has been shortchanged too long.

3. States now have the option to provide thee community-based services to

persons whose incomes are 300% of the SSI income benefit.

4. Benefits can be targeted either to specific population groups without

violating Medicaid’s comparability requirements. Alternatively, States

could target by functional needs. This permits States to have multiple

programs, each targeted at specific populations, e.g., one for persons

with physical needs and another benefit package targeted at persons

with chronic mental illnesses. It permits your State to define

populations’ needs with great precision and specifics.

5. Services can be narrowly defined, e.g., personal care or home health

aide, instead of the Waiver package of services. There goes a big

excuse States have used with Waivers, i.e., they had to provide a broad

range of services to everyone on the Waiver.

6. States have the option to offer consumers “self-direction.” In the

8/6/10 Dear State Medicaid Director letter, it states that “CMS urges

all States to afford participants the opportunity to direct some or all

of their HCBS. Self-direction permits participants to plan and

purchase their HCBS under their direction and control or through an

authorized representative.” Well, how about that?

These changes become effective October 1, 2010.

You and your State Medicaid officials have to begin this process now!

Let’s not let this slip away. There could be great financial savings if these provisions are used creatively.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at

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Steve Gold, The Disability Odyssey continues

The following information is forwarded to you by the DBTAC-Great Lakes ADA Center (www.adagreatlakes.org) for you information: ODEP Releases Making the Move to Managing Your Own Personal Assistance Services (PAS): A Toolkit for Youth Transitioning to Adulthood

 Through its Youth Technical Assistance Center, the National Collaborative on Workforce and Disability-Youth, ODEP is releasing Making the Move to Managing Your Own Personal Assistance Services (PAS): A Toolkit for Youth Transitioning to Adulthood. Whether moving from school or a home setting to work, college, or living on their own, transition-age youth with significant disabilities and their families or friends will benefit from the information and guidance offered by the toolkit as they navigate the complex world of PAS.

 Accessing and maintaining long-term supports such as PAS has often been a significant barrier to employment youth and adults with disabilities. This new toolkit assists youth in strengthening some of the most fundamental skills essential for successfully managing their own PAS: effective communication, time-management, working with others, and establishing professional relationships. Such skills are key to not only enhancing independence, but also thriving in the workplace and growing professionally.

 The toolkit offers sample worksheets, questions, and charts that provide readers clear, helpful examples of things to consider along the path to greater independence. Stories from real youth and their families give practical insight and guidance for youth with disabilities who want to manage their own PAS.

 For more information or to download a Word or PDF version of the toolkit, visit the ODEP’s Youth Technical Assistance Center, the National Collaborative on Workforce and Disability-Youth.

Contact: Deane Beebe, Media Relations Director

June 10, 2010                                                                 718-928-2033 (office) 646-285-1039 (cell)

   dbeebe@phinational.org

Two-Thirds of States Lack Public Registries to

Help Consumers and Independent Home and Personal Care Aides Locate One Another

– Public Infrastructure is Needed to Support Trend in Consumer-Directed Care –

New York, NY— A national survey conducted by PHI to assess whether states have a public “matching services registry” to facilitate connections between consumers who receive self-directed care in their homes — and independent direct-care workers who provide that care — found that only one-third of the states have developed this type of registry.

Self-directed care allows elders and people with disabilities, or their families, to directly hire and supervise independent caregivers who provide personal care services and supports.

“Consumer-directed care is the fastest growing service delivery option,” said PHI Director of Policy Research Dorie Seavey, Ph.D., who conducted the survey, “yet there is little public infrastructure in place to help consumers and providers find each other for appropriate and efficient employment matches.

“Robust, public matching service registries can alleviate some of the challenges that both consumers and workers face. They can reduce unmet need due to difficulties that consumers encounter trying to locate independent providers. And for workers, they can play a valuable role in stabilizing employment and providing access points for training and other resources,” Dr. Seavey said.

Public “matching service registries” are interactive electronic databases that typically provide up-to-date detailed information about the consumer’s needs and preferences and the worker’s availability, skills, and preferences. They may also offer additional services such as worker screening and orientation, access to consumer and worker training, and recruitment and outreach to potential workers. Consumers and workers must each initiate their side of the transaction.

PHI’s state-by-state survey on public “matching services registries” found that:

• 16 states had statewide matching services
• 5 states had regional matching services
• 2 states had matching services under consideration or development
• 28 states had no statewide or regional matching service

A list of the states is below.

“The typical information and referral service offered by resource centers in aging and disability networks today is little more than a list pulled out of a drawer and the information may not be up to date,” said Dr. Seavey. “Matching service registries can play a significant role in building an infrastructure for the self-directed care that will be in even greater demand with the passage of the CLASS Act.”

There are two other types of public registries currently in use. “Quality assurance registries” –  such as the nurse aide registries that exist in every state – provide directories of individuals who have satisfactorily completed a state’s training requirements to work in nursing homes and other long-term care programs. Some states also maintain “safety registries” that list workers with criminal backgrounds or abuse findings.

Today there are over 3 million direct?care workers and over one million new positions are needed by 2018, according to the U.S. Bureau of Labor Statistics (BLS). A quarter of the nearly one million Personal and Home Care Aides in 2008 were either directly employed by private households or were self-employed, according to the BLS Employment Projections Program. However, a PHI Fact Sheet explains that this figure significantly underestimates the number of independent providers of direct-care services.

The PHI Public Matching Services Registry Project is a multi-year project that will continue to document and track matching service registries across the states; highlight what is learned from these efforts; and encourage policies that improve and support infrastructure for self-direction.

More information on public matching services registries is available on PHI’s website, including an interactive map that illustrates what states have these registries and provides a snapshot description of the service. The PHI Public Matching Services Registry Project is funded with support from the National Institute on Disability and Rehabilitation Research through the Center for Personal Assistance Services at the University of California at San Francisco.

Statewide Matching Service Registries (16)

Arkansas

California (52 county-based registries)

Connecticut

Massachusetts

Maine

Michigan

North Dakota

New Hampshire

New Jersey

Ohio

Oregon

Rhode Island

South Carolina

Vermont

Washington

Wisconsin

Regional Matching Services Registries (5)

Idaho

Illinois

Kansas

New York

Pennsylvania

Recent Legislative Efforts to Launch Matching Services Registries (2)

Connecticut

Missouri

– end –

PHI works to improve the lives of people who need home and residential care—and the lives of the workers who provide that care. Using our workplace and policy expertise, we help consumers, workers, employers, and policymakers improve eldercare and disability services by creating quality direct-care jobs. Our goal is to ensure caring, stable relationships between consumers and workers, so that both may live with dignity, respect, and independence. 

Those interested can go to www.disability.gov and be able to see a 34 page report titled ” The Report on Caregiving in America”. This report goes into many facets about caregiving and caregivers.

HOW TO MARKET YOURSELF, ADVERTISE AND HIRE A PERSONAL CARE ASSISTANT (PCA)
What qualities should I look for in a Personal Care Assistant (PCA)?

You are bringing an individual into your home to assist you with your activities of daily living (ADLs) which can be very personal. You want to find someone who:
• Is composed, caring, conscientious, and compassionate
• Is punctual
• Is dependable and reliable. If you live alone, the applicant needs to understand that you rely on him/her to show up as scheduled
• Is honest, trustworthy, and can maintain confidentiality
• Has a clean and professional appearance and displays good hygiene (e.g., washing hands)
• Can communicate effectively with you (e.g., can read, write and speak your language)
• Can cook and clean
• Can lift or maneuver X pounds easily

Continue reading ‘Hiring A PCA’ »

Supervising your PCA -General Tips

After you have hired a Personal Care Assistant (PCA), it’s important to establish a clear understanding between you and your PCA as to exactly what you expect. It’s also a good idea to keep a Daily Journal to refresh your memory of events if needed.You could:
• Let your PCA know your needs upfront and how you would like things done.
• Provide a thorough list of duties/responsibilities, complete with an explanation of your expectations of what it takes to do the task correctly. Review this in person with the PCA.
• Discuss your rules and expectations. Don’t be shy, be specific. The PCA works for you and should do what you want him or her to do related to your needs.
• Establish a performance evaluation and do a review of performance after the first month, third month, sixth month and 12 months. After that, complete every six and 12 months. If duties change, review more frequently.
• Rate performance on “needs improvement,” “meeting expectations,” or “doing more than expectations.” [See sample Performance Evaluation below.]
• Set goals you would like to have your PCA achieve to improve her/his skills and ability to meet your needs.

Continue reading ‘Supervising Your PCA’ »