JFActivist

Building Bridges Across Movements: Domestic Workers and the Disability Community Partnering to Improve Care

AAPD is partnering with the National Domestic Workers Alliance, Jobs with Justice, and Hand in Hand: The Domestic Employers Association for the Caring Across Generations campaign: an initiative centered on transforming long-term care in the United States for our loved ones who count on the support of caregivers to meet their basic daily needs, the workers who provide the care, and the families who struggle to access and afford care for their loved ones. 

On Tuesday, July 12^th, the campaign will be hosting a Care Congress, where seniors, people with disabilities, family caregivers, home care workers, domestic workers, children and families of care workers and people who need care will be sharing their care stories.  

We need as many people with disabilities to be part of this important dialogue!

What the Care Congress program will include:

• Sharing care stories: sharing testimonies and vision for change between seniors, people with disabilities, family caregivers, home care workers, domestic workers, children and families of care workers and people who need care
• Giving voice to change: engaging elected officials and key members of the Administration on the need for change
• Growing a movement at home: workshops and skill sharing to support participants to build the Caring Across Generations movement in their home communities.

The Caring Across Generations movement is centered on promoting honest, productive discussion among all those invested in improving care. If we are to meaningfully improve the care system for everyone, it is crucial that people with disabilities share their stories.

We need you at the table on July 12th!

RSVP to the first ever Care Congress today

Nothing about us, without us!

 

 

Medicare, CMS, Hospitals and Unnecessary Institutionalization

via SteveGoldADA.blogspot.com (6.24.11):

Medicare, CMS, Hospitals, and Unnecessarily Institutionalization. Information Bulletin # 334 (6/2011).

There’s been a number of news articles recently stating that CMS will track hospital spending for Medicare recipients and will reward hospitals that keep costs down and penalize hospitals for costs incurred within 90 days after the person leaves the hospital.

It’s a “Medicare spending per beneficiary” device to measure hospital performance. For example, we have national data for infections occurring after surgery and/or as a result of just being in a hospital. Hospitals with much higher rates will be penalized. Similarly, there’s national data for heart attack mortality rates against which hospitals can be compared, rated, and then rewarded or penalized.

Obviously, besides improving medical care, rewards/penalties are an important strategy to control health costs, something everyone agrees is necessary.

We have a simple suggestion for CMS.

How about CMS including in its “Medicare spending per beneficiary” the measure of placement in nursing homes directly from acute care hospitals? This could actually be easily implemented because CMS could actually enforce its own federal regulations which require hospitals to do real and meaningful “discharge planning”?...

CMS - you have a financial interest, the regulatory authority, as well as an interest in the ADA’s mandate that services be provided “in the most integrated setting appropriate,” to address hospital dumping.

Include in the “Medicare spending per beneficiary” plan a measure of post-hospital placements. Reward hospitals that place people in the community with services and penalize hospitals with the worst dumping scores.

 

>>>To Read the Full Post

 

What other steps can be taken to address hospital dumping? Please share your thoughts in comments below.

Medicare Proposes New Standards for Community Mental Health Centers

via the Centers for Medicare and Medicaid Services (6.16.11): 

Medicare proposes new standards for Community Mental Health Centers

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that is designed to improve the quality and safety of treatment provided to more than 25,000 Medicare beneficiaries who receive care at Community Mental Health Centers (CMHCs) each year.

The notice of proposed rulemaking would establish conditions of participation (CoPs) for CMHCs for the first time.  The proposed rule includes health and safety standards for CMHCs that participate in the Medicare program, and are an important step in CMS’ commitment to assuring the delivery of safe, quality care to clients of CMHCs.   In particular, the proposed new conditions focus on a client-centered, outcome-oriented approach.

“This rule proposes new provisions that will protect the tens of thousands of Medicare beneficiaries who receive care from a CMHC every year,” said CMS Administrator Donald M. Berwick. “Memorializing the best practices of behavioral healthcare in new Medicare standards gives us the unique opportunity to be sure that safe and effective client-focused care is available to all clients in all communities”...

>>>For the Full Press Release...

 

How do you feel this rule will "assure the delivery of safe, quality care to clients of CMHC's"? Share your thoughts in comments below.

 

Abuse in Residential Care Facilities: How Long Will It Continue?

via Time Magazine (6.7.11): 

Why So Much Abuse Is Allowed to Continue in Residential Care

by Maia Szalavitz

The stories are beyond horrifying: an autistic boy crushed to death by a "restraint" gone awry; a disabled woman's diaper pulled aside as she is raped; an elderly woman left to lie on a urine-soaked box spring for six days after being beaten.

In two of the nation's largest states, major media investigations this spring revealed hellish conditions in institutions for the disabled: The New York Times exposed ongoing violations, including physical and psychological abuse, in state-run homes for the developmentally disabled, while the Miami Herald uncovered similar tales of maltreatment and neglect in assisted-living homes for the elderly...

>>>For the Full Article...

How do you feel that institutional living settings increase PWD's vulnerability? How can these abuses of power be prevented? Please share your thoughts in comments below.

Walgreens Wins Big with Disability Employment Program

via DCvelocity.com (6.6.11):

Walgreens wins big with unique employment program

by Peter Bradley

...Randy Lewis, senior vice president of distribution and logistics for Walgreens, was the driving force behind Walgreens' extraordinary program to employ people with disabilities at its DC in Anderson, S.C. We first wrote about that effort in October 2007. In that story, we noted that Walgreens had committed to the plan even before selecting a site for the facility. And it was never seen as a short-term initiative or social experiment. Walgreens' decision to locate in Anderson was largely driven by the area's sizeable labor pool of disabled workers and the support services needed to help them succeed. "We wanted a sustainable model," Lewis said at the time.

And sustainable it has been. Today, workers with disabilities make up 40 percent of the work force at the Anderson DC, performing the same work as their more typically abled co-workers for the same pay. Walgreens has expanded the program to other facilities, most recently to its newest DC in Connecticut. And the Walgreens example has inspired other companies, including Lowes, Best Buy, Meijer, and Sears, to make similar efforts...

>>>For the Full Article...

 

How can the Walgreen's employment program for PWD serve as a model for other companies seeking to promote inclusivity and diversity?  Share your thoughts in comments below.

A System in Disarray: Mistreatment and Mismanagement at NY Institutions for People with Developmental Disabilities

via the NY Times (6.5.11):
  

A Disabled Boy’s Death, and a System in Disarray

by Danny Hakim

...On a February afternoon in 2007, Jonathan, a skinny, autistic 13-year-old, was asphyxiated, slowly crushed to death in the back seat of a van by a state employee who had worked nearly 200 hours without a day off over 15 days. The employee, a ninth-grade dropout with a criminal conviction for selling marijuana, had been on duty during at least one previous episode of alleged abuse involving Jonathan...

In the front seat of the van, the driver, another state worker at Oswald D. Heck Developmental Center, watched through the rear-view mirror but said little. He had been fired from four different private providers of services to the developmentally disabled before the state hired him to care for the same vulnerable population.

O. D. Heck is one of nine large institutions in New York that house the developmentally disabled, those with cerebral palsy, autism, Down syndrome and other conditions.

These institutions spend two and a half times as much money, per resident, as the thousands of smaller group homes that care for far more of the 135,000 developmentally disabled New Yorkers receiving services.

But the institutions are hardly a model: Those who run them have tolerated physical and psychological abuse, knowingly hired unqualified workers, ignored complaints by whistle-blowers and failed to credibly investigate cases of abuse and neglect, according to a review by The New York Times of thousands of state records and court documents, along with interviews of current and former employees...

>>>For the Full Article...

 

How can recorded accounts of these institutions' mistreatment of residents and irresponsible management of funding be used to advocate for quality living situations for people with developmental disabilities? Please share your thoughts in comments below. 

National Ranking of Disability Services Released: Where Does Your State Stand?

via DisabilityScoop.com (4.28.11):
  

Vermont Tops National Ranking Of Disability Services

Vermont offers the best Medicaid services for individuals with intellectual and developmental disabilities while Mississippi provides the worst, according to an annual ranking released Thursday.

The 50-state analysis from United Cerebral Palsy compares services offered across the country, giving preference to states where more individuals are served in the community as opposed to institutions.

Vermont, Arizona, Michigan, New Hampshire and California fare best in the ranking. Meanwhile, the District of Columbia, Illinois, Texas, Arkansas and Mississippi round out the bottom of the list. (Find out where your state stands >>)...

>>>For the Full Article

How do you feel this study relates to your personal experiences in your own state? Please share your thoughts in comments below.

Action Alert -- Tell U.S. Congress "Don't Slash Medicaid!"

From AAPD (6.2.11):                                                             

                     

Action Alert

  Tell U.S. Congress: “Don't Slash Medicaid!”

Contact your Representatives and Senators to advocate against more proposals to slash funding for Medicaid.

It is critically important that Congress be made aware of our strong opposition to large cuts in the federal funding for Medicaid. These cuts are under serious consideration in on-going discussions in a current legislative package. The discussion involves linking an increase in the total amount of debt the federal government can incur with cuts in annual federal spending. The deadline for this legislative package is now set at August 3.  This is the date on which the federal government believes it will be unable to pay existing debt if the debt ceiling is not increased. Our voices must be heard before then!

Background: There is a consensus that a failure to increase the debt ceiling by August 3 would have catastrophic consequences for the United States and global economies. At the same time, it is believed that it will not be possible to pass legislation to raise the debt ceiling without accompanying legislation to reduce the annual federal budget deficit.

In discussions about reducing federal spending, Medicaid is a natural target. In fiscal 2011, Medicaid cost $275 billion, about 7.6% of all federal spending. The cost will increase significantly over the next decade due to an aging population and increases in medical costs. The pressure to cut Medicaid will intensify because it will be difficult to make substantial cuts in the other large entitlement programs, Social Security and Medicare, because they have larger constituencies than Medicaid.

Proposals:  There are a number of pending concepts for reducing Medicaid, and it may not be clear until close to August 3 which proposals will be seriously considered. In these circumstances the best approach for supporters of Medicaid is to make every Member of Congress (and the Administration) aware of our strong opposition to any proposals which would make major cuts. Our opposition needs to be expressed early and often.

Ryan Plan: The most prominent proposal is the Ryan plan that passed the House in May. The Ryan plan would reduce Medicaid funding by about $772 billion (about 35%) over the next decade compared to a status quo program. It would be left to the states to limit their programs to deal with reduced federal support. They are likely to curtail the services they cover and limit eligibility. The Ryan plan is unlikely to be accepted by the Senate.

Other proposals: These are generally less specific than Ryan’s plan. Most would also lead to major cuts and consequential changes at the state level. These include proposals to limit all federal spending to a percentage of Gross Domestic Product (GDP), or to impose this type of limit on all health care programs, or all entitlement programs. It would be difficult to meet these limits without major cuts in Medicaid.

Suggested Disability Talking Points:

• Medicaid is critical for the health care of 8 million people with disabilities.
• Medicaid pays for wheelchairs and prosthetic devices for people with disabilities such as spinal chord injury, cerebral palsy and other disabilities.
• Medicaid pays for prescription drugs for persons with mental illnesses and epilepsy and other medical conditions.
• Medicaid pays for programs to enable people with intellectual disabilities to live and work in the community.
• Medicaid’s Early and Periodic Screening Diagnosis & Treatment program helps identify children’s disabilities early and gets them the care they need.

Pending proposals for “block grants” and “global spending caps” would undermine these important programs by reducing funding for Medicaid.  They would deny health and long term care to millions of vulnerable Americans.

The Ryan block grant plan would reduce funding over the next 10 years by $772 billion (35%) compared to continuation of the status quo. Global spending cap proposals would also lead to substantial reductions in Medicaid funding.

Reduced federal funding would compel the states -- that have serious financial problems of their own -- to sharply restrict enrollment, eligibility and benefits for the populations they now serve.  These changes could impact many of the current waivers that support community-based living for people with disabilities. The changes could have a disproportionate impact on people with disabilities who rely on Medicaid to enhance their ability to live and work in their communities and to avoid costly and unnecessary institutionalizations.

Ten Advocacy Steps

1. Write or e-mail your Representatives and Senators today.  
2. Call your two U.S. Senators and U.S. House Representative in their local state offices to set up a time to meet when they are home next. Under the current schedule:
   1. U.S. House Members are expected to be in their districts June 4-12, June 25-July 5, and July 16-24. Make an appointment today!
   2. To determine who is your U.S. Congressional Representative, please go to the official site at https://writerep.house.gov/writerep/welcome.shtml 
   3. To find out your U.S. Congressional Representative’s local address and phone numbers, go to http://www.house.gov/
   4. Senators are scheduled for a recess July 2-10. To find your U.S. Senator, go to http://www.senate.gov/general/contact_information/senators_cfm.cfm
   5. This list includes their Senate address and phone numbers. If you can only get a meeting with a staff person, do that too.
3. If you or someone you know with a disability benefits from Medicaid directly, be sure to mention that at the meeting.
4. Be sure to write a letter (send snail mail) using the Talking Points above; organize a “Save Medicaid for Us” Letter Writing event.
5. Go to Members’ websites and write them Emails or fill out the online form and let your opinion be heard. Organize an “Email to Save Medicaid” party.
6. If Members hold Town Meetings, show up, sit at the front and make the points above. If you have facts and figures about your state Medicaid program, be sure to mention that at the meeting. Tell ‘em what the cuts would really mean to you! Remember, personal stories stick in Members’ minds.
7. Be sure to state that you are a “registered voter” in any letter or at any Town Meeting.
8. If you are not a registered voter, go to your state election website at http://tinyurl.com/29x7g5a and register today!
9. If you see letters to the editor or op eds or TV news items decrying wasteful Medicaid spending, be sure to respond quickly using the Talking Points above.
10. Let AAPD know what you hear or learn in your meetings, via email to Policy@aapd.com  We can take your information – without your name -- with us when we meet any Congressional Members or Administration officials.

Health Care Reform Implementation: Feds Announce Lower Health Insurance Rates for People with Preexisting Conditions

via AAPD (6.1.11):

Health Care Reform Implementation: Feds Announce Lower Rates for Health Insurance for People with Preexisting Conditions

By David Heymsfeld, Policy Advisor, AAPD

On May 31, AAPD attended a press conference at which the U.S. Secretary of Health and Human Services (HHS) Kathleen Sebelius announced significant reductions in premiums for insurance for persons with preexisting conditions. This insurance is provided under the new health care reform act (the Affordable Care Act, or ACA). Also announced were new standards of eligibility to make it easier to obtain the insurance. These changes should be very helpful to people with disabilities who may have difficulties in obtaining health insurance at reasonable prices because of preexisting conditions.

Background: The ACA established a federally funded program (the Preexisting Condition Insurance Program or PCIP)  to offer health insurance at a reasonable cost to people who have been without insurance for six months and have been unable to get insurance because of a health condition. The PCIP program will be in effect between 2010 and 2014, at which time all health insurance will have to be open to people with preexisting conditions.

Under the PCIP program, states have the option of establishing their own programs (twenty-seven states do so) or letting the federal government establish the program (twenty-three states and the District of Columbia do so).  In both cases individuals purchasing the insurance must pay premiums comparable to those charged for regular policies in the state. Federal funding is available to cover costs beyond those covered by the premiums.

PCIP Program Status: To date, the program has had only limited effectiveness as in the first year only 18,000 people have purchased this insurance.  The Congressional Budget Office had estimated that there would be 200,000 enrollees by 2013. A major problem appears to be the high cost of premiums that people must pay for the insurance in many states.

Reductions in Premiums:  Under PCIP the premiums are established on a state-by-state basis, to be comparable to the costs of insurance in that state.  The May 31, 2011 reductions were designed to bring each state’s PCIP premiums closer to market rates. The reductions are as high as 40% in some states, and lower in other states. For example, in Florida where the reduction will be 40%, the monthly premium for a standard plan for a person over 55 will drop from $526 to $376.

In six states there are no reductions, because these states are already at market rates. The HHS action only dealt with the twenty-three states with programs run by the federal government. The states that run their own programs are being encouraged to take similar action.  Specific information on each state may be found at http://www.HealthCare.gov/news/factsheets/pcip05312011a.html.  

No Letter of Denial Now Needed: The other change is that applicants for PCIP will no longer need to submit a letter of denial from an insurance company. Under the new requirements applicants will be able to submit a letter from a medical professional stating that they have a pre-existing condition.

Advocacy Steps

1.  If you are currently uninsured because of a pre-existing condition, contact your state’s PCIP to enroll. To contact the plan in your state, go to https://www.pcip.gov/StatePlans.html

2.  Work to educate residents of your state of any reduction in premiums in your state.

2.  If your state is one that runs its own program, encourage the state to reduce premiums under the new federal guidelines. For a list of the states which run their own programs, see https://www.pcip.gov/StatePlans.html

Disability Health Care Coalition Survey: Need Your Participation by Tomorrow, June 1!

via AAPD (5.31.11):

Disability Health Care Coalition Survey: Your Participation Needed by June 1

AAPD is a member of a disability-based health care & assistive technology coalition known as The ITEM Coalition. More at http://www.itemcoalition.org/  ITEM advocates to make sure rehabilitative and habilitative services and devices are covered by insurance plans as the marketplace changes. To make sure this happens, ITEM is collecting information on typical coverage of these services and devices by employer-sponsored health insurance plans. We’re particularly interested in things like physical therapy, occupational therapy, speech therapy, etc. and devices  (durable medical equipment) and things like orthotics, prosthetics, or other assistive devices.

If you -- or someone you are responding for --  have health insurance through an employer and you have (or previously had) a disability or chronic condition, please take a moment to respond to this quick online survey called “Insurance Coverage of Rehabilitative and Habilitative Devices,” at http://www.surveymonkey.com/s/LY58SY5

 Your participation in the survey will help AAPD and our colleagues in the ITEM coalition ensure that healthcare reform best serves the needs of individuals with disabilities and chronic conditions. The survey has 10 questions and should only take 5 minutes to complete. Your responses will be kept anonymous. We will use the answers to make sure these things continue to be covered!

If you have questions about the survey or about the ITEM coalition, please contact Theresa Morgan at the ITEM Coalition via E-mail Theresa.morgan@ppsv.com