Reviewing the System Is Only Part of the Answer

Reviewing the system for awarding disability benefits is necessary but it will not solve the real problem.http://online.wsj.com/article/SB10001424052970204844504577098810070396878.html?mod=rss_Health

It is true that the trust fund for Social Security Disability benefits is running out of money and will not survive another decade.  It is important that this system get reviewed.  However, just reviewing this aspect of the system will not even come close to resolving the issues both the government systems and persons with disabilities face.

One problem we have is that we keep trying to fix pieces of the system.  Our disability policy has more Band-Aids than substance at this time.  But, it appears that we will keep on adding more.  It is a system that is based on the fact that, in the past, persons with disabilities were totally incapable of substantial gainful employment and were likely to die in a few short years.  That is no longer true, but the policy has not changed.

If we had a disability policy and system that reflected today’s reality, we could save the government a great deal of money and, at the same time, make life better for persons with disabilities. 

As things stand now, most people who receive disability benefits live in poverty and are forced to remain in that state in order to receive critical services.  At the same time, persons with disabilities are viewed as lazy (just check the comments at the end of the article) and unwilling to work.  This perception is perpetuated by the lawyers who advertise that people are entitled to these benefits, as though a life of poverty were something to strive for.

It is really time to look at the big picture.

Annette Bourbonniere

www.accessing-ability.com

Twitter:  @AccessInclude

Is Managed Care the Answer for Dual Eligibles?

Is managed care the answer for dual eligibles?

More and more persons with disabilities are among the growing number of dual eligibles, i.e. people eligible for both Medicare and Medicaid coverage.  Persons with disabilities are eligible for Medicare either because of age or their disability and are eligible for Medicaid because of the poverty that has been forced upon them. 

There are good arguments both for and against managed care for this population, as can be seen from this article in the LA Times:  http://www.latimes.com/news/local/la-me-healthcare-duals-20111114,0,3197520.story.

Whatever we do to make healthcare better for this population now, we need to be realistic about how this problem came about and decide how to prevent this in the future.  What we do now is focus on one aspect of policy at a time and try to put a bandaid on it.  What we end up with is an unwieldy and unworkable system. 

A disability policy that is based on current reality, that does not force persons with disabilities to live in poverty in order to obtain critical services is needed soon.  Current policy is so expensive the system is about to implode.  It is possible to have a policy that saves government many dollars and still improve the lives of persons with disabilities. 

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Proposed New Rules for Federal Contractors

The Obama Administration has proposed new guidelines for hiring workers with disabilities that would require all federal contractors to set goals of having 7% of their workforce composed of persons with disabilities.

Certainly, this will add some muscle to the Americans with Disabilities Act, since it requires action which is stronger than the passive of not discriminating.  Of course, there will be the ever-present paperwork needed to document this effort and businesses will object to that, as they have objected to paperwork requirements of Affirmative Action and the ADA. 

Some other concerns include how to document this 7% since the ADA does not allow you to ask about disability.  That’s not quite true, though, is it?  AFTER a person is hired, it is allowed to ask disability related questions and, if the response is voluntary, this documentation can be accomplished. 

What I find exciting about these new guidelines is that federal contractors will have to document their efforts to recruit individuals with disabilities.  This outreach is crucial to all successful employment programs and needing to document it will ultimately lead to workforces that are more inclusive of persons with disabilities.

This will not resolve all the employment issues of persons with disabilities, but it is a giant step in the right direction.

You can read the notice of proposed rule-making or submit a comment at http://www.regulations.gov.  Comments will be accepted until February 7, 2012.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Why Disability Policy Needs to Change

We talk about the need for disability policy to change, and people wonder how big the problem is.  Consider this scenario.  It is only one person, but it is a realistic reflection of how disability policy works now.

A woman with a disability makes the decision that working is better than not working, even though she is not able to get health insurance because of her disability.  Of course, since she has no insurance, she never really gets ahead.  However, she considers work to be therapeutic and continues. 

As time goes on, the aging process catches up with her and she is diagnosed with a chronic disease on top of her original disability.  Now there is a significant cost added and she just plain cannot keep up.  Since she is working, she is not eligible for any assistance.  Over time, she loses all that she owns and even becomes homeless.  Ahh!  Now she is eligible for assistance.  She gets disability benefits (since she cannot work during this process), medical assistance (what she most needs) and subsidized housing.  Now she can begin putting her life back together and get back to work.  Right?

Of course, there is the need to continually report and qualify for her benefits.  Every program requires its own reporting, even though they all use the same information.  Some programs even require reports two or three times a year.  This really does nothing to motivate or improve self-esteem.  It is a real downer.  It also forces her to keep her income to a level that does not put her over limits required for receiving assistance.  No way to get ahead.

But, she manages this and is at least grateful that her medical expenses are covered.  She gets the adaptive equipment she needs and takes care of herself medically.  Then it happens.  She turns 65 and it all changes.  Her $700 a month in Social Security benefits gets cut by $115 to pay for Medicare.  Then she finds that her medications are not longer completely covered.   With the extra help available, her plan D provides for a lower copay.  She needs only to pay $1.10 for generic medications and $3.30 for name brand medications, for covered drugs.  And that’s the catch.  “Covered drugs” does not cover all her medications.  Other medical supplies are also cut, mostly in half.  Medicare only covers adaptive equipment that allows her to function in her home.  What is needed to go outside and have any kind of life is not covered.  Added up, her medical expenses again eat up most of her income.  The prospect of again becoming homeless looms.  There is really no way out.

At what point does any of this make sense? 

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

The problems with disability policy based on medical model

When disability policy was developed, disability was viewed in the medical model.  The understanding was that the person had a medical problem that was in need of fixing and that, until that medical problem could be fixed, that person was unable to work.  If the medical problem could not be fixed, the person would be considered totally and permanently disabled. 

We put physicians and other medical providers in charge of whether or not a person could work, whether or not a person receives various disability benefits and what services and accommodations a person with a disability needs. 

While we are inundating medical providers with paperwork to attest to these things, no one seems to take into consideration that they are not the ones with all the answers. 

While most disabilities have a physiological beginning, that doesn’t necessarily mean they need or will respond to medical interventions.  For example, if a person is in an accident and incurs a brain injury, the disability can be permanent.  However, the time for effective medical therapy is only for a short period after the injury.  If the person still has the disability after 20 years, what do we expect a physician to do? 

Some disabilities are the result of medical conditions that need ongoing treatment, but many do not need medical intervention.  Yet, we put them all in the same category and require that there be medical documentation of all kinds of things related to disability. 

In the meantime, since most medical providers have the same view of disability as the average population, they are responding with the viewpoint that they are supposed to be able to decide major life issues for these people.  Should the person work?  What are the person’s transportation needs?  Does a person need a roll-in shower?  What about a parking pass?  Should the person be in a nursing home?  If so, can we keep the person out with appropriate services?  What services?  (Read the last three again to note the irony.)

Removing disability issues from the medical establishment could benefit persons with disabilities, ease the burden on medical providers and reduce costs for society.  Since the medical model is now recognized as not appropriate for determining disability, let’s next consider what the basis for disability needs to be.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Gong on Disability No Panacea

Social Security Disability, Supplemental Security Income, Medicare and Medicaid are all in jeopardy.  The growth in recipients cannot be sustained.  However, the standards for receiving Social Security Disability and SSI have eased.  At one time, the standard was that the recipient could not engage in any substantial employment at all.  Now there are television lawyers who promise people that they are entitled to these benefits and that they will help them receive them.

What most people do not realize is that “going on disability” is not finding a pot of gold at the end of the rainbow.  In general, it means living in poverty.  Having nothing to do and no money to do it with it is a common complaint from people who are on disability.  Which brings us to the fact that working is a quality-of-life issue at least as much as a need-to-work-to-pay-my-bills issue.

At this time, people legitimately receive disability benefits for three reasons:  1)  They really and truly cannot work (this is a small percentage of recipients); 2) They are unemployed due to discrimination because of their disability (ADA needs more enforcement); and 3) They need to be on disability to receive essential services that are not available unless someone is on disability.

Clearly, we need to address how disability policy works in this country so that people are not forced to live in poverty simply because they have a disability.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Taxi Please!

Why does it have to be so difficult to enforce the federal Americans with Disabilities Act?

In New York City, the city agency that governs taxis doesn’t think that having more accessible taxis is worth enforcing.  http://www.newmobility.com/articleViewIE.cfm?id=11939

Not only would requiring taxi companies to make all new taxis wheelchair accessible not cost the city a single dime, it would save the city significant money since it would reduce the dependence on the Access-a-Ride that is funded by the city.

So, what is the resistance?  This resistance is widespread and truthfully makes no sense. 

Businesses resist providing access since they never look at the benefits, only the costs.  But the truth is that state and city governments turn a blind eye to access issues on a regular basis also.  This blind eye is not only toward their own access responsibilities, but cities are consistently unwilling to enforce access laws in their communities.

A question that all state and city governments should ask is whether they would tolerate discrimination toward any other minority.  Or, would they tolerate businesses that put out signs saying that persons with disabilities are not allowed in?  If they would not tolerate discrimination toward other minorities or businesses that put out signs that verbalize their discrimination toward people with disabilities, they should not tolerate discriminatory actions or omissions.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

We need a new system before cutting out the old

Both the federal government and individual states are putting on pressure to cut Medicaid benefits to persons with disabilities.

There are some services required by persons with disabilities that are only covered by Medicaid and are too expensive for the average person to afford without assistance.  The way disability policy works in this country and in most states is that persons with disabilities (or the parents of children with disabilities) need to impoverish themselves in order to qualify for these services.  The only other alternative is to work for the sole purpose of paying for these services and living in poverty anyway.  Even then, there is no guarantee that these individuals and families could afford these services without assistance.

After forcing these people to live in poverty in order to have critical services, the government now wants to cut these services.  While that is probably legal (barely), it can hardly be considered moral.  Persons with disabilities have no cushion to fall back upon, since that is not allowed, and so-called work incentives have such limits that they are not the success that was anticipated.  At the very least, a new system should be in place before pulling the plug on the old one.

If anything points out the failure of disability policy in this country, this is it.  No other minority is forced to live in poverty in order to survive.  Add to that living in constant fear that what is needed for survival will be taken away, it’s no wonder work incentives have little power to motivate. 

What we need is a policy that treats persons with disabilities like valued human beings.  Rather than forcing them to live in poverty and then trying to motivate them to get off the system we forced them into, we should avoid putting them in the system. 

There is probably not much we can do about moving persons currently on disability, who have been living in poverty without any cushion, into a new system.  However, we can avoid putting more people into this system that does not work and cannot work. 

The system we have now has no more validity.  It was designed for a different time in history.  There is nothing that can fix it.  Certainly not taking away services without putting in place a system that works for our time. 

The question is whether or not governments have what it takes to build a new, workable system.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Second Rule of Construction

The second rule of construction for determining whether a disability “substantially limits” a person states:  An impairment is a disability within the meaning of this section if it substantially limits the ability of an individual to perform a major life activity as compared to most people in

the general population. An impairment need not prevent, or significantly or severely restrict, the individual from performing a major life activity in order to be considered substantially limiting.

Nonetheless, not every impairment will constitute a disability within the meaning of this section.

The EEOC is making it clear that a disability only has to limit the ability to perform a major life activity when compared to the performance of most people.  Again, the interpretation is broad and meant to include more people than fewer people.  A person can be limited in without being restricted from performing this major life activity.  This rule also allows the comparison to be to one’s peers rather than to most people.  It also allows the limitation to be compared to how the same individual performed without the limitation.

As this rule follows the one that says the term “substantially limits” needs to be expansive, there is again a clear intention to change the focus from the decision about who is to be included to the act of discrimination. 

But that does not mean that there is no standard.  As broad as the standard may be, a standard does still exist.  Not all impairments cause the person to be limited. 

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Senator Harkin's Address to U.S. Chamber of Commerce

Last week, Senator Tom Harkin (D-IA) addressed the U.S. Chamber of Commerce to talk about why Americans with disabilities are leaving the workforce in such high numbers.   The full text of his address is found at http://harkin.senate.gov/press/release.cfm?i=332449. 

The high rate of unemployment of persons with disabilities is a very complicated and complex issue.  There is still a great deal of discrimination toward persons with disabilities in the workplace, due in part to the low expectations of persons with disabilities that employers who have no experience with employees with disabilities have. 

Even diversity specialists have difficulty trying to find where to fit persons with disabilities.  Some think they need to establish call centers.  Others think that telecommuting is the answer.  I have even heard them label persons with disabilities as “differently abled” because they are afraid to note that they have disabilities.  Clearly there is a huge need for education and enlightenment.

All is not lost, though, when you realize that a company such as Walgreens actually sets internal goals of the percentage of employees with disabilities they will hire.  While these goals currently apply only to their distribution centers, I would hope that they will expand them to their overall employment plan.

Other factors affecting the employment of persons with disabilities include the perverse disability policies on both the state and national levels where even so-called work incentives build in serious limitations on how far a person with a disability can go before being at risk of losing the very services that allow them to work.  At the same time, we have lawyers selling disability as a desirable way of life.

We do need to approach this from all angles and Senator Harkin is certainly to be applauded for his efforts in this regard.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

The Disability Impact on Budget Problems

The government has budget problems – big budget problems.  One major problem is the expansion of Medicare and Medicaid. And, a significant part of that problem is due to disability policy and the way it is managed in this country.

As it works now, in order to get your disability covered under any kind of health insurance, it is necessary to “go on disability”, which means to stop working in order to qualify.  In order to get some of the specifically disability related services that persons with disabilities need in order to work, it is necessary to stop working.  If that sounds like a perverse system to you, you are not alone. 

This is a system that came into being when persons with disabilities were not able to work.  The technology that exists today was not available.  Many persons with disabilities were institutionalized and many died prematurely because of complications.  The current system helped to support these people in the community so as to reduce institutionalization. The level of support is minimal but, since persons with disabilities essentially had no life, it was adequate. 

For some reason, there has been the perception that persons with disabilities were living great lives without the need to work.  There is even an entire industry that promotes going on disability, as though that is a goal worthy of effort.  After all, some of them say, you pay into the system, so you are entitled.

The truth is that going on disability is the first step on a path that leads to a life of poverty in a system from which it is nearly impossible to escape.  At the same time, the system on which all these people are dependent is going to implode.  There are so-called work incentives geared to aid transition off of disability, but the system is considerably more complicated than these incentives imply.  In fact, the average person with a disability would have to earn $50,000 per year to simply replace the services needed.  $50,000 will still guarantee living a poverty level, but the services will be paid for.  That is not exactly an incentive to work.

The answer is a change in disability policy that allows persons with disabilities to work without being penalized.  It will require a radical shift but everyone, including federal and state budgets, would benefit.

                                                                                                

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Why Does Disability Have to Equal Poverty?

Disability equals poverty – most of the time.  The system created by disability policy perpetuates this status.  Why does that have to be?

First of all, having a disability is expensive.  We know that.  Wheelchairs, guide dogs, special transportation, personal care assistants, etc. are part of what make our lives work.  These are expenses over and above what the average person needs to pay in order to survive. 

In order to get any assistance with these additional expenses, it is required that a person “go on disability”.  If it is Social Security Disability that we are talking about, there is a six-month waiting period between work and the payment of benefits – if there are no delays.  Six months of extraordinary expenses and no income are not the stepping stones to wealth. 

For assistance with some benefits, you are required to have income below what is necessary to live.  And you have to remain there.

To be sure, there are what are called work incentives.  These would allow a person with a disability to return to work and temporarily maintain some of the necessary benefits.  Sometimes, it’s even possible to buy into a system that will provide these critical services.  But, there is a hitch.  There is a ceiling, a very low ceiling, below which your income must remain.  Reach or exceed that limit and all benefits disappear, whether or not you really have the income to cover them.  Since assets must also be limited, it is extremely difficult, even for the most motivated person to make that transition.  Poverty reigns and the system makes sure that it does.  There is no way out for most.

There are those who believe that this is a conspiracy perpetrated by government employees so that they may remain employed.  I have another view. 

We have a system that was designed to support persons with disabilities when employment and the technology that supports it were not available.  If persons with disabilities lived at all, they were often in residential settings and certainly not living full lives.  As life, technology and potential improved, the system did not keep up.  There have been band aids added to try to fix one aspect or another, but the system itself is the same.

For those who have already been pulled down into the system, changing disability policy could be adding insult to injury.  But, creating a new disability policy that would take effect at a defined time and would cover all new disabilities, whether incurred through birth, illness or injury,  needs to happen.   Soon.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Is Medicaid Collapsing?

Over the past 10 years, Medicaid enrollment across the 50 states has grown by approximately 50% according to a study by the Kaiser Commission. (http://www.kff.org/medicaid/upload/8050.pdf)    Of course the economy has contributed to this, as has the rise in health insurance costs, leading many employers to drop health insurance as a benefit.  However, disability policy has played a significant role in this as well.

Current disability policy dictates that persons with disabilities declare themselves unable to work and impoverish themselves in order to qualify for Medicaid, which will cover critical services that are not covered under private insurance policies.  The problem with this is that people who may be able to work are removed from the employment – and tax –rolls and become dependent on public support. 

In an economy that is as stressed as our current one is, this makes no sense.  To make matters worse, many states are now cutting the services provided, leaving many persons with disabilities with no recourse – No money and no support. 

There are programs that attempt to patch this system, but it’s like playing Whack-A-Mole.  A bandaid on one problem creates another problem in the system.  It’s time to face the reality that the current system is unsustainable. 

Building a new system from the ground up will require courage, but maintaining the status quo has no future. 

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Diversity Inc. Publishes Top 10 Companies

Diversity Inc. has published its top 10 Ten Companies for Recruitment and Retention http://www.diversityinc.com/article/8326/The-DiversityInc-Top-10-Companies-for-Recruitment--Retention

These companies all include disabilities in their diversity plan.  But, how do they recruit persons with disabilities when identification of persons with disabilities is not clear. 

It’s easy to identify persons who use wheelchairs or who are blind and some others, but what about people with perceptual problems or behavioral health disabilities or cancer or HIV/AIDS?  Many persons with disabilities do not disclose their disabilities because of their realistic concern that they will face discrimination. 

Another question is for what kind of jobs are persons with disabilities recruited?  Are they specifically recruited for call centers and other low-end jobs or work-at-home situations or are they recruited for all jobs?  What are the opportunities for advancement for persons with disabilities?

I’m not saying that these 10 companies fail in these areas because I honestly don’t know.  These areas are issues that many companies fail to address and these questions are questions that all companies should ask of themselves.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Why Are Healthcare Providers Responsible for Disability Issues?

Why do we insist on making doctors or anyone in the healthcare system responsible for disability issues?

The reality is that disability is not a medical issue. The cause of it may have been and complications may also be medical issues, but the disability itself simply exists. Except for the very temporary kind of disability, there is not much that health-care providers can do to change the existence of a disability itself. Nevertheless, we require medical documentation to collect disability benefits, to get parking passes and bus passes, to prove the need for subsidized housing or to qualify for government health benefits and some employers require medical documentation when employees request job accommodations.

Health-care providers, for the most part, have a very poor understanding of what a disability is and what the disability system is. There is nothing in their training that prepares them for this. They often believe that the compassionate response to requests for documentation is to encourage persons with disabilities to apply for Social Security and stay home. They have no idea that this type of response could doom their patients with disabilities to a life of poverty and boredom.

How can this system be right?

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Has the ADA Improved the Lives of Americans with Disabilities?

The Kessler foundation and the National Organization on Disability released its survey looking at quality of life measures for persons with disabilities. http://www.2010disabilitysurveys.org/pdfs/surveyresults.pdf

The survey shows where the ADA has generated progress and where there are still significant gaps between Americans with and without disabilities.  Employment of persons with disabilities still lags far behind employment of persons without disabilities.  Consequently, household income and those areas where income significantly affects participation also lag behind.  According to the report the gaps between Americans with and without disabilities show that persons with disabilities were much more negatively affected by the economic recession.  No surprise there!

Disability policy in this country mandates that persons with disabilities impoverish themselves in order to qualify for critical services that are not covered under traditional insurance.  In order to regain financial independence, we have a longer way to go than those without disabilities.  While there are well-intended patches to this system, there is little likelihood these patches will result in great changes.  A total overhaul of disability policy is in order.

The survey did show a couple of areas of progress;  There has been improvement in the numbers of Americans with disabilities who have attained educational levels that should result in improved employment outcomes and there has also been an improvement in political participation by persons with disabilities.  Both of those areas of improvement bode well for the future.

Read the full study to see where the ADA has been effective and where we still have lots of work to do.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude