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

Are Charter Schools Discriminating Against Persons with Disabilities?

Charter schools in Florida and elsewhere are not admitting students with disabilities.  http://www.npr.org/2011/12/14/143659449/florida-charter-schools-failing-disabled-students.

While they claim they do not turn away students because of their disabilities, they do say they are not equipped to meet their needs.  Of course, then, one has to ask why they are not so equipped.  They are publicly supported.  Of course, not every public school is equipped for every student either, but students are more likely to have their needs met at most public schools. 

Part of the problem is that students with disabilities most often have Individualized Education Plans (IEP’s) and those IEP’s will not send a child to a school that cannot meet their needs. 

Some charter schools specialize in children with disabilities, but that is just another form of segregation and, unless it is really impossible to meet the needs of these students elsewhere, special schools are a giant step backwards. 

How widespread is this problem?  What are the solutions?

Annette Bourbonniere

www.accessing-ability.com

access-ability.verizon.net

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

Using iPads for Voting

Oregon has begun implementing the use of iPads to assist voters with disabilities. http://www.nytimes.com/2011/11/17/us/oregon-tries-out-voting-by-ipad-for-disabled.html?_r=1 Election workers bring the iPads to the voters’ homes or nursing homes, along with a portable printer.  Because there is the ability to enlarge the view for persons with visual impairments and because there is no need to be able to grasp a pen for marking the ballot, this use of technology has the potential to solve a number of problems for voters with disabilities.  Once the ballot is completed, it can be printed out and approved by the voter before mailing or being brought to election stations.  Screen readers can read back the ballot before printing for those who cannot see it to review it.

As more counties and states try this out, it is likely they will look at it as a way for other voters to cast their ballots as well.  Once again, an accommodation will become an innovation.

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

Primary Care and Healthcare Access

Another healthcare issue for persons with disabilities is physical access. 

Physical access goes beyond ramps and elevators.  It includes restrooms, exam rooms and any other room or space that is ordinarily accessed by patients.

There are standards for all accessible bathrooms put out by the Federal Access Board.

More recently, this same Federal Access Board has published guidelines for accessible healthcare facilities.  These guidelines include adequate space between and in exam rooms, accessible exam tables, lifts, scales and other equipment.  Almost no healthcare facilities meet these guidelines.

Primary care providers are the ones who see persons with disabilities the most, since they are in charge of coordinating all the other care.  Yet, these very same providers are paid the least and so are least able to afford the equipment needed by persons with disabilities.  This puts all of us who need this type of equipment at a disadvantage.

This is one more reason that this country needs to address the issues related to primary care.  No healthcare system, managed care, fee-for-service, or any other configuration, will work until we can provide stable, quality, accessible primary care.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude