Friday, July 22, 2011

The Feds double standard on community living

Here is an interesting article by Sally Abrahms published in the AARP Bulletin for July/August 2011 on housing for homeless veterans.

"Homeless Veterans No More" describes a model program to house and provide services to about 40 formerly homeless veterans at the Gordon H. Mansfield Veterans Community in Pittsfield, Massachusetts. The veterans live in brand-new attached units in a development subsidized by the U.S. Department of Housing and Urban Development and the the Department of Veterans Affairs. Each veteran buys a limited-equity ownership in the development and pays about $7,000 in  rent per year with some of that refunded. In addition to earned income, they receive Social Security and veterans disability benefits

A non-profit organization, Soldier On, created the project and provides medical, mental health, and job training services on-site or at its transitional shelter building next door.

According to the article, of the 550 vets served per year by Soldier On, 88% have substance abuse issues and 84% have mental health issues. Most of these veterans not only were homeless, but they also have disabilities similar to non-veterans who are served through other federally-funded programs.

Compare this situation to non-veterans with disabilities who receive Home and Community Based Services (HCBS) through waivers that allow Medicaid funds to pay for services in the community. The same federal government that subsidizes and supports vets in the community described above is proposing to place similar communities off-limits for non-veterans with disabilities. The federal Centers for Medicare and Medicaid Services (CMS) characterizes these settings, especially larger congregate housing developments, as isolated, segregated, and not sufficiently integrated into the community to qualify as community based. In fact, for people with developmental and intellectual disabilities, CMS would not even call the Soldier On program a community, dismissing the idea that people with disabilities with common needs and interests might chose to live together for their mutual benefit.

If the programs and housing for homeless veterans were subject to the proposed rules from CMS and they had to rely on HCBS funding, they would suffer severe limitations:

  • The Mansfield Veterans Community is located next door to the transitional shelter building where many of the vets receive services. Under the CMS proposed regulations, that would not be allowed because CMS has determined that a setting that is "in a building on the grounds of, or immediately adjacent to, a public institution; or a housing complex designed expressly around an individual's diagnosis or disability" is not sufficiently integrated into the community.
  • Soldier On has received federal funding to build 60 homes on the campus of the VA Medical Center in Northampton, Massachussetts, a program that would not receive Medicaid funding or support under the proposed CMS rules. The VA Medical center has 85 psychiatric beds and a 66-bed nursing home care unit located on the Northampton campus, making it too institution-like for the CMS, regardless of whether residents could use the services provided there.
  • Residents at the Mansfield Veterans Community have a great deal of personal freedom and independence, but there are rules they have to follow. They are accountable for their actions, such as for not paying their rent on time or having a drug or alcohol relapse. CMS proposals would only allow settings that do not impose rules on residents that could limit "daily life activities". It is questionable whether the restrictions imposed  on the veterans would be tolerated by CMS  if a disabled non-veteran needed and chose to live in a similar setting.
Of course there are differences in the population of homeless disabled veterans and people with developmental and intellectual disabilities, but there are a lot of similarities such as stigmatization by society, difficulty being accepted and integrated into the community, and numerous unmet physical and mental health needs.

In the case of people with developmental and intellectual disabilities, despite all the lip service paid to "self-determination" and "independence", the federal government and government-funded advocacy organizations believe that they know better than people with disabilities and their families what they should want and need. To unnecessarily limit options available is an impediment to creating a system of care that can truly meet the needs of this diverse population.

1 comment:

David Hart said...

To the author great blog!!! after reading both the AARP story and your insights, I am more upset now than ever.

Who doe CMS think they are?

These veterans gave their lives to protect us. We do not honor them correctly. For example in November "Vetrans Day" has become a "watered down", "trade a day" holiday. And to not give them the best care avaiable is a crime.

We need to define community. If the Solider On plan is not a community then what is? And setting rules that need to followed and having accountability only helps the individual grow and get better.
As you said there is a big difference between Vets and individuals with ID/DD and their guardians, but they do have at least one thing in common; and that is they have the right to live where they want to. If that is on the grounds of a VA hospital in new housing or in an ICF/MR facility/community or in the community under a waiver then so be it.