Saturday, October 27, 2018

Michigan's Direct Care Worker Staffing Crisis

Michigan’s Community Mental Health system serves people with intellectual and developmental disabilities, mental illness and substance use disorders. Crain's Detroit Business featured an article on 10/21/18 on the "Staffing Crisis of direct care mental health workers faces clients, families" by Jay Greene. The article covers a Crain’s health summit panel that was chaired by Robert Stein, the general counsel for the Michigan Assisted Living Association (MALA). MALA represents providers of assisted living and similar services including mental health services to people with developmental and other disabilities. [note: direct care workers are also known as Direct Support Professional or DSPs.]

According to Stein, “We have a real crisis with support services to people with disabilities…Wage levels are not competitive with retail companies, fast food restaurants and others. The funding levels have been constrained for many years.”

A MALA survey found “the average turnover rate for agencies providing staff is 37 percent, the starting wage is $10.46 per hour and the average number of open positions for full-time staff is 12 percent, 20 percent for part-time staff.”

Although the legislature “approved $64 million in additional funding in the fiscal 2018 budget to increase the average hourly rate by 50 cents..”, the panel characterized this as a “drop in the bucket”.

The article quotes Robert White, a parent advocate who has two adult sons with autism, as commenting that "Paying [direct service professional] $2 above the minimum wage (of $10 per hour) prevents more people from leaving the system. …We also need a supplemental budget in the lame duck session and future budgets to come [that] must have non-negotiated budget items. We can't kick the can down the road. It is an infrastructure requirement, a civil and constitutional right to have these services like good roads, good education and clean water to drink." [emphasis added]

Here is a quote from State Rep. Christine Greig, D-Farmington Hills, the Michigan House Democratic Floor Leader:

"I get really frustrated by state government and how we fund things,…We talk about integration. We should be talking about great quality care, not about money. You start from an outcomes standpoint. What does the provider, patient need in services. The money flows from that."

[I agree, and I wish more legislators and advocates would support this approach to funding services, rather than promoting the idea that full inclusion in the “community” is the highest and only worthwhile goal of our our system of services.]

The panel also discussed the kinds of things that direct care givers do:

Robert White says in response: ”My older son has high medical needs, 24-7 supervision, in taking the meds he needs, bathing ... nutrition, safety, socialization in the community…The home he is in is currently understaffed. Managers are actively taking shifts. Many caregivers work many shifts. There is mental and physical fatigue, possible errors. It is not their fault. They are truly their lifeline."

John Williams, executive director of Progressive Lifestyles Inc., pointed out that "A lot of staff work two and three jobs. It is unattractive to get involved. …in many cases, it is a very physical job with wide spectrum of disabilities. One day you will lift somebody from a wheelchair to a bed. (The next day) help people move in, repair a stove, fix a washing machine. It's a very demanding job."

According to the article, Stein said MALA and others are “starting a grass roots effort to lobby state legislators to add a line item in the Medicaid supplemental budget that would amount to an increase of 75 cents per hour.”

Wednesday, October 24, 2018

Vote411: Voter information from the League of Women Voters

Here's how to get the information on candidates and ballot issues that you need before you vote on November 6, 2018.

Go to VOTE411 and enter your street address, city, state, and zip code. Up pops your personalized ballot. Click away to find out more about candidates and other issues on your ballot. For example, here is the page that popped up when I entered my address in Washtenaw County, MI. Further clicking revealed my personalized ballot information .

There’s a lot to read, so allow time to study your ballot. 
In addition, here are local Washtenaw County videos of Forums and presentations.  

Two of the statewide ballot proposals on voting and redistricting are especially important. Here is a video presentation about them. 

This is a recorded discussion on Proposal 2, the Redistricting ballot proposal (a.k.a. Voters Not Politicians) that would create an independent citizens commission to draw the lines for legislative districts in Michigan. 

Here is another recorded discussion on Proposal 3 that seeks to make voting in Michigan more convenient, accessible and secure with 8 common sense improvements that would be secured in the Michigan constitution.

Sunday, October 14, 2018

2018 Together for Choice Conference, 10/17 - 10/19


Together For Choice is a national non-profit organization formed "to protect and advance the right of individuals with intellectual and developmental disabilities (I/DD) to live, work, and thrive in communities and settings of their choice." TGF is sponsoring a conference in Chicago, October 17 to 19, 2018. I regret that I will not be there, but I hope that others will attend and that there will be plenty to share with people who could not be there in person.

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Please join us October 17-19, 2018 on Misericordia's beautiful campus in Chicago.

Together for Choice is a national grassroots advocacy organization formally incorporated in 2017 with over 800 members in 47 states. Our mission is to protect and advance the right of individuals with intellectual and developmental disabilities (I/DD) to live, work, and thrive in communities and settings of their choice. We work with national networks, self-advocates, families, and service providers to advance choice, quality, and increased resources for the I/DD population. Since our incorporation, we have been educating the public and governmental officials on the need for Medicaid funding of choice-based housing and employment/developmental training models, as well as increased resources at the federal and state levels to ensure quality services. Our continued focus is to develop policy reform initiatives addressing the myriad of I/DD community needs.

Agenda and Conference Schedule


The conference includes an impressive array of speakers:

David Axelrod, Keynote Address

Rodney Biggert, "The Trials and Unanswered Questions of the 14(c) Certificate"

Taylor Brose, "The DSP Workforce Crisis: Finding Solutions"

William Choslovsky, "Protecting the ICF Entitlement: the Real Meaning of Olmstead"

Sr. Rosemary Connelly, RSM, Conference Opening Statements

Michael Diaz, "Creating Sustainable Community Partners to Enhance Service Options"

Jill Escher, "The National Council on Severe Autism: What is an Essential Care Non-Profit?"

Melissa Harris, "HCBS Regulation and Implementation"

Rob Johnson, Keynote Address

Jim Kokoris, Keynote Address: "A Special Life"

Paul C. Landers, "The DSP Workforce Crisis: Finding Solutions"

Christopher B. Lowther, "CMS's Medicaid Home- and Community-Based Settings Regulations: How We Got Here and Where We're Headed"

Crystal Makowski, Ed.D., "Where Do We Go From Here? Best Practices!"

Patrick Mannix, "America’s Workforce: Empowering All – Updates from the Office of Disability Employment Policy"

Molly Nocon, Housing Model Discussion

Philip J. Peisch, "CMS's Medicaid Home- and Community-Based Settings Regulations: How We Got Here and Where We're Headed"

Tuesday, October 9, 2018

Meet VOR: A Voice of Reason

This description of VOR, an organization that I have belonged to for over 15 years, was part of the packet of materials passed along to every member of the US House of Representatives and the US Senate in June 2018. Regretfully, I missed this year's VOR conference, but VOR's message is clear: even though we represent a small minority (about 5% of the I/DD population), we support a full range of services and residential options to meet the needs of all people with I/DD. 

"The goals of one group should never be placed at odds with the needs of the other. "

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Meet VOR:  A Voice of Reason, speaking out for people with Intellectual and Developmental Disabilities

For 35 years, VOR has advocated for high quality care and human rights for all people with intellectual and developmental disabilities (I/DD). Our membership is mostly comprised of families of individuals with severe or profound intellectual disabilities, often complicated by significant medical, psychological, or behavioral conditions. Many of our loved ones are non-verbal or non-ambulatory. Many engage in self-injuring behaviors. They often require 24/7 care, provided by well-trained and caring direct support professionals. Our family members constitute a minority within a minority. They represent about 5% of the entire population of individuals with I/DD. The home and community-based settings that work for many people with I/DD often fail to meet the needs of these severely disabled, vulnerable individuals.

To acknowledge the extensive range of needs and aspirations of all members of this diverse population, VOR supports Individual and Family Choice, and a Full Continuum of Care. In order to have choice, there must be a full range of quality options available, tailored to meet the intellectual, psychological, behavioral, and physical needs of this diverse population. One size never fits all. 


We support the goals of those who aspire to integrate into the society around them in their choices of residence, education, and employment. We also support the needs of those who would be endangered in an under-protected environment, who can never integrate fully because they cannot even perform the simplest of daily skills, like brushing their teeth, washing, toileting, or verbalizing their needs, their desires, their agitation, or their anger. The goals of one group should never be placed at odds with the needs of the other. We support all residential options, including the individual’s own home, family home, group homes, intentional communities, and larger congregate settings, such as public and private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF’s/IID, or ICF’s).

By the same principle, we support a full range of employment opportunities for people with I/DD. We support the drive for integrated, competitive employment and laud the proliferation of programs aimed at helping people with intellectual disabilities achieve their full potential. But we oppose the movement to eliminate center-based employment, sheltered workshops, and the movement to eliminate compensatory wages by eliminating Section 14(c) of the Fair Labor Standards Act. People who cannot compete in the open job market need this opportunity. They enjoy this level of work, the peer environment, and the opportunity to be productive. The movement toward competitive employment for some should not mandate the elimination of programs that work for others. 

There is no singular solution that is appropriate to all individuals with I/DD. Yet, this is the underlying premise of policies promoted by many powerful advocacy groups. This is a dangerous assumption, especially for the most vulnerable... 

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For more information on VOR, read more of the 2018 conference materials