Patti's Blog - Advocate for Elders, People with Disabilities and Their Families

Ensuring safe, quality home care

Patti's Comments: This is true for people with disabilities of all ages!

Excerpt from azcentral.com: (click for entire article)

Every day, tens of thousands of Arizona's most vulnerable seniors rely on in-home caregivers to look after them in their declining years.

These tireless aides spend hours helping with tasks the elderly can no longer do by themselves, from light housekeeping to dressing and bathing, and are often their only regular contact with the outside world.

But this burgeoning sector of the health industry remains virtually unregulated.

And as it grows rapidly in tandem with an aging population, there are concerns that it's employing too many unqualified workers and attracting a few unscrupulous ones who prey on the infirm by defrauding and abusing the very people they are paid to take care of.

Arizona is one of more than 20 states that don't license or monitor businesses that provide non-medical home care for seniors.

There are no rules that require the men and women who spend hours each week alone with elderly residents to know basic first aid or CPR. Nor are there any laws on the books that compel home-care companies to carry out criminal background checks on applicants, meaning ex-convicts can end up as caregivers.

"Anyone in the state can hang up their sign and get business cards and say, 'I have a home-care agency,' and the consumer doesn't know who is going to be going into the house or what background they have," said Gail Silverstein, president of Care Corner Personal Services, who is pushing for licensing laws.

"These are people who are going into the homes of vulnerable adults. There's a lot to be concerned about," she said.

Paralyzed patients fear their future if Medicaid is cut

Patti's Comments: These folks are certainly not the only ones worrying about all of this.

Excerpt from the Denver Post: (click for entire article)

A proposal to drastically cut the Medicaid reimbursement for two centers in Colorado that care for a unique group of severely injured patients has provoked panic among families and a promise from the state that no patients will be kicked out — for now.

Family members, who were first told of the cut last fall, were initially warned that they might have to move their loved ones out of Colorado in 2010, uprooting entire families to find care centers that will take their loved ones.

State Medicaid officials now say they are backpedaling from the cuts they initially proposed, but their signal that change is coming already has resulted in refusals to accept new patients by both of the Colorado long-term care facilities — Vista View Care Center in Thornton and Westwind Campus of Care in Pueblo.

"The bottom line is that the state prematurely made an unnecessary policy change that is ethically, logistically and fiscally unsound," said Ian Pearson, a paralyzed Thornton patient who types by using his eyebrow muscles and moving sensors on his forehead. "Colorado is effectively trying to save money by exporting and pawning off this patient population to other states."

Debating over the disabled

Patti's Comments: This debate should no longer be a debate!

Excerpt from The Sun Chronicle: (click for entire article)

Advocates worry state plan to shut developmental facilities will stunt care
The right to choose is taking on a new meaning in Massachusetts, as advocates take two sides of a very different issue: the closure of state facilities for the developmentally disabled.

Gov. Deval Patrick's Community First initiative, announced in December, will close four of the state's six facilities for the mentally and intellectually disabled, and move some 400 residents to community-based, state-operated group homes.

The administration's rationale, which has supporters among mental health advocates, is that moving the disabled into the community will improve the quality of life for former residents of state facilities and free up funds for other community-based services such as transportation, day care and job training programs for the former patients.

But other advocates, including family members of those who will be moved, are fearful their loved ones won't receive the consistent, regulated care that they get now.

Putting Your Faith in a Power of Attorney

Patti's Comments: Great article that outlines the pros and cons of a durable power of attorney!

Excerpt from The New York Times: (click for entire article)

TRUST and estate lawyers routinely tell their clients about the importance of signing a durable power of attorney. Often written at the same time as a will, it appoints a family member, friend or adviser as an agent to act on your behalf in financial and legal matters — even if you become incompetent.

But as essential as these documents are, they face new — and continuing — obstacles. One is using them amid the disruptions in the financial services industry. Another is an old problem that may have grown more acute after recent scams and frauds: Many people mistrust these documents, which give unbridled power to your agent. So some people sign them to appease their lawyers but never give them to the person designated to handle their affairs.

“A power of attorney is a license to steal,” said Bernard A. Krooks, a specialist in elder law at Littman Krooks in New York who nonetheless encourages clients to sign a power of attorney. “You have to be careful who you appoint as your agent.”

New Food Benefits for SSI Recipients

The following is an e-mail from The Arc Michigan:

New Food Benefits for SSI Recipients

As many as 80,000 Michigan senior citizens and adults with disabilities could automatically get help with their food budgets this year under a new federal pilot project.

The U.S. Department of Agriculture's Food and Nutrition Service granted Michigan a series of waivers allowing the state to implement the Michigan Combined Application Project (MiCAP). Under the project, adults who receive Supplemental Security Income (SSI), no other income, and who live independently could receive at least $60 each month in food assistance.

Currently The State of Michigan is mailing outreach applications to those who pre-qualify by standard mail. Read the application carefully and keep page 2 as it may answer most of the questions you may have about applying for food benefits from assistance with MiCAP. MiCAP is different from traditional food stamps or Food Assistance Program (FAP).

MiCAP benefits take up to 30 business days to process. If you have questions you may call the MiCAP phone number 1-877-416-4227. Phone hours are Monday through Friday 8:00 a.m. to 12:00 p.m. and 1:00 p.m. to 4:15 p.m. No holidays and weekends.

To find out more go to DHS Pub-50, Michigan Combined Application Project.

What is a Social Security fee petition?

A “fee petition” is a way your lawyer asks Social Security for fees for his services.

I though attorneys were paid a percentage of what I get?

Percentage-based contingency fee agreements are the most common way attorneys get paid in Slocial Security cases. However there are two ways an attorney might get paid.

Fee agreements based on a percentage of back benefits:
If you win, the attorney gets 25% of your back benefits up to a $6,000 cap (this is an increase from the $5,300 cap in effect before June 2009). The 25% or $6,000  is a standard fee agreement that Social Security will almost always approve if the case is won and results in back benefits.

Fee agreements based on a fee petition:
This is the wild west of fee agreements. Your attorney has to itemize his time and ask Social Security to be paid a certain amount. Social Security will approve whatever it sees fit, which may be more or less than $6,000.

When are fee petitions used?
Typically, fee petitions are required when the attorney works on an overpayment case. However, they are also necessary you hired two attorneys and the first attorney has not withdrawn or has not waived fees. This often comes up when a person has moved and had to hire a new attorney.

Fee petitions are also used if a person disagrees with Social Security approving the standard 25% fee agreement.  If that happens, the attorney must petition Social Security to have his or her fees approved.

Job Announcement from Brain Injury Association of Michigan

The following is an e-mail from The Brain Injury Association of Michigan:

The Brain Injury Association of Michigan is pleased to announce that the Michigan Department of Community Health has received another federal TBI Grant!   In addition to continuing our Veterans Program, BIAMI is hiring a part-time staff person to assist persons with brain injuries and their families receive services.  

Please forward this e-mail to anyone you feel may meet these qualifications and is interested in part-time employment.

Thank you
TBI Ombudsperson

The preferred candidate for TBI Ombudsman will be either a person with a brain injury, a family member of a person with a brain injury.  This person should have a bachelor's degree and a master's degree in counseling or similar field of study, preferred.  In addition, the candidate should have served for at least five years in a related position.  The TBI Ombudsman position will be a one-half (.5 FTE) full time equivalent position.

Travel is required to attend meetings with persons with a brain injury or their families to advocate on their behalf.  For more information, visit the BIAMI website to view the job description.   

Interested persons should submit their resume to cburda@biami.org

Brain Injury Association of Michigan
7305 Grand River, Suite 100
Brighton, MI  48114

(810) 229-5880
(810) 229-8947

website: www.biami.org
E-mail: info@biami.org

You have to be disabled for 12 months - the Durational Requirement

Excerpt from Social Security Insider: (click for entire article)

Have you ever seen this in a Social Security denial?

"While your condition may prevent you from working at the present, we do not feel that your condition will remain disabling for 12 months.

[Claim denied]"

First, Social Security says that you are disabled. Then, they deny the claim. What is going on?

To qualify for Social Security disability benefits, you have to be disabled. However, that is only part of the analysis.  Social Security also requires that your disability be expected to last for at least 12 months.

This is called the durational requirement. If your disability is not expected to last for 12 months, or does not actually last for 12 months (or longer), Social Security will deny the claim.

FIGHT FOR IN-HOME SERVICES IN 2010 STATE BUDGET!

Patti's Comments: The key message to give folks is that community based services are more cost effective then institutionally based services and the quality of care is maximized. It is a shame to see so many folks on the waiting list for waiver services.

Excerpt from

Area Agencies on Aging Association of Michigan Advocacy Alert: (click below link for entire article)

The Governor’s budget recommendation for FY 2010 included a $17 million increase for the MI Choice Medicaid Waiver program, but $2 million in cuts for in-home services funded by the Office of Services to the Aging (OSA).  The House of Representatives approved the MI Choice increase, and reversed the cuts to OSA.   The Community Health budget is now in the Senate. 

But it doesn’t look good.  A big drop in state revenues means it will be an uphill battle to hold onto the MI Choice increase and reverse the OSA cuts for next year.  The economic crisis is so bad, it forced the Governor and Legislature to make mid-year Executive Order cuts for FY 2009, including a $1.8 million reduction to OSA, and the elimination of Single Points of Entry.  Thankfully, there were no cuts to MI Choice or Home Help.

Your advocacy is needed to protect funding for home and community-based services in next year’s (FY 2010) state budget.  We’ve made progress in rebalancing long term care and going backwards is unthinkable!

Download Advocacy alert on fy 2010 budget 5-19-09

OCR issues revised guidelines concerning Section 504 protections for students with disabilities.

OCR issues revised guidelines concerning Section 504 protections for students with disabilities.

The U.S. Education Department’s Office for Civil Rights (OCR) has issued a revised guidance about the requirements of Section 504 with respect to students with disabilities.  Protecting Students With Disabilities, Frequently Asked Questions About Section 504 and the Education of Children with Disabilities, http://www.ed.gov/about/offices/list/ocr/504faq.html.  The primary purpose of the revision is to incorporate references to the Americans with Disabilities Act Amendments Act (ADAAA) of 2008.  OCR believes that it does not need to amend its regulations and states that it is interpreting Section 504 consistent with the ADAAA.  The guidance is in a question and answer format and discusses a number of issues in addition to the impact of the ADAAA on eligibility.  Several of them will be discussed here.

OCR discusses the appeal process that is available if an individual is not satisfied by the decision of the Regional Office.  First, the person may contact the OCR staff person whose name appears in the complaint resolution letter, identifying their concerns, factual or legal, with as much specificity as possible.  If that does not resolve the concern, they may send a request for reconsideration to the Director of the field office.  Finally, they may submit a written appeal to the Deputy Assistant Secretary for Enforcement.  Protecting Students, Quest. 8.

Regarding changes as a result of the ADAAA, OCR notes that its definition of major life activities is not exhaustive.  Therefore, additional examples in the ADAAA do not need to be formally included in amended regulations.  Id. Quest. 12.  Moreover, in light of the ADAAA, other than ordinary eye glasses or contact lenses, school districts may no longer consider the effects of mitigating measures.  Id. Quest. 21.  OCR then quotes the list of examples of mitigating measures from the ADAAA, which can include such things as medication, medical supplies, assistive technology, and “learned behavioral or adaptive neurological adaptations.”  Id.

Temporary impairments are to be considered on a case-by-case basis, considering the expected duration of the impairment and the extent to which it actually limits a major life activity.  Id. Quest. 34.  Moreover, persons are not to be “regarded as” having a disability if the impairment is transitory and minor.   A transitory impairment is one with an expected duration of 6 months or less.  Id.

OCR also clarified the circumstances where a student is required to be re-evaluated pursuant to Section 504.  Section 504 requires that re-evaluations occur “periodically.”  Id. Quest. 30.  In addition, re-evaluations must occur prior to a significant change in placement.  An exclusion from school for more than 10 school days is considered a significant change in placement.  “OCR would also consider transferring a student from one type of program to another or terminating or significantly reducing a related service as a significant change in placement.”  Id.