March 4, 2022
VOR Weekly News Update
VOR is a national non-profit organization that advocates for
high quality care and human rights for all people with
intellectual and developmental disabilities.
VOR promises to empower you to make and protect quality of life choices for individuals with developmental disabilities
VOR & YOU:
March is
Developmental Disabilities Awareness Month

In 1987, President Ronald Reagan recognized Developmental Disabilities Awareness Month to “increase public awareness of the needs and the potential of Americans who face developmental disabilities and to provide the opportunities they need in order to live productive lives and to achieve their full potential.”

A developmental disability is defined as a mental or physical disorder that begins from the ages of 0-22. The person must have at least three functional limitations such as learning, mobility, self-care self-direction, capacity for living independently and economic self-sufficiency.


Spread Awareness of Developmental Disabilities
This is a great time to spread awareness of your loved one, their disability, and the environment in which they live, learn, or work.

Please reach out to your elected officials and invite them to meet your family member with I/DD and tour the facility they call home, see them at school or in their day program, or visit the facility at which they work with the benefit of a 14(c) certificate.

If your elected officials aren't available this month, schedule a visit for the months ahead.
So many of our ICF campuses are at their prettiest in the months of May and June!
SAVE THE DATES!

VOR's Legislative Initiative, 2022

Sunday, May 15, 2022
On Zoom
To be followed by Zoom meetings with Congressional Offices May 16 - 19

VOR Annual Meeting

Sunday, June 12, 2022
On Zoom

Due to the ongoing Covid pandemic and the continued lock down of many congressional offices in Washington, D.C., we are holding our annual events online via Zoom again this year.
We ask members to please mark the dates in your calendars.
More information on how you may participate in these events will be coming soon.
National News:
Private Equity Takes Aim At Disability Services
By Shaun Heasley, Disability Scoop, March 4, 2022
Private equity firms are increasingly investing in services for young people with autism, intellectual and developmental disabilities with potentially troubling consequences, a new report warns.
The firms, which aim to maximize profits quickly, are buying up companies in all types of behavioral services, a field that has traditionally been left to nonprofits.

In addition to disability services, private equity is taking over programs catering to youth in foster care, the juvenile justice system and troubled teen programs, according to an analysis by the Private Equity Stakeholder Project, a nonprofit that works to shine a light on the industry.

The report includes a listing of more than 60 service providers — many of which operate in multiple states — that have been purchased by private equity firms since 2006.

Private equity has a track record of reducing staff, using unlicensed staff, providing inadequate training, low pay, overlooking maintenance and other cost-cutting measures that can lead to abuse and unsafe conditions, the report says, citing cases where youth were left in “horrific conditions” while private equity owners raked in profits.
For example, the Private Equity Stakeholder Project notes that Centerbridge Capital and the Vistria Group have taken in nearly $500 million in debt-funded dividends in just two years of owning The Mentor Network, which provides foster care as well as residential and community services to children and adults with intellectual and developmental disabilities. This comes even as the company — which as of September is now called Sevita — has faced “numerous allegations of widespread abuse, neglect, and deaths” over the last two decades.

“Private equity firms often aim to double or triple their investment over 4-7 years. The pursuit of these outsized return expectations over relatively short time horizons can lead to cost-cutting that hurts care,” the report states. “Limited regulation of youth behavioral services coupled with the private equity playbook of maximizing profit over short time horizons raises profound concerns about the increasing investment by private equity firms in the sector.”
CMS Wallops Nursing Homes with Planned Staffing Requirements and Increased Penalties
By Danielle Brown, McKnight's Long-Term Care News, February 28, 2022
The Centers for Medicare & Medicaid Services will establish minimum staffing requirements as part of a broad plan to “crack down on unsafe nursing homes,” the White House announced on Monday.
The agency said it plans to conduct a new study to determine the level and type of staffing needed to ensure safe and quality care and will issue proposed rules within one year.

The reform measure is part of four new initiatives to ensure that residents get the quality care they need, according to the White House. President Joe Biden plans to raise the initiatives, which are sure to chafe nursing home operators, during his State of the Union address Tuesday evening.

Biden also will call on Congress to supply almost $500 million to increase CMS’s survey budget by nearly 25%, an administration statement said.
The new initiatives also include plans to reduce resident room crowding, with CMS planning to explore ways to accelerate phasing out rooms with three or more residents and to promote single-occupancy rooms.

The agency also intends to update the Skilled Nursing Facility Value-Based Purchasing Program by proposing new payment changes based on staffing adequacy and the resident experience, as well as how well facilities retain staff.

Lastly, the agency will launch a new effort to identify what it calls problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications.

The administration announcement took especially harsh aim at private equity’s ownership of nursing homes.

“Private equity firms have been buying up struggling nursing homes, and research shows that private equity-owned nursing homes tend to have significantly worse outcomes for residents,” a fact sheet provided by the White House said.

It noted that private equity firms’ investment in nursing homes “has ballooned” from $5 billion in 2000 to more than $100 billion in 2018, with about 5% of all nursing homes now owned by private equity firms.

It explained a recent study found that residents in nursing homes bought by private equity were 11.1% more likely to have a preventable emergency department visit and 8.7% more likely to experience a preventable hospitalization, when compared to residents of for-profit nursing homes not associated with private equity.

Another examination over 17 years , a working paper, examined 18,000 nursing facilities and found that private equity ownership increased “excess” resident mortality by 10%, increased prescription of antipsychotic drugs for residents by 50%, decreased hours of frontline nursing staffing by 3%, and increased taxpayer spending per resident by 11%.

“That suggests an additional 20,150 lives lost as a result of private equity ownership,” the administration said. Another study found that private equity-backed nursing homes’ COVID-19 infection and death rates were 30% and 40% above statewide averages, respectively.
Government Watchdog Raises Concerns About Abuse At Residential Facilities
By Shaun Heasley, Disability Scoop, March 1, 2022
More should be done to ensure that abuse does not go unnoticed at residential schools and other similar facilities serving youth with disabilities, government investigators say.

A new report from the Government Accountability office finds that local, state and federal agencies are not sufficiently coordinating their efforts to monitor residential facilities for young people with disabilities and those in foster care.

Investigators interviewed officials in Arkansas, California, Massachusetts and Washington, D.C. responsible for overseeing residential facilities serving those in the child welfare system and residential schools paid for by Medicaid, the Individuals with Disabilities Education Act or other federal sources. They also spoke with stakeholder groups and examined state laws and regulations.
The report found that different interpretations of what counts as maltreatment can lead facilities to report too many or too few incidents. It is primarily up to state and local agencies to oversee these types of facilities, but government investigators said that they were told “states face some challenges related to data collection, training and imposing consequences and holding facilities accountable for maltreatment in these facilities.”

The report recommends that the U.S. Department of Health and Human Services work with the Department of Education to help states share information about best practices for preventing and addressing mistreatment in residential facilities.
Programs for People with Disabilities Still Await Funding
By Andy Miller (Georgia Health News) & Lauren Weber (Kaiser Health News) via the Atlanta Journal-Constitution, March 2, 2022
Matthew Southern, 35, who has intellectual and developmental disabilities, is able to stay out of an institution because health aides paid through a Medicaid program assist him and his roommate with ordinary tasks.

But amid a worker shortage worsened by the pandemic, Southern’s father, Dan, has had to step in to fill in gaps in his son’s care by volunteering at their Lilburn home, 45 minutes away from his own home in Kennesaw, a northwestern Atlanta suburb. He blames the low pay across the industry.

“No one wants to work for $12 an hour,” Dan Southern said. “People can work at Burger King and make more money.”

Last year brought an injection of hope: The federal government, through the American Rescue Plan Act that President Joe Biden signed into law in March 2021, increased funding with a 10-percentage point match that could amount to some $25 billion in federal money for Medicaid home and community-based services, which have long faced staffing crunches.

That massive infusion of cash could be used by states to buttress wages, move people off waiting lists for disability services, train more workers, or expand covered services for vulnerable elderly and disabled people, helping to keep them out of nursing homes.
But almost a year later, Indiana, Massachusetts, New York, North Carolina, Ohio, and Washington were among 19 states as of Feb. 17 yet to receive the “conditional approval” needed from the Centers for Medicare & Medicaid Services to fully access the money.

Over half of states — 28 of them — received such approval in 2022, according to CMS. That’s more than nine months after the relief package was signed into law. California, for example, received its conditional approval Jan. 4. Other states are waiting for legislative or other approvals, KHN found by querying all state Medicaid offices.

For those dealing with worker shortages, though, the delay has real consequences.

In Georgia, Bob Rice’s stepdaughter, Jennifer, a nonverbal 50-year-old with cerebral palsy who uses a wheelchair, has lived at a group home in Athens run by Hope Haven of Northeast Georgia for several years.

But amid staffing shortages during the pandemic, Hope Haven closed the facility down.

Since then, Jennifer has cycled into her third group home — one that’s an hour away from Rice’s house. And Rice fears that the staffing problem will disrupt their lives again.
Two New KFF Analyses: Combined Federal and State Spending on Medicaid Home and Community-Based Services (HCBS) Totaled $116 billion in FY 2020, Serving Millions of Elderly Adults and People with Disabilities

The federal government and the states together spent a total of $116 billion on Medicaid home and community-based services (HCBS) in FY 2020, serving millions of elderly adults and people with disabilities, a new KFF analysis finds.

Medicaid is the nation’s primary payer for such services, which include assistive technology, personal care to help people with bathing or preparing meals, and therapies to help people regain or acquire self-care and independent living skills. There is long-standing unmet need for such services nationally, as well as perennial shortages in the direct care workforce. Both have been exacerbated by the pandemic and rising demand for services related to the aging population.

Congress took a step toward approving new funding for HCBS when lawmakers included $150 billion for such services in the House-passed Build Back Better Act (BBBA). But the bill faces legislative challenges in the Senate and the fate of the proposed funding remains uncertain.

The new analysis, based on KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC, finds that most enrollees receive home and community-based services that are optional coverage choices made by state Medicaid programs, usually in the form of waivers or optional state plan benefits. That results in substantial variation in HCBS eligibility, spending and benefits across states.

A second analysis based on KFF’s survey examines the landscape of state policy choices about Medicaid HCBS in FY 2020, presenting the latest data available, and the first since the onset of the pandemic. For the last decade states have pursued expanding HCBS as an alternative to institutional long-term care. Spending on HCBS accounted for 59 percent of total Medicaid long-term services and supports spending in FY 2019, the most recent year for which data is available.

Nationally, 3 million people receive HCBS through waivers. Over 2.5 million people receive HCBS as part of the state plan benefit package. However, the total number of people who received HCBS across all authorities is not available because some individuals may receive both waiver and state plan services.
Odds of Nurse Flight Jump 50% in 10 Months
By Kimberly Marselas, McKnight's Long-Term Care News, March 1, 2022

Nearly a third of U.S. registered nurses are considering leaving their current patient-care role, according to the latest survey on healthcare worker attitudes from research firm McKinsey.
The 32% “likely” to leave represents an increase of 10 percentage points since McKinsey’s last poll about 10 months ago.

And it’s not just RNs ready to walk away.

The firm’s survey of 866 frontline nurses and other healthcare professionals providing direct patient care in a variety of settings also showed 28% of licensed practical nurses and 27% of certified nurse aides are likely to leave.

Among those who said they were likely to leave their current positions, a whopping 71% said they would leave direct care or their healthcare career altogether.

“The strongest drivers of intent to leave included insufficient staffing levels, seeking higher pay, not feeling listened to or supported at work, and the emotional toll of the job,” noted study authors Gretchen Berlin, RN, McKinsey’s senior partner in Washington, D.C., and partners Meredith Lapointe and Mhoire Murphy.

The numbers of those likely to leave ticked up over the course of 2021, even as wages did. And nowhere was that scenario worse than in skilled nursing settings.

A study published in JAMA Health Forum Friday found that skilled nursing had the largest 2020 employment declines among all healthcare sectors except dentists’ offices. Nursing homes lost 8.4% of their workforce, according to a RAND Corp. analysis of data from the Bureau of Labor Statistics.
In early 2021, SNFs saw an even steeper decline of 13.6% compared to 2019 levels, despite having the largest wage increases at 9.5% in 2020 and 6.3% in 2021.

The McKinsey respondents, which included about 3% working in long-term care settings, reinforced that many nurses need more than higher pay to stay. Though skilled nursing responses weren’t broken out, 30 of 94 home care nurses said they were likely to leave.

Job satisfaction slipped noticeably in 2021, according to McKnight’s own 2022 Outlook survey. At the time, staffing experts called those declines dangerous territory for nurse managers and staff in other top-level positions, where shortages were intensifying. That survey was conducted around the same time period as the latest McKinsey findings.

In the McKinsey analysis, nurses with less than 10 years of experience cited higher pay as a more influential factor, but retirement and the physical toll of the job were bigger factors for registered nurses with more experience.

Just over 60% of those likely to leave said an “unmanageable workload” was a reason to leave; with 57.9% citing a need for work-life balance. Among those likely to stay in direct patient care, 66% said they were “doing meaningful work” and 65.2% said haveing “caring and trusting teammates” were critical factors.
White House Unveils COVID Plan Focused On People With Disabilities
By Michelle Diament, Disability Scoop, February 28, 2022

Following criticism from disability advocates, the Biden administration is taking new steps to better address the needs of people with disabilities during the ongoing COVID-19 pandemic.
The White House said it is rolling out efforts to make testing more accessible to people with disabilities, to get masks to those who are unable to leave their homes and to ensure that vulnerable students can learn safely in person.

The moves announced late last week come after the administration faced blowback from advocates for overlooking the needs of people with disabilities during the pandemic.

The issue came to a head in January when Centers for Disease Control and Prevention Director Rochelle Walensky discussed a study looking at the effectiveness of COVID-19 vaccines during an appearance on ABC’s “Good Morning America.”

“The overwhelming number of deaths, over 75%, occurred in people who had at least four comorbidities, so really these are people who were unwell to begin with, and yes, really encouraging news in the context of omicron,” Walensky said. “We’re really encouraged by these results.”

Advocates were outraged by the comments, noting that people with comorbidities are people with disabilities. Walensky ended up apologizing during a subsequent meeting with 10 disability groups and she committed to regular meetings between senior leaders at her agency and the advocacy groups.
Now, the Biden administration is detailing additional actions to better serve this community.
CDC Adds IDD To List Of Conditions At Increased Risk From COVID-19
By Michelle Diament, Disability Scoop, March 3, 2022

Nearly two years into the pandemic, the Centers for Disease Control and Prevention is for the first time acknowledging that people with intellectual and developmental disabilities have an elevated risk of severe disease from COVID-19.

The agency quietly updated its list of medical conditions known to be associated with a heightened chance of severe illness from the virus in mid-February.

“People with some types of disabilities may be more likely to get very sick from COVID-19 because of underlying medical conditions, living in congregate settings, or systemic health and social inequities,” the latest guidance states.

The list includes people with intellectual and developmental disabilities, birth defects, cerebral palsy, Down syndrome, attention-deficit hyperactivity disorder, learning disabilities, spinal cord injuries and “people with any type of disability that makes it more difficult to do certain activities or interact with the world around them, including people who need help with self-care or daily activities.”

Individuals with conditions on the CDC list are “more likely to get very sick with COVID-19,” according to the guidance. That could mean being hospitalized, needing intensive care, requiring a ventilator or death.
The CDC said that people with such conditions should stay up to date on COVID-19 vaccines and use preventive measures like wearing masks and avoiding crowded spaces.
State News:
Minnesota Group Home Capacity Shrinks Amid Staffing Shortages
By Glenn Howatt, Star Tribune, March 2, 2022
Facing ongoing worker shortages, the number of group homes in Minnesota fell for the first time in the past three years.

The state lost 32 group homes in the last quarter of 2021 with 3,858 homes licensed to provide care to people with disabilities. Until then, the number of homes was growing as the number of new homes exceeded those that closed.

More closures are on the horizon. Ten group homes operated by Cardinal of Minnesota in Olmsted and Winona counties are scheduled to close on Saturday. ACR Homes said it will close four of its homes by mid-March.

Altogether, 59 group home residents will be displaced by the closures announced in just the first two months of 2022 — that's more than half of the 109 residents who had to find new homes because of closures in 2019, the most recent high.

"I am nervous that this is the beginning, not the end, of the challenges," said Sen. Jim Abeler, R-Anoka, chair of the Minnesota Senate's Human Services Reform Finance and Policy Committee, on Tuesday. "At this point everybody is in a crisis mode."

The industry has long faced worker shortages, but the COVID-19 pandemic made things worse as some staff got ill or needed to care for infected family members.

Because their pay rates are set by Minnesota law, group homes find it difficult to compete with retail and other industries where hourly wages are increasing.
Washington - We’re Caregivers and a State Medicaid Raise is Overdue Given the People We Help
By By Judy Kinyua and Ronald Domond, Seattle Times, February 25, 2022

Today, the direct-support professionals providing care in the homes of people with intellectual and developmental disabilities have a lower starting wage than the person helping you check out your groceries or take your fast food order. As caregivers that commute from Tacoma and Auburn to support our clients in Kent, we love our jobs. But the current low wages just don’t make sense and we hope that the Legislature will fund a Medicaid increase so that we can start catching up to the rising cost-of-living in our region.

We come from different backgrounds, but we have the same love for our work. Judy serves six clients and has been a caregiversince moving from Kenya in 2017, where she worked as a pharmacy assistant. Ronald has lived in Tacoma since 2001 and has worked as a direct-support professional for five years, today serving five clients in Kent and two in Tacoma. Together, we are proud of the support that we provide and the level of enduring compassion and patience that it requires.

We all live in a world full of difficult jobs, but caregivers have a pretty tough one. We provide foundational care that allows our clients to live in their own homes. That means that we cook their meals, bathe them, manage their medications, take them on walks, find them entertainment and do their grocery shopping. Depending on their needs, we may help them get out of their bed into their wheelchair or just help them change positions regularly so that they are comfortable. We support individuals that are nonverbal and have autism, so we work hard to understand their personal sign language so that we know when they want to go outside or stay inside. We try and protect them from financial scams, pushed by those who target vulnerable people.

During the pandemic, we have helped guard them against infection and sanitize their homes daily. Washington has long put off investing in a wage increase for direct support professionals, but these last few years have made that gap especially painful.

More than 99% of our clients rely on Medicaid for their care, which means that unless the Legislature increases its Medicaid investment, our wages cannot keep up with the ever escalating cost-of-living in our region. It used to be that direct-support professionals in our state earned 23.7% above minimum wage, but today that has fallen to only 5%. 

Washington is almost dead last in keeping up and we can see it in the very high turnover of almost 50% annually among our colleagues. This high turnover is challenging for all of the clients that we support, as those with intellectual and developmental disabilities are forced to constantly meet new people for support. And in turn, it requires patience and time to learn the unique needs of each client so that they are receiving the best possible support.

On behalf of the 12,000 caregivers serving 4,600 clients statewide, we are not asking for anything complicated. Right now, the average starting wage for direct-support professionals is $15.26 and we are hoping that the Legislature will increase its investment in Medicaid so that the starting wage can be raised to $18-$20 per hour with a cost-of-living adjustment to keep up with inflation. This will make it a little bit easier to afford gas for those of us with long commutes and will make rent or a mortgage a little easier to manage. For many of us, it may even mean only having to work one job instead of two or three. It will also help supported-living providers hire and keep caregivers longer during this incredibly competitive time for good workers, improving our ability to provide consistent support for those in our care.
VOR Bill Watch:
[Please click on blue link to view information about the bill]

VOR SUPPORTS:

Modifying the Build Back Better Act to include language to provide funding for Intermediate Care Facilities in parity with increased funding for HCBS services, and to remove any provisions that would phase out or eliminate 14(c) wage certificate programs.

H.R. 4779 & S. 1437 - Recognizing the Role of Direct Support Professionals Act - To require the Office of Management and Budget to revise the Standard Occupational Classification system to establish a separate code for direct support professionals, and for other purposes.
H.R.6075 - The HEADs UP Act - To amend the Public Health Service Act to expand and improve health care services by health centers and the National Health Service Corps for individuals with a developmental disability as a Medically Underserved Population (MUP).

H.R.4761 - A bill to amend the Rehabilitation Act of 1973 to ensure workplace choice and opportunity for young adults with disabilities.

H.R.4762 - A Bill to amend the Rehabilitation Act of 1973 to clarify the definition of competitive integrated employment.


VOR OPPOSES:

S. 3417 - The Latonya Reeves Freedom Act of 2021 - This bill may be seen as the offspring of the Disability Integration Act from the 116th Congress. It misrepresents Olmstead, and contains provisions that would be harmful to the existence of ICFs, including a section that would promote lawsuits against larger congregate care facilities.

H.R. 603 & S. 53 - The Raise the Wage Act - These bills are aimed at raising the minimum wage, but they also have provisions to phase out and ultimately eliminate vocational centers and 14 (c) wage certificates over the next six years and to immediately stop the issuing of any new certificates. VOR believes the issue of employment options for individuals with intellectual disabilities should not be buried in a bill for raising the federal minimum wage. Both issues deserve clean, stand-alone bills.

H.R.1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration.

H.R. 2383 & S. 3238 - The Transformation to Competitive Integrated Employment Act - this bill purports to assist employers providing employment under special certificates issued under section 14(c) of the Fair Labor Standards Act of 1938 in transforming their business and program models to models that support individuals with disabilities through competitive integrated employment, to phase out the use of these special certificates. We feel that, if enacted, tens of thousands of people with I/DD and autism will still be forced out of opportunities they currently, needlessly, and left without viable alternatives to occupy their time or address their needs and their abilities.

H.R.4131 & S.2210 - The Better Care Better Jobs Act - To be clear, we don't oppose this bill. We object to the fact that it excludes the most vulnerable members of the I/DD population.

While the Better Care Better Jobs Act would greatly increase the amount of federal funding for people with I/DD, it only supports those in waiver programs receiving Home and Community Based Services. It unjustly discriminates against those who have chosen Intermediate Care Facilities as the necessary and proper form of residential treatment. By giving a 10% increase n federal matching funds only to HCBS clients, and providing training and increased pay only to direct support professionals working in HCBS facilities, the act deliberately favors one form of treatment over another, one ideology over another, and one set of people with I/DD over another.
Direct Support Professionals:
VOR ❤️s OUR DIRECT SUPPORT PROFESSIONALS!

Our loved ones' caregivers are essential to their health, safety, and happiness.
In appreciation of their good work and kind hearts, VOR offers free digital memberships to any DSP who would like to join.

We encourage our members to speak with their loved ones' caregivers to extend this offer of our gratitude.

If you are a Direct Support Professional interested in receiving our newsletter and e-content, please write us at


with your name, email address, and the name of the facility at which you work. Please include the name of the VOR member who told you of this offer.

What's Happening In Your Community?

Is there an issue in your loved one's home that you need help with?
Do you have information or a news story you would like to share?
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