September 22 2023

VOR's Weekly News Update

Personal Stories Wanted

We are seeking personal stories from our families.

We'd like to hear about the quality of care your loved one receives, whether in a pubic or private ICF, a group home, or with supports in your own home.

We'd like to hear about your loved one's day program, or the work they partake in at a sheltered workshop.

We'd like to hear ideas for how well your state's

DD Services System is working for your family, how things might be improved, and what forces are at play in your state to preserve choice, especially for those on the more severe or profound end of the I/DD and autism scales.

Please contact us at [email protected]

If you can write a paragraph or two, or a page or so, and include pictures, we'll try to put as many as possible into the next issue of

The VOR VOICE

...............................Meanwhile..............................

We'd like to thank all who participated in our Quarterly Networking Meeting last night on

Why ICFs Matter

The meeting was quite a success!

VOR Families had an opportunity to share their experiences about care in ICFs, community settings, and at-home services.

We are considering following up with a meeting to discuss how to preserve and revitalize the ICF system. Please let us know if you would be interested in attending by writing us at

[email protected]

One topic that did arise was a discussion on Active Treatment, which is one of several factors that make ICF care different from the care offered in

Home and Community Based Services.

For more information about Active Treatment,

Please click on the following links:

CF/MR Glossary (cms.gov)

Active Treatment (cms.gov)

To Our Autism Families:

The Interagency Autism Coordinating Committee (IACC)

is holding a Full Committee Meeting on

October 11, 2023 10 am - 5 pm ET

The comment period was open until 9/20/23, but you can still try to submit comments. Someone will see them.

We'd like our families to make sure the Committee hears the voices of families of individuals with Severe Autism, to make sure that they cannot continue to marginalize our loved ones and the needs of our families.

Please Submit Comments to:

https://iacc.hhs.gov/meetings/public-comments/submit/index.jsp

For more information about or to register for the Committee Meeting,

Please Click Here

Note: Here's an article that we thought summed up the best arguments against closing Sheltered Workshops:

A Sub-Minimum Wage or No Wage At All?

By John Phelan, Econlib, September 19, 2023

Legislators in Minnesota are currently debating a bill which illustrates one of the most fundamental questions of public policy. HF 2513 would abolish subminimum wages for people with disabilities. If enacted, the legislation would have drastic consequences for about 70 day and employment centers — also known as ‘sheltered workshops’ — across the state that benefit from a special allowance in federal labor law that permits them to pay disabled workers below the federal minimum wage.

Supporters of the bill argue that:

Fundamentally, this is a civil rights issue,” said Natasha Merz, assistant commissioner at the Department of Human Services (DHS), which supports the shift away from subminimum wage work. “Work is one of the main ways that humans create community…and if we only rely on service models that have the tendency to isolate and segregate people, then we’re cutting off their opportunity to be fully contributing members of society.

Of course, this assumes that the alternative to employment in these centers is employment somewhere else. In fact, the alternative might be no employment at all.

Another of the bill’s supporters, Minnesota’s biggest newspaper, the Star Tribune, offers a number of examples of workers who have moved away from such employment as arguments in favor of its abolition. Of course, those examples could just as easily be taken to show that abolishing sheltered workshops isn’t necessary.

But even so, as one correspondent notes: “There is no mention of the “not so abled” that the law would leave behind:

I have a nephew with Angelman syndrome, a serious genetic disability. He is nonverbal and requires 24/7 care. But he is highly social. He loves being around “his people.” If supervised and motivated, he can perform some of those “menial” tasks. Sheltered workshop environments gave him an opportunity to interact with others and to enjoy the benefits of meaningful work that suited his abilities. His work provided him social interactions with others of varying skills.

I don’t know the number of people who will forever lose such opportunities to get out of the house and to work in a safe and structured environment. For my nephew and his parents, it was never about the money. He made only $70 one year. His parents put the money in his “fun money pouch.” He knew it was money he had earned. His parents helped him spend it on fun activities.

The highly supervised work structure helped him be more responsive when he was with his personal care attendant. The program saved his parents thousands of dollars in paid professional care.

Between COVID and the closing of the few remaining work programs, my nephew now has few opportunities to get out of the house and be in society. The structured workshops had kind staff who labored diligently to provide individuals with serious disabilities some of the joys and rewards of work.

Minnesota’s model of disability employment can, in fact, be seen as a success. An estimated 48% of Civilians with Disabilities Aged 18-64 Years Living in the Community were employed in Minnesota in 2019, the sixth highest rate in the United States. That rate comes, in part, from people like that gentleman with Angelman syndrome who would not be employed without the sheltered workshops. In 2020, 98% of comments submitted to the U.S. Civil Rights Commission for a report on this issue supported keeping such programs in place.

Evidence suggests that if this bill passes the “not so abled” will suffer. Prof. Carlisle Ford Runge of the University of Minnesota points out that:

Evidence from three other states that have eliminated below-minimum wages is deeply disturbing, as reported in 2018 by a national group representing autistic adults. In Maine, two-thirds of disabled former workshop employees are now unemployed. Those who are still working work an average of 12 hours a week, the lowest average in the country. In the state of Washington, 80% of those with severe cognitive impairment remain unemployed. In Vermont, there are now fewer developmentally disabled adults in supported employment than in 2002, when employment workshops closed. As the document citing these failures states in conclusion: “When sheltered workshops close, participants often end up idle at home, not in competitive, minimum wage jobs.”

This is the fundamental policy question here: We all wish that disability carried no wage penalty but the sad reality is that in many cases it does and we cannot magic it away with the wave of a legislative wand. Reality often gives us a choice between a sub-optimal outcome and an even more sub-optimal one. In those situations – in this situation – we ought to choose the former instead of pretending that some third option exists. The personal costs of pursuing such fantasies will be devastating.

The full article with active links may be found here

International Equal Pay Day: Canada’s Unions Call for an Integrated, Long-term Care Workforce Strategy

Canadian Labour Congress, September 18, 2023

Whether it’s health care, child care, long-term care, or community and social services, care sectors across Canada are experiencing severe staffing shortages and wage discrimination. At the root of this crisis is the stark reality that care work is unrecognized and undervalued. On International Equal Pay Day, Canada’s unions are calling for increased wages for care workers and a Care Economy Commission to develop a comprehensive, integrated strategy to address the care workforce crisis in the long term.

In Canada, an estimated 3 million workers are employed in paid care occupations, amounting to nearly 1 in 5 workers. Most of these workers are women, and are often racialized and newcomer women.

“Our jobs, our families and our economy depend on having our care needs met. We know how crucial these services and caregivers are; from supporting our seniors and our children, to ensuring people living with disabilities can live dignified lives, and more,” said Bea Bruske, President of the Canadian Labour Congress (CLC). “For too long, political leaders and Canadian society have taken both paid and unpaid care work for granted. As a result, much of this work—largely performed by women—remains precarious and undervalued, while those who perform it are at constant risk of violence and harassment.”

“Care workers have shared countless stories of overwork and burnout, low wages, and inadequate working conditions. It’s pushing people out of these sectors, and as more workers leave these problems will only deepen. We must confront this crisis now by boosting wages as a first step, and by developing an integrated care workforce strategy for the long term,” said Siobhán Vipond, CLC Executive Vice-President.

“Care workers deserve better, and so do the people they care for,” said Bruske. “Care work should be rewarded appropriately—with better pay that reflects the value of their work; with good, stable jobs; and with safe and healthy working conditions. Building a better care workforce will ensure that everyone has access to care if or when they need it.”

Read or download the press release here

Back Issues of VOR's Weekly Newsletter are available on our web site.

Please Click Here!

Note: Several policy articles appeared in the news this week relating to the end of payments to family caregivers and shortages in the Long-Term Care Workforce. The first article below is a good introduction to the second article, a much longer and thorough report from KFF. The third is a press release from the Administration for Commuity Living, showing that in the wake of a several billion dollar loss of funds to family caregivers, they are proposing a 3.56 milion dollar grant program. The pain continues for the families of people with intellectual and developmental disabilties and austism....

End of Pandemic-Era Payments to Family Caregivers Could Complicate Workforce Shortages

By Kathleen Steele Gaivin, McKnight's, September 20, 2023

During the pandemic, most states allowed some form of payment to family caregivers whose loved ones were receiving Medicaid home- and community-based services. As those payments dry up, workforce shortages could be exacerbated, according to a KFF analysis published Tuesday.

(Note: see article below)

More than 4 million people rely on Medicaid HCBS, according to the health policy analysis firm formerly known as the Kaiser Family Foundation or the Henry J. Kaiser Family Foundation.

“Medicare generally does not cover HCBS and in 2020, Medicaid spent $162 billion on HCBS — a majority of the $245 billion in total HCBS spending,” according to the brief.

As states wind down payments to family caregivers and remove other pandemic-era policies, this “could complicate ongoing workforce shortages and create new challenges for enrollees,” according to a survey of state Medicaid HCBS officials from KFF. The 50-state survey was conducted between May and August.

“With ongoing workforce shortages, families may have difficulty finding paid workers to take over their responsibilities when the policies expire,” noted authors Alice Burns, associate of director of KFF’s Program on Medicaid & Uninsured; Maiss Mohamed, research assistant at the program; and Molly O’Malley Watts, owner and principal at Watts Health Policy Consulting.

Twelve states are ending payments to family caregivers who are legally responsible for the person for which they are caring, and five states will be ending payments to other types of family caregivers.

The authors noted that states have generally been more generous with family caregivers being paid even if they were not legally responsible for the person receiving care and if the person receiving care was enrolled in an HCBS waiver. Among the 50 states with HCBS waivers that responded to the survey, 41 states allow payments to spouses, parents of minor children, and other legally responsible relatives; and 49 states allow payments for other family members and friends.

“Beyond administrative hurdles, the end of the PHE authorities may place further strain on the HCBS workforce and on family caregivers who provide HCBS. Many of the PHE authorities were enacted in response to HCBS workforce shortages that were exacerbated by the COVID-19 pandemic,” the authors said. “As the pandemic era ends, employment in the long-term services and supports sectors continues to remain below pre-pandemic levels and it is unclear whether HCBS workforce shortages will become worse.”

Read the full article here

Pandemic-Era Changes to Medicaid Home- and Community-Based Services (HCBS): A Closer Look at Family Caregiver Policies

By Alice Burns, Maiss Mohamed, and Molly O’Malley Watts, KFF, September 19, 2023 

KFF estimates that there are over 4 million people using Medicaid home- and community-based services (HCBS), which include medical and supportive services that assist people with the activities of daily living (such as eating, bathing, and dressing) and instrumental activities of daily living (such as preparing meals, managing medications, and housekeeping). They are provided to people who need such services because of aging, chronic illness, or disability and may include personal care, adult daycare, home health aide services, transportation, and supported employment. Medicare generally does not cover HCBS and in 2020, Medicaid spent $162 billion on HCBS—a majority of the $245 billion in total HCBS spending.

Although all states offer some HCBS through Medicaid, most services are optional for states, and states may cover different services for different types of Medicaid enrollees. To be eligible for Medicaid HCBS, individuals must have limited financial resources and significant functional impairments.

During the COVID-19 pandemic, people who use HCBS were at heightened risk of serious illness or death from exposure to COVID-19 and were disproportionately likely to need hospital or nursing facility care when HCBS were unavailable, but there were fewer workers available and willing to provide services. Recognizing those challenges, the federal government provided states with new authorities to maintain access to HCBS during the public health emergency (PHE), which was in place from 2020 until May 11, 2023. Family caregivers played a critical role in helping to mitigate the consequences of workforce shortages and many states used the new authorities to support and pay family caregivers.

Drawing from KFF’s 50-state survey of state Medicaid HCBS officials, conducted between May and August of 2023, this issue brief describes how states used the PHE authorities to strengthen their HCBS programs, changes as the PHE ends, and the role of family caregivers in providing HCBS. Key take-aways include:

Continued

ACL Awards $3.6 Million to Improve Support for Family Caregivers

Press release from the Administration for Community Living, September 20, 2023

ACL is pleased to announce four new cooperative agreements for ACL’s 2023 grant initiative in support of the 2022 National Strategy to Support Family Caregivers (the Strategy). The project period for these new grants is September 30, 2023-September 29, 2027. The collective award amount is over $3.6 million. Funds for this initiative are drawn from Title III-E formula funds and use the demonstration authority found in Sec 373(i) of the Older Americans Act.

Through these four-year awards, grantees will develop, test, and disseminate new approaches for supporting family caregivers, using the Strategy as a roadmap. Each grantee will focus on one goal within the Strategy:

• Community Catalyst
• Goal 1: Increase awareness of and outreach to family caregivers
• Regents of the University of California, San Francisco
• Goal 2: Advance partnerships and engagement with family caregivers
• USAging
• Goal 3: Strengthen services and supports for family caregivers
• National Alliance for Caregiving
• Goal 5: Expand data, research, and evidence-based practices to support family caregivers

At this time, no project has been funded to address Goal 4: Ensure financial and workplace security for family caregivers. To address this important priority, ACL will be issuing a Notice of Funding Opportunity in October 2023 requesting applications that will increase awareness of — and access to — the resources available to address financial and workplace security for family caregivers, as well as identify unmet needs. 

Press release available here

RN Training Would Receive $1.2 Billion Boost under Senate Bill

By Kathleen Steele Gaivin, McKnight's, September 18, 2023

Community colleges and universities would receive $1.2 billion in grants to boost the number of students enrolled in accredited, two-year registered nursing programs if a bill introduced into the Senate on Thursday is passed into law as written.

The funds under the Primary Care and Health Workforce Act also could be used to expand the number of qualified preceptors at clinical rotation sites, provide direct support for students, support partnerships with health facilities for clinical training, purchase distance learning technology and simulation equipment, and other capital projects.

In all, proponents estimate that the measure would enable schools to train up to 60,000 additional nurses.

The proposed allocation is part of a broader $26 billion bill introduced by Sens. Bernie Sanders (I-VT) and Roger Marshall (R-KS) that is meant to address the “major shortages of nurses, primary care doctors, and other important healthcare jobs across the country,” according to a press release from Sanders. The legislation is expected to be marked up on Thursday in the Senate Committee on Health, Education, Labor and Pensions.

Within the next two years, the United States will need 200,000 to 450,000 additional nurses, according to recent estimates cited by Sanders.

Continued

See Also:

Bipartisan Senate Bill Aims to Increase Nurse Training Programs 

By Kathleen Steele Gaivin, McKnight's, September 22, 2023

A bipartisan group of senators has introduced legislation meant to address the nursing shortage affecting healthcare providers and communities throughout the United States.

The Train More Nurses Act, introduced Wednesday by Sens. Mike Braun (R-IN), Susan Collins (R-ME) and Jacky Rosen (D-NV), directs the Health and Human Services and Labor secretaries to conduct a review of all nursing grant programs to find ways to increase faculty members at nursing schools, particularly in underserved areas. If passed as written, it also would increase pathways for licensed practical nurses to become registered nurses.

A shortage of nurses is not limited to the senators’ states, although Rosen noted that a recent analysis found that the state he represents, Nevada, is among the states with the fewest nurses per capita in the nation. 

The Train More Nurses Act comes at a critical time, with the proposal of a minimum staffing requirements that most nursing homes will be required to meet within the next three years 

If the draft rule released earlier this month by the Centers for Medicare & Medicaid Services is implemented as written, non-rural nursing homes will be required to provide a minimum of three hours per patient day of direct care — 0.55 hours of that care by a registered nurse and 2.45 hours by a nurse aide — within three years. Rural nursing homes will have five years to implement the overall hourly rate.

The mandated per-day levels are well below the 4.1 cumulative hours per day level that a CMS study recommended in 2001. But some 75% of nursing homes currently would need to add staffing to reach even the proposed compliance levels, CMS said. 

“There are simply no people to hire — especially nurses,” LeadingAge President and CEO Katie Smith Sloan said earlier this month. “The proposed rule requires that nursing homes hire additional staff. But where are they coming from?”

Continued

‘Incomplete’ Oversight lets Medicaid Managed Care Denials go Largely Unchecked: MACPAC   

By Kimberly Marselas, McKnight's, September 22, 2023

While much of the outrage around managed care denials has been directed toward Medicare Advantage plans, a federal advisory panel Thursday outlined policies that could force states to better track denials of medically necessary care in their managed Medicaid programs.

States can monitor denial rates and assess whether individual denials are appropriate, but most do not tackle that in any robust way, analysts told the Medicaid and CHIP Payment and Access Commission, which advises Congress on Medicaid policy.

“The federal minimum standards lack critical components to determine whether MCOs [Managed Care Organizations] are inappropriately denying care to Medicaid beneficiaries,” said Senior Analyst Lesely Baseman. “Our findings suggest that oversight requirements are incomplete in data monitoring, clinical audits and transparency.”

Medicaid is far and away the biggest funder of nursing home services in the US.

The Health and Human and Services Department Office of Inspector General found 13 states conduct some type of clinical audit, and in some instances, have found evidence of inappropriate denials of prior authorization. Earlier this week, the OIG reported that New York state officials used the wrong information to let stand half the denials in a sample of managed care appeals.

There also is no federal requirement to publicly report denials in Medicaid managed care, and just 14 states do so in any form currently.

“As a result, little is known about the extent to which beneficiaries are denied services, and the extent to which beneficiary appeals are upheld or reversed,” Baseman explained.

MACPAC could advise the Centers for Medicare & Medicaid Service to:

• Establish data reporting requirements of denials and appeal outcomes by all states
• Require states to audit denials for clinical appropriateness
• Publicly report new denial and appeal data in the Managed Care Program Annual Report
• Include denials and appeals data on new state quality rating systems sites to better serve beneficiaries when deciding on plans

Continued

ICYMI: A Prescription for Americans Dually Eligible for Medicare and Medicaid

Press Release from Sen. Bill Cassidy, MD, September 15, 2023

U.S. Senator Bill Cassidy, M.D. (R-LA) and his health fellow Sunjay Letchuman, a medical student at Mount Sinai, co-authored a Viewpoint in the Journal of the American Medical Association on patients jointly enrolled in Medicare and Medicaid. The Viewpoint asserts that poor payment coordination between Medicare and Medicaid drives uncoordinated care and worse outcomes for a majority of the 12.2 million low-income and older or disabled people in the United States who are jointly enrolled in Medicare and Medicaid.

“Despite taxpayers spending more money on persons who are dually eligible, their health outcomes are worse,” wrote Dr. Cassidy and Mr. Letchuman. “The root cause of worse outcomes despite spending more money is a lack of coordination of care… Disjointed payment should no longer drive uncoordinated care. The federal government should come up with a set of guidelines and require that care be coordinated between Medicare and Medicaid.”

“Ensuring that all parts of our government are working together to empower Americans with tools to live longer, happier, and healthier lives is common sense. When we succeed, not only will patients be healthier, but we will simultaneously make Medicare more sustainable and help address our nation’s debt,” concluded Dr. Cassidy and Mr. Letchuman.

This population, known as “dual eligibles,” is a diverse group with a complex, unique set of needs. Dual eligibles include individuals with multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia and developmental disabilities, and others who are relatively healthy.

While representing a small proportion of Medicare and Medicaid beneficiaries, dual eligibles account for a disproportionate share of overall spending. In the Medicare program, 19% of enrollees are dually eligible but account for 34% of spending. Similarly, 14% of Medicaid enrollees are dually eligible but constitute 30% of overall spending. In 2019, combined Medicare and Medicaid spending on dual eligibles rose to a total of $440.2 billion.

Cassidy is leading a bipartisan group of senators in the development of legislation to improve coverage for dually-eligible individuals. The group includes Senators Tim Scott (R-SC), John Cornyn (R-TX), Mark Warner (D-VA), Tom Carper (D-DE), and Bob Menendez (D-NJ). Last November, the group sought information regarding shortfalls in the current system of care for dual eligibles, how to improve patient health outcomes, and the role of federal or state governments in dual eligibles’ care. Discussion draft legislation was released for feedback in May as the working group gears up to formally introduce a bill in the U.S. Senate.

Continued

Read the full JAMA article here

Please click here to register for the event

[Please click on blue link to view information about the bill]

VOR SUPPORTS:

S.1332 / H.R.2941 - Recognizing the Role of Direct Support Professionals Act

Sen Maggie Hassan (D-NH) / Rep. Brian Fitzpatrick (R-PA) This bill requires the Office of Management and Budget to establish a separate category within the Standard Occupational Classification system for direct support professionals (i.e., individuals who provide services to promote independence in individuals with an intellectual or developmental disability) for data reporting purposes.

H.R. 553 - Workplace Choice and Flexibility for Individuals with Disabilities Act

Rep. Glenn Grothman (R-WI-6) - This bill would amend the Rehabilitation Act of 1973 to clarify the definition of competitive integrated employment.

H.R.1296 - Restoration of Employment Choice for Adults with Disabilities Act Rep. Glenn Grothman (R-WI-6) - To amend the Rehabilitation Act of 1973 to ensure workplace choice and opportunity for young adults with disabilities.

H.R.485 - Protecting Health Care for All Patients Act of 2023

Rep. Cathy McMorris Rodgers (R-WA-5) - This bill prohibits all federal health care programs, including the Federal Employees Health Benefits Program, and federally funded state health care programs (e.g., Medicaid) from using prices that are based on quality-adjusted life years (i.e., measures that discount the value of a life based on disability) to determine relevant thresholds for coverage, reimbursements, or incentive programs.

H.R.670 - Think Differently Database Act

Rep. Marcus Molinaro (R-NY-19) - This bill would amend title IV of the Public Health Service Act to direct the Secretary of Health and Human Services to establish a clearinghouse on intellectual disabilities, and for other purposes. Such clearinghouse shall include information on individual community-based services and long-term support services available to individuals eligible for medical assistance under a State plan under the Medicaid program under title XIX of the Social Security Act.

S.1298 - Supporting Our Direct Care Workforce and Family Caregivers Act

Sen. Time Kaine (D-VA) A bill to award grants for the creation, recruitment, training and education, retention, and advancement of the direct care workforce and to award grants to support family caregivers.

H.R.2965 / S.1333 - Autism Family Caregivers Act of 2023

Rep. Grace Meng (D-NY) / Sen. Robert Menendez (D_NJ) To award grants for providing evidence-based caregiver skills training to family caregivers of children with autism spectrum disorder or other developmental disabilities 

H.R.3380 - HEADs UP Act of 2023

Rep. Seth Moulton (D-MA) This bill authorizes the Department of Health and Human Services (HHS) to award grants to support health centers that provide services for individuals with developmental disabilities, including dental care. Grant recipients must provide specialized treatment to individuals with developmental disabilities as necessary.

VOR OPPOSES:

S.533 / H.R.1263 Transformation to Competitive Employment Act

Sen. Bob Casey (D-PA) / Rep. Bobby Scott (D-VA 3) - This bill would support employers who wish to transform their facilities to provide only competitive integrated employment while forcing the elimination of programs that offer employment opportunities under Section 14(c) of the Fair Labor Standards Act. This bill would be unlikely to create a significant increase in employment for people with I/DD and autism, but would deprive over 120,000 individuals of the opportunity to work, develop skills, and be part of their community.

S. 1148 - The Guardianship Bill of Rights

Sen. Bob Casey (D-PA) - A bill to establish rights for people being considered for and in protective arrangements, including guardianships and conservatorships, or other arrangements, to provide decision supports. This bill would give ACL power to create a Guardianship Council and appropriate more money to P&As so they may encourage people to leave guardianships and move to Supported Decision Making. Dangerous over-reach in response to media hype on Britney Spears, et al.

VOR HAS SIGNIFICANT CONCERNS WITH:

S.100 / H.R.547- Better Care Better Jobs Act

Sen. Bob Casey (D-PA) Rep. Debbie Dingell (D MI) This bill establishes programs and provides funds for state Medicaid programs to improve home- and community-based services (HCBS), such as home health care, personal care, case management, and rehabilitative services.

The bill also makes permanent (1) the Money Follows the Person Rebalancing Demonstration Program (a grant program to help states increase the use of HCBS for long-term care and decrease the use of institutional care), and (2) certain provisions regarding Medicaid eligibility that protect against spousal impoverishment for recipients of HCBS.

S.762 / H.R.1493 - The HCBS Access Act

Sen. Bob Casey (D-PA) Rep. Debbie Dingell (D MI) While this bill purports to eliminate waiting lists and provide more Home and Community-Based Services for people with I/DD and autism, it favors the aspirations of those individuals who are most independent and neglects the very real needs of those most dependent on Medicaid Long-Term Services and Supports. It would not distribute funds appropriate to the varying needs of individuals, but to providers of HCBS programs. It fails to recognize the severity of the DSP and Nursing Crises, and paints an unrealistic picture of a simplistic solution. This is a purely political bill that would ultimately fail to make the extensive changes that the DD/A system needs.

VOR supports increasing funding for people with I/DD, but we have concerns that the above bills, in their current form, would discriminate against people with the most severe I/DD and autism and jeopardize the higher-care facilities that are most appropriate to their needs.



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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 receive our newsletter.

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

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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?

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Do you have information or a news story you would like to share?

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