Art of Accessibility: Finding Empowerment Through Modeling

Cover and link for The Independence Times Winter 2019Looking to find a job here in the Springs, Alphie Omar began visiting The Independence Center’s (The IC) Employment department close to seven years ago. Over that time, he’s worked with Yvonne Bacher and Starr Vahsholtz to develop marketable job skills, update his resume, and to look for employment. After getting a little advice from Yvonne and Starr, he also earned a certificate in Microsoft Office from the Pikes Peak Work Force Center, then secured a data entry job. Yvonne tells me that “Alphie has incredible, incredible drive and has overcome enormous challenges.” Like many other men of his age, Alphie likes watching football, going bowling, visiting the park, and participating in various other activities in his free time. What makes Alphie different, is the fact he has no arms or legs, and has a learning disability.

Photo of Alphie Omar on the runway

Alphie Omar on the runway

This being the case, Alphie seemed like the perfect person to model in The Independence Center’s Art of Accessibility event. We started Art of Accessibility last year as a way to share the creative and artistic work of people with disabilities to the public. The event, which coincides with the First Friday Art Walk in downtown Colorado Springs, serves as a venue to display both traditional and performing art. Since starting Art of Accessibility, much focus has been placed on painting, drawing, and even dance. For the most recent Art of Accessibility though, we thought we would take a slightly different track by focusing on the design of clothing for, and modeling by, people with disabilities. The more traditional forms of art such as painting and drawing that have been displayed at previous Art of Accessibility events, were still present, but the fashion show was the headliner.

In the past, people with disabilities were forced to use the same clothing as everyone else, even if the clothing didn’t function well with their specific disability. In recent years, the need for clothing that fits better and is easier to use, has become a growing trend. Clothing and shoes can be given larger openings, Velcro can be used in place of zippers and buttons, and other modifications can greatly increase the accessibility of clothing for people with all types of disabilities.

On Friday, September 7th, several examples of these wonderful designs were on display for the community to see. Several individuals, including Alphie had the opportunity to show off their new outfits, which were purchased by The Independence Center with help from the Men’s Exchange and the Women’s Resource Center, and modified by a seamstress in Denver. The models showed off the various accessibility features, and had a great time in the process. If you or someone you know would like more information about Art of Accessibility, or about accessible clothing, visit us on the web at http://bit.ly/The-IC, or give us a call at 719-471-8181.

Local Business Parking Lots Aren’t Accessible

Photo of Tim Ashley loading into his accessible van.

Tim Ashley loading into his accessible van.

Earlier this year, with help from disability consulting organization ADA Surveys and Plans (ASAP) and sponsorship from the Colorado Advisory Council for Persons with Disabilities, The Independence Center conducted a campaign called “Better Access Is Better Business.” The purpose of the campaign was to help businesses identify elements in their parking lots that aren’t in compliance with the American with Disabilities Act (ADA), and hopefully make the necessary changes to remedy the issues. ASAP conducted over one hundred parking lot surveys between El Paso, Pueblo, and Teller counties, checking for a variety of elements required by the ADA.

The survey results were not what we hoped for, but weren’t all together surprising either. Findings showed far too many business parking lots in the Pikes Peak region fail to comply with the ADA. There were numerous infractions among businesses surveyed, but the top three most common issues were the complete absence or incorrect dimensioning of adjacent access aisles, the lack of parking spaces with access aisles for vans with wheelchair ramps, and the complete lack or improper placement of accessible parking signs.

The underlying problem is the rules established by the ADA cannot be directly enforced by local governments or Regional Building, since the ADA is a civil rights law. For the interior portion of local buildings, the Pikes Peak Regional Building Department enforces the ADA through a set of building codes developed by the American National Standards Institute (ANSI), but they do not inspect beyond five feet of the building’s entrance. This directly leads to the lack of accessibility for people with disabilities. Cities and towns should pass their own ordinances laying out rules based on the ADA, which determine parking lot requirements. They can then use their Code Enforcement Officers to inspect and approve any parking lots that are being repaved or restriped. Without proper inspections, accessibility issues easily go unnoticed and business owners have no idea they’re out of compliance.

The IC advocates for people with disabilities in and around Colorado Springs, and this issue has caused harm to far too many people to ignore. According to Patricia Yeager, CEO of The Independence Center, “Parking lots are a gateway to economic and civic activity in our community and the lack of accessible parking lots denies access to individuals with disabilities”.

With proper inspections and educational efforts, this problem can be solved. Someone needs to be inspecting these parking lots; whether it be the municipality, Regional Building, or some other entity – to not do so, is unjust and puts business owners at risk of drive-by lawsuits. The IC plans to create a training program and provide training to asphalt and parking lot striping companies to improve their knowledge of accessible parking lot regulations. If you would like to learn more about The IC’s community advocacy efforts, visit http://bit.ly/TheICAdvocacy

 

Building a Space Where Anyone Can Live

When Jeremy J. Chatelain moved to Colorado Springs for a new job last year, he knew finding the right house would be difficult. As a person with quadriplegia, Jeremy knew there were several features he had to have in his new home that wouldn’t be easy to find. Zero-step entries, roll-in showers, lower light switches, raised electrical outlets, lever handle doors, lever knob deadbolts, pull faucets, and extra-wide interior and exterior doors were essential.

Owning other homes before, Jeremy and his wife have always had to make major home modifications in order for Jeremy to live in each of their homes. These modifications have ranged from building door ramps, to elevating the bath tub onto wooden beams in order to fit a Hoyer-style lift underneath so Jeremy could bathe. The process was painstaking, expensive, and often left much to be desired.

When Jeremy first began speaking to local home builders, no one seemed to have the combination of accessibility features he was looking for. When he came across Challenger Homes, things started looking up. As part of their standard floorplan options, Challenger had a couple of homes that could be built to incorporate the principles of universal design. This was a game changer. Knowing this, Jeremy felt a sense of relief, and knew that Challenger would build his next home.

Universal design is a concept that is planned into residential or commercial design from the beginning and is intended to be useable by the greatest number of people. The purpose is to design a space that can be used by people with or without disabilities alike, without having to make alterations for an individual’s particular needs. At first glance, a home designed using universal design principles is hard to differentiate from a non-accessible home.

Universal design differs from accessible design in that accessible design addresses the needs of a specific disability or individual, such as Braille for a person who is blind or wide doorways for a person who uses a wheelchair. Many times, accessibly designed homes are retrofitted to become accessible after a person with a disability moves in. This can result in a home that was obviously modified to accommodate an individual with a specific disability.

Upon entering Jeremy’s home, it’s hard to tell it’s different than any other new home. You really have to search to identify what makes it a universally designed home. But when the features are pointed out, it seems obvious. Jeremy tells me, “The entry ways are such a needed point for somebody in a wheelchair.” And he’s right. The threshold leading from the exterior entryway of the home to the foyer is the same level, meaning that anyone in a wheelchair can easily enter and exit the home without having to traverse the several inch drop found in a standard home. The light switches are lowered and the wall outlets are raised, both to a level that is easier to reach for someone in a wheelchair. These are just a few examples, but really highlight how simple and inexpensive changes during construction can make life much easier for people with disabilities, without affecting usability for people who don’t have disabilities.

For Jeremy, his universally designed home is everything he hoped it would be. I can tell he’s proud when he gives me a tour. It’s beautiful – and it doesn’t look like it was designed for someone who uses a wheelchair. It’s a home that could be used by a person of any ability, now or in the future as one ages. I only wish that more home builders would realize there are plenty of people out there who would happily support the prospect of purchasing a home that was built using universal design principles. When discussing how you compel home builders to build more universally designed homes, Jeremy says “I would solicit a business that has specifically chosen to use universal design.” And he has a good point. With nearly twenty percent of the U.S. population recognized as has having a disability, that is a huge swath of the housing market that isn’t being served. Seems like common sense to me.

Photo of Jeremy Chatelain sitting at his kitchen counter that was designed to be low enough for access.

Jeremy Chatelain sitting at his kitchen counter that was designed to be low enough for access.

Photo of Jeremy using the lever handle to open the door.

This universally designed house has lever doors which make it easier to open.

Photo of Jeremy's universally designed shower with reinforced pull bars and zero entry shower.

Jeremy’s universally designed shower with reinforced pull bars and zero entry shower.

Finding Your Way Home – Hospital to Home Program

Mandi Strantz, Care Transition Coordinator for The Independence Center, works tirelessly to keep people with disabilities, who have landed in the hospital, from unnecessarily being transitioned to nursing homes. There’s a disturbing trend when people with complex cases are hospitalized, and aren’t recovering quickly enough. They are often transferred to nursing homes, where many patients find themselves trapped. After not being in their home for an extended period of time, bills can go unpaid, life moves on, and they lose the ability to move back home. Even if they are still able to live a life of independence, many individuals don’t have the necessary network or resources in place to escape the clutches of institutional living. When speaking to Strantz about this epidemic, she tells me “That’s how individuals get stuck there, and have a very difficult time getting back home, and end up losing everything they have. So we want to have a paradigm shift in thinking, to say let’s get people home – it’s better for them as a person, it’s better for their health, and it’s cheaper.”

The Independence Center’s Hospital to Home Transitions (H2H) program is a pilot program that began in March of 2018. The program was started after two years of discussions and planning on how to best tackle the issue of unnecessary nursing home placements. H2H provides services such as meals in the home, transportation, setting up home health care, setting up homemaking services such as housekeeping and grocery pickup, procuring and setting up durable medical equipment, and helping with medication delivery and funding. By providing these types of services, patients receive the supports they need to get back in their home to focus on their recovery without being institutionalized.

One of the most puzzling aspects of the unnecessary transitioning of patients to nursing homes, is the astronomical cost. According to the U.S. Department of Health and Human Services, in 2017, the average cost of a private room in a U.S. nursing home was $7,698 per month, or roughly $92,000 per year. By transitioning people back into their homes, it maintains the patient’s independence and saves a fortune for everyone involved – from the hospital, to the insurance company, to Medicaid. When speaking about the cost, Mandi tells me that between the eleven individuals the H2H program has helped transition home, the cost has been significantly lower.

Darioun’s Transition Story

Photo of Darioun and Mandy

Darioun and Mandy

One patient who has benefited from the H2H program is Darioun McCune. After being shot in the abdomen, Darioun faced numerous surgeries and an extremely complex and extended recovery. Several months after being hospitalized, Darioun was released, but was quickly readmitted with pneumonia. Upon his second discharge, the H2H program stepped in. Many cases with this level of complexity would have resulted in the patient being transferred to a nursing home, but with the persistence of his Aunt Sonya and the H2H program, Darioun was able to find the supports he needed to recover at home. Sonya was even able to become Darioun’s caregiver through The IC’s Home Health department. The IC’s Benefits department was able to help Darioun get the benefits he needed to pay for his care, and to arrange transportation to and from high school, where Darioun is working to graduate and go on to college. When asked about his experience with The IC’s H2H program, Darioun says he’s very thankful, going on to say “I got a chance to meet so many people at The IC. They have helped me understand that everybody with disabilities, aren’t helpless”. Without the intervention of the H2H program, it’s hard to say where Darioun would be in his recovery, but what is certain, is that H2H has helped to make the transition easier.

The H2H pilot program was launched in partnership with UC Health – Memorial Hospital in Colorado Springs with help from Joseph Foecking, Director of Rehabilitation at Memorial Health System, and a Board Member here at The Independence Center. So far the program has been an overwhelming success, beating initial goals for the number of patients transitioned home, and for the small number of patients readmitted to the hospital. The results of the pilot program are clear, by providing needed supports for patients recovering in their homes, everyone wins.

The future of the H2H program looks bright, as the pilot program was recently extended for another six months. Going forward, we’re hopeful other local hospitals will recognize the value of the program and adopt this more humane and cost effective philosophy. To learn more about the H2H program, visit The IC on the web at http://bit.ly/The-IC, or by telephone at 719-471-8181.

Do you need a doctor with accessible equipment?

Check out our online map which shows which Primary Care offices and clinics have accessible exam equipment and what kind. Visit bitly.theic-accessibleoffices

Helping People with Hearing Loss

Photo of award presentation

Stacy Gibson receiving award from Hal Moffat, President – Woodmen Valley Sertoma

Stacy Gibson, IL Specialist with Hard of Hearing Emphasis at The Independence Center was recently honored with the “Service to Mankind Club Award” by Woodman Valley Sertoma for her work connecting people with hearing loss with the help they need, through the Sertoma HEARS program. The HEARS program helps people with hearing loss, who are in need of financial assistance, to purchase hearing aids.

Stacy’s award stems from her work with two local men who were having a difficult time and needed help with their hearing loss. One was a man experiencing homelessness, and the other was an elderly man with cognitive disabilities living at a local assisted living facility. The man was about to be thrown out onto the street because of the inability to control his behavioral issues. They contacted The IC’s Hard of Hearing department and Stacy made arrangements for a visit.

In preparation for the meeting, she brought a pocket talker, an electronic device similar to a hearing aid, but hangs around the neck and amplifies sound into a pair of earbuds. The man put the pocket talker on, and was able to have a conversation with the Director of the facility. They explained the rules and their expectations, and the man immediately understood. His behavior has improved drastically. It turns out he was acting out because of his frustration from not being able to communicate. Through The IC’s Assistive Technology Program, Stacy was able to get the man his own pocket talker, and since then, he has been a whole different person.

Congratulations to Stacy Gibson for this well-deserved award. To learn more, visit The IC’s Hard of Hearing department webpage at http://bit.ly/TheIC-HoH.

CEO Corner – The Art of Letting Go!

Phot of Patricia Yeager in front of purple flowers

Patricia Yeager, Ph.D., CEO

In August 2017, Tim Gore, our Development Director and Courtney Stone, IL Senior Manager came to me with a hare-brained idea to put on an art show featuring local artists with disabilities, the first Friday of September, which was four weeks away. It was a great idea to pull our artists into the thriving First Friday Art Walk held every month in Colorado Springs, but four weeks? I shook my head and started to say, “You two are old enough to know that you can’t pull off something like that in four weeks!” I stopped for a moment and thought, “Well, rather than me telling them, it would be better if they found it out on their own. A painful lesson for sure, but at some point in everyone’s career, they have to learn to plan ahead.”

Later, I found out they left my office laughing and saying, “Was that a challenge? We’ll show her!” And just like that, The Art of Accessibility (AoA) was born in exactly four weeks! Now we are changing the art world in the Pikes Peak region to be more inclusive of persons with disabilities. People came to all 4 events we put on over the past year. Artists with disabilities showed their art, received feedback, and sold their work.Colorado Springs Fine Arts Center at Colorado College decided, with a little prodding from Tim and Courtney, to purchase an accessible pottery wheel. Paul Spotts, our assistive technology staff person with quadriplegia, had to be dragged to the pottery class to try out the wheel. Once there, he was the one who enjoyed it so much he had to be dragged away! This reaction so inspired the Fine Arts Center staff, that they are starting to market their classes to persons with disabilities.

Next, we noticed the van used to transport people to and from various art venues was not accessible to patrons who used mobility devices. This might explain why galleries were not really seeing people with disabilities during the First Friday Art walks. Tim and Courtney informed Art Walk staff of the need for an accessible vehicle to serve First Friday patrons. After several months of discussion an accessible van showed up at the Art Walk venues!

Meanwhile, back at the Art of Accessibility events, staff started to add exhibits. We had a dance troupe of persons with intellectual disabilities and the most recent event, held in September 2018, featured a fashion show of sharply dressed men and women with disabilities. Each person’s attire was described by the MC and each told a bit of their story. One person in particular surprised me as I had never heard him speak a full sentence. There he was chatting away with the audience while showing off his beautiful jacket, tailored just for him, thanks to the Men’s Exchange! Who knew this little event could be so life changing?

Tim and Courtney sitting on stairs laughing

Tim Gore and Courtney Stone photographed by AoA artist, Bryan York

In October, Art of Accessibility won best gallery exhibit at the Pikes Peak Arts Council awards. The IC was the only non-art focused organization to be nominated, let alone win. It was a big deal! Now our event has been selected to receive the 2019 Business for the Arts Award presented by Colorado Business Committee for the Arts. While we are thrilled to be noticed, it is really about showcasing and empowering artists with disabilities across the state. Perhaps other communities will look at our event and think of ways to include their local artists with disabilities.

And I learned to let go and let others do things differently than I would! There is always more than one way to accomplish a goal, as Tim and Courtney had so much fun in showing me!

Get Paid to Be Caregiver for Spouse or Family Member in Colorado

“There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.” These words are perhaps the most profound truth about caregiving, and they were spoken by former First Lady Rosalynn Carter.

Rosalynn understood caregiving because she cared for her father before he passed away when she was 12 years old. After he passed from leukemia, she helped her mother care for her three younger siblings. After leaving the White House, Rosalynn helped care for President Carter’s three siblings (who all passed away from cancer) and her own mother.

There was something else Rosalynn understood: not all caregivers realize they are caregivers. “People don’t want to admit that they are caregivers. They feel it is just their responsibility to care for a mother or a grandmother.”

The first step to receiving much-needed support lies in being able to self-identify as a caregiver. Once you are able to accept and articulate this, it opens the door to be able to ask for and receive help.

Rosalynn herself laughed when she admitted, “I didn’t realize I was a caregiver until I got involved in this work.”

How Do I Know If I Am a Caregiver?

Family Caregiver Alliance defines a “caregiver” as “a spouse, partner, family member, friend, or neighbor involved in assisting others with activities of daily living and/or medical tasks.” Anyone who is caring for a loved one with a disability, or who is elderly or chronically ill is a caregiver. It doesn’t have to be full time. Although, in many cases, caregiving is 24/7 work.

No matter full or part time, caregiving takes a toll. The burden of caregiving can greatly impact the following areas: financial, friendships and family life, physical and mental health, and a caregiver’s job or career.

Financial Impact of Caregiving

The financial impact of caregiving is mentioned first, because the financial hit can be the most devastating to all areas of life for the caregiver. Not only do caregivers often have to give up jobs or careers, or take reduced hours at work, but caregivers end up spending money for their loved one’s care as well.

In this article, we’ll look at one major way of alleviating financial stress in caregiving: becoming a paid caregiver for your loved one.

If I Get Paid for Caring For My Loved One, Doesn’t this Diminish What I’m Doing?

The question of payment for doing what one already considers a duty or display of love is a valid one. For instance, parents can sometimes feel uneasy about receiving payment to care for a disabled child. Spouses will often feel like receiving payment for showing love through care may not be right. The answer to this lies in the perspective. How about this for perspective: in many ways, receiving payment for caregiving elevates caregiving. It’s an acknowledgment of the work and the sacrifice you are performing. I remember words my real estate agent Brian Boals told me when I wanted to sell my house: “People pay for value.” And in caregiving, as with all things, people do pay for value.

AARP’s Public Policy Institute found in 2015 the value of home care services performed by informal caregivers was $470 billion in 2013. That $470 billion was actually larger than the entire national spending on paid home care and Medicaid spending combined for 2013. Interestingly enough, the institute titled that report “Valuing the Invaluable.”

As a caregiver, you are performing an invaluable service and it deserves to be valued.

Which Programs Pay for Family Members and Spouses to Become Caregivers

This leads us to the question: “How do I get paid for being a caregiver in Colorado?” It doesn’t have a simple single answer, but we’re going to look at a few home health service delivery options in Colorado that your loved one might qualify for.

In Home Support Services (IHSS)

Family, friends, and spouses may be able to be hired as a caregiver under Colorado’s IHSS delivery model for home health care. IHSS is available under certain Medicaid HCBS Waivers.

The Independence Center is a home health agency that supports IHSS and is actively hiring qualified spouses and loved ones as caregivers

Click here to read more information about IHSS from The Independence Center.

Consumer Directed Attendant Support Services (CDASS)

Colorado’s Consumer Directed Attendant Support Services (CDASS) is another Participant Directed service delivery model similar to IHSS. The primary difference is participants on CDASS do not work with a home health agency.

Click here to go to Colorado.gov’s helpful information page about CDASS, including how to apply.

Veteran Directed Home and Community Based Services (VD-HCBS)

Marine veteran Cpl. Richard Stalder smiles with sunglasses on and looking at the camera while seated in his wheelchair outside on a sunny day with his archery kit. He is accompanied by his mother, who is standing to his left, with sunglasses on and looking at him.

Marine veteran Cpl. Richard Stalder, a native of Muenster, Texas, is a wounded warrior competing in archery, cycling and shooting during the 2014 Marine Corps Trials on Marine Corps Base Camp Pendleton, Calif., March 4, 2014. Stalder’s mother, Claudia Stalder, became his primary caregiver following his diagnosis. (U.S. Marine Corps photo by Cpl. Lisette Leyva/Released)

Caregivers of veterans face unique challenges, and can benefit from VA benefits the veteran receives. Another Participant Directed service delivery model is the Veteran Directed Home and Community Based Services (VD-HCBS), which is a VA benefit.

If you care for a veteran who resides in the Pikes Peak region, including El Paso, Park, Elbert, Kiowa, Teller, Kit Carson, Cheyenne, or Lincoln counties, your loved one may be eligible for The Independence Center’s Veteran In Charge program.

Receive Caregiver Support through The Independence Center

Even if your loved one with a disability doesn’t qualify for any of the above programs, it’s still important for you as a caregiver to actively seek support for yourself. Without active support, the toll of caregiving can wreak havoc with your health and stability.

One avenue of support is respite care. Respite care is designed to give caregivers a break. Click here for a guide to respite care in Colorado.

Other types of support can be found in support groupsclasses, and even online courses like the caregiver course specifically for caregivers of people with dementia provided by Catherine Hammond of Hammond Law Group in Colorado Springs. Hammond Law Group is known for helping families in Colorado prepare and act in case of a family member’s disability.

The Independence Center is here for you and can help you access caregiver support and resources. We can also help you navigate the Long Term Services and Supports (LTSS) system in the Pikes Peak region. Please call us at 719-471-8181. This entry was posted on Thursday, January 10th, 2019 at 5:41 pm and is filed under The IC Blog

Veteran Directed Home and Community Based Services (VD-HCBS) in Colorado

If you’ve read Stephen Ambrose’s book Band of Brothers or seen Steven Spielberg’s and Tom Hank’s HBO miniseries production of that story, you’re familiar with the person and character of Cpt. Herbert Sobel. Sobel served nine years in the U.S. military, was a member of the 101st Airborne Division and the famed volunteer-based Easy Company, 506th Parachute Infantry. Regardless of what you think about his infantry training and leadership skills, the last decades of his life were tragic.

Herbert Sobel attempted suicide by shooting himself through the temple in 1970. He survived the attempt, but the bullet passed behind his eyes, severing the optic nerves. He experienced complete blindness for the remaining 17 years of his life. Herbert Sobel spent his last 17 years in a VA nursing home, where he died of malnutrition in 1987. No funeral was held.

If you know the Band of Brothers account, Sobel was not remembered well by the soldiers under him. However, no veteran should suffer a demise such as Sobel’s. And while VA nursing homes have come a long way since the 1980’s, there are now options for veterans to receive homemaker, personal care, meal delivery, transportation, and health related goods and services in their own homes.

Home and Community Based Care As an Alternative to Institutionalization for Veterans

A lot has changed for the better on the Long Term Services and Supports front since the 1980’s. Veterans at risk of nursing home placement are now able to access these services and supports in the comfort of their own homes for as long as possible. Traditional home health agency services are a good option. Those services are all decided on and managed by the agency.

However, many veterans would prefer to have control over their own home health care, and with the new participant-centered model of home health care service delivery, you can. I’m talking about the arrival of Veteran Directed Home and Community Based Services (VD-HCBS) in Colorado.

Specifically, if you’re in the Pikes Peak region which includes El Paso, Park, Elbert, Kiowa, Teller, Kit Carson, Cheyenne, or Lincoln counties, you may be eligible for The Independence Center’s Veteran In Charge program. Veteran in Charge program is one of Colorado’s top VD-HCBS programs because The Independence Center is all about advocating for your right to have choice, control, and independence if you have a disability. Click here to read the success story of how The Independence Center’s Veteran in Charge program came into existence.

What ‘Veteran Directed’ Means

Veterans enrolled in VD-HCBS have more control than participants of traditional home health service delivery over which mix of goods and services they need to keep them living independently in their own homes. No matter your age, if you meet qualification criteria for the program, you are given a flexible monthly personal budget with which to purchase goods and services, including hiring of caregivers. You are in charge of who you hire, as well as training and scheduling of your home health caregivers. You are allowed to hire family members (including spouses) or friends to provide these home care services.

How the Program works

Graphic with soldier in the center representing Veteran or veteran representative and showing 8 boxes with the following information: makes budgeting decisions & sets salary for caregivers, hires and dismisses caregivers, sets tasks for caregivers, trains and schedules caregivers, determines good and services needed, keeps time sheets and other employment records, receives support from options counselor, and works with Financial Management Service provider


To get started, contact your Colorado VA social worker, who will determine your eligibility for the VD-HCBS program. If you don’t have a social worker, you can contact the main Rocky Mountain VA social work line at 720-723-3018.

Once your eligibility has been determined, the VA program coordinator will orient you to the program. The VA will then give you a referral to either the local Area Agency on AgingAging and Disability Resource Center, or Center for Independent Living. In the case of the Veteran in Charge VD-HCBS program in the Pikes Peak region, The Independence Center is the Center for Independent Living that you will be referred to. There, you’ll receive an options counselor who will work with you to develop a personalized service plan with the goal of keeping you independent in your home for as long as possible. The counselor at The Independence Center is called a Veteran Coach. Your counselor will provide an in-home assessment and will help you with care and service planning.

Through a collaborative effort between you, your counselor and the VA medical center, a monthly budget and plan for home health care expenses and services will be authorized by the VA. With VD-HCBS, you are not confined to typical home health care service packages. You can completely customize your services to your needs.

If you need help finding a caregiver, your counselor will assist with that. The counselor will also arrange for a Financial Management Services (FMS) company to help with the financial side of things. Your counselor/coach will be there for ongoing support for both you and your caregiver(s), so you never have to go it alone.

With VD-HCBS, you become the employer for your home health caregiver(s). The FMS will prepare paychecks for your home health caregiver(s), tax returns, and other payroll documents. Payments to caregivers are authorized by the veteran and the FMS. Your counselor and the VA coordinator will help identify other VA benefits that can help you live independently. The VD-HCBS program does not allow duplication of other VA benefits.

Types of Goods and Services You Can Receive With VD-HCBS

With the goal of keeping you out of a nursing home for as long as possible, VD-HCBS gives you a VA authorized budget with which to purchase the following types of services:

  • In-home personal care such as assistance with bathing and toileting
  • Homemaker services such as laundry and housekeeping
    Chore and maintenance service such as yard and snow removal
  • Health maintenance costs such as dietary counseling or massage therapy
  • Caregiver education, training, and support
  • Home modifications such as bathroom grab bars and wheelchair ramps
  • Adult day care
  • Nutritional services prescribed by a doctor or dietician
  • Respite care to relieve caregivers
  • Assistive or monitoring devices
  • Environmental support
  • Grocery and/or meal delivery
  • Transportation for socialization or medical appointments
  • Emergency response system

How To Qualify for Veteran Directed Home and Community Based Services (VD-HCBS)

To qualify for the VD-HCBS program you must:

  • Be enrolled in Veterans Health Administration. If you are not already enrolled in Veterans Administration Health Care (VAHC), click here to find out if you are eligible for VAHC and how to apply.
  • Meet eligibility criteria that show you are at risk of nursing home placement. Typically this means that you require assistance with at least three activities of daily living, although there can be other criteria like cognitive impairment or needing hospice.
  • Be interested in and able to manage your own care or able to appoint someone who can direct your care on your behalf
  • You must live at home or with a loved one or in an independent living facility that does not offer home care support

Why Choose The Independence Center’s Veteran in Charge VD-HCBS Program

As a Center for Independent Living, The Independence Center (The IC) is designed to be an advocate for people with disabilities and their caregivers and families. This means we are always advocating for independence, choice, and control in your own life and health care.

The Aging and Disability Business Institute has this to say about The IC’s Veteran in Charge program:

“The IC’s experience in disability and independent living services, self-advocacy and consumer direction positions them to operate a successful VD‑HCBS program….

Ultimately, building relationships with veterans within the program is at the heart of the success. These relationships are nurtured at every step of the process….

The IC invested time to ensure the best structure and foundation to administer their Veteran In Charge program. Building relationships with the Denver VAMC was critical for the launch and the ongoing success and growth of the program. The IC leadership reached out to other VD-HCBS sites to ask for recommendations and lessons learned before launching the program and the insights shared from experienced peers proved invaluable. Additionally, The IC dedicated substantial time to researching various Financial Management Service (FMS) agencies, an integral partner in the VD-HCBS program (FMS agencies are third-party entities that assist veterans with managing their self-direction budgets and can help with various employment responsibilities).”

To learn more about The Independence Center’s Veteran in Charge Program, call us at 719-471-8181.

In-Home Support Services (IHSS) in Colorado

I’m about to give you the good news about In-Home Support Services (IHSS) in Colorado. The good news is IHSS is available in Colorado if you’re on certain Medicaid Home and Community Based Services (HCBS) Waivers.

If you’re not sure what IHSS is, read on. All the basics are covered in this article, including definitions, qualifying information, and helpful links to other articles.

In my last article we looked at trends in Long Term Services and Supports (LTSS) and how Participant Directed Programs have become available in Colorado. ‘Participant Directed’ refers to how typical LTSS services are accessed and managed. This is in contrast to what is known as Traditional Directed, or Physician Directed care. You, as participant, can now select your own caregivers and direct your own care.

One of these progressive models that allows you to direct your own home care is In-Home Support Services (IHSS).

What is In-Home Support Services (IHSS)?

IHSS is a participant directed service delivery model for people with disabilities who qualify for Home and Community Based Services (HCBS) Waivers. It is not a specific public health program. IHSS refers to the way you as a participant already on an HCBS Waiver can manage your own home health care.

IHSS has to do with the way home health care services are accessed, delivered, and managed. Instead of a physician being the director of your care, you become the ‘boss’. IHSS has been approved by Centers for Medicare & Medicaid and allows you to direct your own in-home care under the authority of a participating home health agency.

Even if your health is unstable, if you are able to direct and manage your own care (or have an Authorized Representative of your choosing do it), IHSS may be a good option for you.

Which services qualify as In-Home Support Services (IHSS)?

Colorado statute defines IHSS as “services that are provided by an attendant and include health maintenance activities, support for activities of daily living, personal care services… and homemaker services.”

Personal care services are those services like assistance with brushing teeth, bathing, using the restroom, meal preparation and medication reminders.

Homemaker services include household chores and light housework, like grocery shopping and meal preparation.

Health maintenance services are those medically skilled care services such as IVs, feeding tubes, catheter irrigation, enemas, suppositories, and wound care.

Older woman with a disability in electric wheelchair smiles and talks with a woman sitting near her on the bed.

 

Who Hires the Caregiver and Who Employs the Caregiver?

Under IHSS, as participant, you can select who you want to be your caregiver (including your spouse!), and the home health agency you are working with becomes the employer and does the actual hiring, not you.

If you don’t have a home health worker in mind, the agency can help you find someone. With the traditional agency model, the agency hires who THEY want. With IHSS, you select who the agency hires or can choose to utilize an agency caregiver. The agency along with the participant will help train the caregiver to personalize the care.

IHSS is available to qualified participants on the following three HCBS Waivers:

Are spouses allowed to be hired under IHSS in Colorado?

Since 2016, Colorado now allows spouses to be hired as caregivers by a home health agency. Prior to 2016, spouses were not allowed to be reimbursed for care under IHSS. The Independence Center is a home health agency that is actively hiring and training spouses for home care.

One of the biggest perks of being hired as a spouse to care for a spouse with a disability is the benefits that come as a paid employee. Paid employees of a home health agency could be eligible to receive any benefits available, such as health and dental insurance, 401(k), and paid time off.

How Does the Agency fit into IHSS?

IHSS is participant directed care. However, the agency still is the employer (not you) and is responsible for oversight, hiring, training, providing backup services, and nursing supervision. The agency also oversees your care budget and manages payroll for your caregiver(s).

You, as participant, work closely with the agency and your case manager to determine which services and supports you need.

Nurse Practice Act Waived Under IHSS

IHSS contains a valuable provision related to the Nurse Practice Act in Colorado. Tasks that are reserved for skilled nurses (RN or CNA) but that don’t require the clinical judgment of a nurse are allowed to be performed by a home health care worker that is not a nurse. In essence, under IHSS the Nurse Practice Act is waived.

The home health agency through which the IHSS services are being delivered will assess the caregiver’s ability to perform such tasks. This results in considerable cost savings as well as convenience to the participant. By having the the Nurse Practice Act waived, you can receive care from your loved ones, and those family members or friends can be paid for giving care.

For instance, a mother who is employed by the IHSS agency as caregiver for her daughter can perform such tasks without having an additional outside worker come in for the tasks.

Getting Involved with IHSS Policy

Are you an IHSS participant and want to give input into the state administration of IHSS? Consider attending the Participant-Directed Programs Policy Collaborative (PDPPC), which is a joint collaboration between participants and the Colorado Department of Health Care Policy and Financing. Attendance at these monthly meetings is also possible via conference call. For more information including meeting dates and conference call dial-in, click here.

The Independence Center Can Help

Do you have questions about whether IHSS may be right for you? The Independence Center is not only a home health agency with expertise in IHSS, but it is a Center for Independent Living. As such, it advocates at the local and state level for continued increase in quality of life for people with disabilities. If you are considering IHSS, talk to us. We can help you navigate the ins and outs and support you in your decision. Contact our Home Health Office Administrator at 719-471-8181, ext. 130 with questions about IHSS or other participant directed programs.

Participant Directed Services for Home Health Care in Colorado

Long Term Care Changes Put the Power in Your Hands

Once upon a time, being elderly or having a disability that affected your ability to care for yourself meant you were forced to enter a nursing home. Since the end of the twentieth century, there has been a shift in how Long Term Services and Supports (LTSS) are delivered. The movement has gone from institutional, to homelike (in a nursing facility), to the home (of the participant). It’s swung from a focus on individualized care to personalized care. And now there are not only personalized options for long term care, but participants (you!) can actually direct their own care.

In Colorado, this new model is called participant directed programs. Other terms for it include consumer-directed programsself-directed services, or even veteran-directed services (veterans directing their own home health care services through the VD-HCBS program).

This article looks at how trends in long term care have changed for people with disabilities. Once you understand where we have been, you can better appreciate the value of participant directed programs.

Long Term Care: From Institution to Homelike

Prior to the 1960s, and especially in the early twentieth century, the concept of ‘home’ was not part of a nursing facility (and prior almshouses) environment. Facilities were most often places people in their final stage of life would be placed. An environment of impending death was more the norm than a focus on life.

The 1960s brought civil rights to the forefront of Americans’ minds. Social climate became favorable for people with disabilities to gain and assert civil rights in a way that hadn’t yet been possible. Society started to see that people with disabilities are capable of and deserve to be able to live a productive and meaningful life.

With this increased sense of value on the lives of people with disabilities, the 1980s brought societal and legislative changes. A change in nursing home care accompanied this. Nursing facilities were becoming less hospital like (focused on end of life) and more homelike (focused on living life).

From Nursing Home Care to Home and Community Based Services (From Individualized Care to Personalized Care)

Nursing homes have come a long way from being the strictly medical institutions they used to be (similar to hospitals). And they are much more homelike and comfortable then they ever have been. (Hooray!) But because of their limitations, they still give individualized care, not personalized care.

Care in a facility can be individualized, but it cannot be personalized. The area in which this is most visible is timing of care. Because staff need to be efficient to attend to all residents, care is timed on the facility’s schedule, not on your schedule. Nursing facilities still operate on the concept of ‘rounds.’ To increase efficiency, nursing home staff make their rounds to care for patients at the same times each day. If you live in a nursing home, you may ring for assistance outside these times, but the rounds times will not be changed to meet your needs.

Another area where personalized care in a nursing facility is not feasible is caregivers. In nursing facilities, you cannot make personal requests to have caregivers hired or fired, or even specify which caregivers you would like to attend to you on a given shift.

The 1990s started a trend from individualized care to personalized care. People were seeking LTSS personalized to their needs and lifestyles, not limited to what nursing facilities could or couldn’t provide.

Bringing Care to Your Home Instead of Bringing You to the Care (Nursing) Home.

In particular, the 1990s brought about the Medicaid Home and Community Based Services (HCBS) waivers. This shift was all about bringing care to the individual’s home instead of bringing the individual to the care (nursing) home.

Many people with disabilities are now able to receive nursing facility level of care in the comfort, safety, and privacy of their own homes. HCBS Waivers and other funding alternatives have made personalized home health care services accessible more than ever before.

Inside your home, your care goes from individualized to personalized. With no other patients, or staff efficiency needs, there is just you to be cared for. Your home health care can be personalized to your needs.

From Traditional Directed Home Health Care to Participant Directed Home Health Care

Riding on the trend from individualized to personalized LTSS, comes the newest positive change. It’s a big deal. It makes the participant (you!) the director of your care.

In the 1980s and 1990s, LTSS delivery was largely in the hands of home health provider agencies. (It’s still the most common model.) However, now we have available Participant Directed Services in Colorado. Participant Directed Services means you can actually choose your own caregivers and hire and/or train them for your own care (depending on the specific model).

This concept is not new. It was pioneered in the 1970’s by the Independent Living Movement. However, it’s only since the 1990s that Participant Directed Services have been included as a model in Medicaid Waivers and become available more widely in Colorado.

Participant Directed Services Are Participant Centered

Woman and her daughter sit closely and look out a sunny window together

More control over your healthcare is in your best interest. Not only do you generally know more about your own needs, but you are generally more motivated than someone else to ensure the care you receive meets your needs. When you are the director of your care, you can choose and/or hire caregivers to meet your own home health needs, as determined by you. This puts your care squarely in your hands (or in the hands of a designated representative). Your care truly becomes “participant centered” this way—centered around you.

Become the Employer and/or Choose the Caregivers You Hire

With some Participant Directed Service plans, you become the employer of your home health providers. It is no longer even the agency who is the employer. Other plans still have the agency as employer but you can choose who is hired. Consider how empowering it is to no longer be viewed as a patient or a client first, but to be viewed by your care provider as the employer and/or the trainer of your own care needs.

Work With a Home Health Agency in a Way You Direct

This means anyone who is qualified can be hired for your care! This could be someone already employed by an agency but it could also be a friend, a community member, or a family member. In fact, many times caregivers who are family members can now be hired and paid for the care they give.

With Participant Directed Services, the network for care providers opens up. When your potential caregiver pool is not restricted to providers employed by home health agencies, more people can be considered as potential caregivers to be employed. In regions where there are limited caregivers employed by home health care agencies, this is especially helpful.

Participant Directed Services empowers you as the participant to direct your care and work with a provider agency in a way that you direct. It takes a working relationship with a home health agency to a new level.

Benefits of Participant Directed Services for Home Health Care in Colorado

As you can see, the benefits of participant direction give you:

  • Increased choice and flexibility in choosing providers and services,
  • More control over planning and scheduling home health care services,
  • Direct oversight in making sure your needs are met,
  • Direct employment authority over home health workers and caregivers, and
  • Increased control over the type and quality of the supports you receive.

Colorado has three main Participant Directed models of service delivery for LTSS available within some HCBS Waivers and programs.

They are:

  • In-Home Support Services (IHSS),
  • Consumer-Directed Attendant Support Services (CDASS), and
  • Veteran-Directed Home and Community Based Services (VD-HCBS)

We will look at IHSS and VD-HCBS in detail in next articles. The Independence Center provides home health care guidance and services for the IHSS and VD-HCBS Participant Directed models.

The Independence Center Can Help

The Independence Center (The IC) is a home health agency in Colorado that provides both Traditional Directed Services and Participant Directed Services, including Veteran Directed services. Not only does The IC provide LTSS, but it can help you navigate the system for obtaining LTSS. If you have any questions, please contact our Home Health Office Administrator at 719-471-8181, ext. 130.