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Art of Accessibility: Finding Empowerment Through Modeling

Photo of Alphie Omar on the runway

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.

History of Long Term Services and Supports in Colorado

We have a lot going for us in Colorado when it comes to the quality and access of long term services and supports (LTSS). Colorado actually ranks eighth in the nation,  according to the AARP Long-Term Services and Support Scorecard! Colorado is also one of only a few states that uses Medicaid dollars to serve more individuals needing LTSS through home and community based services (HCBS) than nursing facilities.

With this in mind, let’s look at the history of LTSS in Colorado. Here are the landmark highlights of federal and state events that paved the way for access to quality LTSS in Colorado.

1929 – 1939
The Great Depression

The impact of The Great Depression was experienced long after the actual economic downturn between 1929 – 1939. Because many of the elderly population experienced extreme poverty during this time, various pension schemes were introduced.

Black and white photo of Dr. Townsend at a desk with an NBC microphone

Townsend c. 1939, Harris & Ewing [Public domain], via Wikimedia Commons

The most influential of these schemes was the Townsend Plan, started by a 66 year old doctor named Francis E. Townsend. Dr. Townsend was disturbed when he witnessed three elderly women looking for food in a trash can. He proposed a plan that every American over age 60 be provided a federal pension of $200 monthly. At one point there were over 2.2 million Americans who considered themselves Townsend Plan club members who were actively working to make The Townsend Plan the old age pension system of the American government.

1934

As a response to the economic impact of the Great Depression, Franklin D. Roosevelt set up the Committee on Economic Security to study the matter of a federal old age pension system for America. The committee produced a report, which recommended legislating old age and unemployment benefits, as well as public health, child and maternal health programs, and aid to dependent children. The report did not recommend benefits for people with disabilities but it did mention the issue of illness by stating, “illness is one of the major causes of economic insecurity,” and “one-third to one-half of all dependency can be traced to the economic effects of illness.”

1935

President Roosevelt signs the Social Security Act

President Roosevelt signs the Social Security Act: Social Security Online [Public domain], via Wikimedia Commons

After considering the recommendations of Franklin’s committee, congress passed the Social Security Act. President Roosevelt signed it into law on August 14, 1935. The act provided old-age benefits funded by payroll taxes. The means-tested welfare program was intended to bring immediate relief to families affected by the Great Depression. The old-age insurance program was not designed for immediate relief—first payments were not scheduled until 1942. The final bill included public assistance for people of advanced age, for dependent children, and for people with blindness.

1942-1945

Public programs for LTSS were not included in the original Social Security Act except for aid to people with blindness. However, it was an ongoing topic of concern in America, due to huge financial losses experienced in the private disability insurance sector. With America entering into World War II, Roosevelt created a program to help civil defense workers who became disabled while working. This was called the Civilian War Benefits program and it paid partial, full, temporary and permanent disability benefits.

1948

Color photo of Lyndon Johnson signing Medicare bill, with Harry Truman

Lyndon Johnson signing Medicare bill, with Harry Truman, July 30, 1965, White House Press Office [Public domain], via Wikimedia Commons

While not funded immediately, the Advisory Council on Social Security to the Senate Finance Committee recommends disability benefits for disabled workers.

1950

The Social Security Act Amendments of 1950 created the Aid to the Permanently and Totally Disabled (APTD) program.

1965

President Lyndon B. Johnson signed the Social Security Amendments into law, which approved Medicare and Medicaid, on July 30, 1965.

1972

Black and white photo of Ed Roberts, disability rights champion

Edward V Roberts, Unnamed DOR Employee [Public domain], via Wikimedia Commons

Congress passed a law that enabled qualified individuals under the age of 65 with end-stage renal disease to enroll in Medicare, which until that time was strictly an age-based program. This was groundbreaking because it was the first time a medical condition could qualify someone for Medicare.

1972 was also pivotal as Ed Roberts, who was the first student with significant disabilities to attend UC Berkeley, founded the Berkeley Center for Independent Living (CIL). CIL is a nonprofit that advocates for people with disabilities. Ed is widely recognized as the father of the independent living movement.

1975

The forerunner to today’s Individuals with Disabilities Education Act (IDEA) was enacted by congress. The purpose of this law was to protect the education rights and meet the education needs of children with disabilities.

1980

The Omnibus Budget Reconciliation Act of 1980 expanded the home health care benefit of Medicare

1981

Section 1915(c), an amendment of The Social Security Act of 1981, established Medicaid home and community based (HCBS) waivers which allowed for LTSS to be provided at home and at intermediate levels of care instead of strictly nursing home settings.

1983

Colorado implemented the first HCBS Waiver: Home and Community-Based Services for the Developmentally Disabled (HCB-DD). Colorado was one of the first states ever to implement a LTSS waiver. 1983 was also the year that the Colorado Indigent Care Program (CICP) was established to reimburse physicians and other providers for serving uninsured, indigent individuals.

1985

Colorado implemented the Elderly, Blind and Disabled waiver (EBD)

1987

The Omnibus Budget Reconciliation Act of 1987, signed by President Reagan on December 22nd, legislated new quality controls and penalties for nursing homes, including training requirements for nurses aides. (The Independence Center CNA Training Program utilizes these training requirements and more.) The law also required the Department of Health and Human Services to establish training standards for employees of home health agencies. Annual home health agency assessments, including home visits became required. This law was pivotal for people receiving home health care; it guarantees home health care patients/clients receive the same rights as those in nursing homes. This includes the right to be informed in advance of any treatment, to be involved in planning their own care, and the right to voice grievances.

1987 was also the year The Independence Center was founded, as Southern Colorado’s disability resource center and home health provider.

1990

President Bush signs the Americans with Disabilities Act on the South Lawn of the White House. Sharing the dais with the President and he signs the Act are (standing left to right): Rev. Harold Wilkie of Clairmont, California; Sandra Parrino, National Council on Disability; (seated left to right): Evan Kemp, Chairman, Equal Opportunity Commission; and Justin Dart, Presidential Commission on Employment of People with Disabilities. Mrs. Bush and Vice President Quayle participate in the Ceremony.

President Bush signs the Americans with Disabilities Act on the South Lawn of the White House. Sharing the dais with the President as he signs the Act are (standing left to right): Rev. Harold Wilkie of Clairmont, California; Sandra Parrino, National Council on Disability; (seated left to right): Evan Kemp, Chairman, Equal Opportunity Commission; and Justin Dart, Presidential Commission on Employment of People with Disabilities. 26 July 1990 Photo credit: George Bush Presidential Library and Museum. Executive Office of the President of the United States [Public domain], via Wikimedia Commons

Congress passes the Americans with Disabilities Act (ADA), a civil rights law passed by the senate in 1989, protecting Americans with disabilities from discrimination in five key areas of public life. President George H.W. Bush signed the act into law on July 26, 1990.

1990 was also pivotal for Colorado’s children. It was the year Colorado implemented the Children’s HCBS waiver. Legislation that created the first insurance program for low-income, non-Medicaid children in Colorado was also passed in 1990. It was called Colorado Child Health Plan (CCHP),

1991

Total Longterm Care was founded in Denver, Colorado. It was one of the first nationwide Medicare and Medicaid funded Programs of All-Inclusive Care for the Elderly (PACE).

1991 was also the year Colorado legislated the beginning of the Single Entry Point (SEP) system for LTSS. The SEP is a single access point within a geographical area where individuals with disabilities, advanced age, or certain conditions can be screened for LTSS. SEPs provide case management and intake functions. Prior to the SEP system, Colorado operated on a county-based system. The SEP system allows for greater quality assurance because Colorado’s Department of Health Care Policy and Financing has contractual relationships with the SEPs.

1994

Colorado implemented the Persons Living with Aids waiver. (This waiver expired in 2013.)

1995

Portrait of Governor Roy RomerColorado implemented the Persons with Brain Injury (BI) waiver.

1996 Colorado implemented Children’s Habilitation Residential Program (CHRP), Children’s Extensive Support (CES), and Supported Living Services (SLS) waivers. See all state waivers here.

1996 was also the year Colorado state legislature voted to withdraw from the federal Medicaid program due to spiraling Medicaid costs and a taxpayer bill of rights (TABOR) that capped state spending increases at 6%. Governor Romer vetoed the legislation.

1997 Children’s Health Insurance Program (CHIP) was established as a federal-state partnership administered by each state to provide health insurance to children who don’t qualify for Medicaid or have access to other forms of insurance.

The Balanced Budget Act of 1997 establishes the Program of All-Inclusive Care for the Elderly (PACE) model as a permanent Medicare and Medicaid program.

1999

Lois Curtis, the plaintiff in Olmstead v. L.C., (center) presents President Barack Obama with a self-portrait of herself as a child that she painted.

Lois Curtis, the plaintiff in Olmstead v. L.C., (center) presents President Barack Obama with a self-portrait of herself as a child that she painted. Joining them are, from left, Janet Hill and Jessica Long, from the Georgia Department of Labor, and Lee Sanders, of Briggs and Associates. The Oval Office, 20 June 2011; Official White House Photo by Pete Souza [Public domain], via Wikimedia Commons

The U.S. Supreme Court’s ruling in Olmstead vs. L.C. found that states are obligated to make sure people with disabilities are not forced to remain institutionalized if home and community based care can appropriately meet those needs. The basis of this decision is the ADA; the court found that undue institutionalization is a form of discrimination against people with disabilities.

2001

Colorado’s Health Care Task Force, established by the General Assembly, recommended expansion of the PACE project and creation of In-Home Support Services (IHSS), among other initiatives.

2002

Colorado implemented the Community Mental Health Supports (CMHS) waiver

SB 02-027 was signed by Governor Bill Owens, which created participant directed options for LTSS: In-Home Supportive Services (IHSS) and Consumer Directed Attendant Support Services (CDASS).

Governor Bill Owens, 2002 Ariarmstrong CC BY-SA 4.0 from Wikimedia Commons

2003

Centers for Medicare & Medicaid Services approves Colorado participant-directed CDASS and IHSS programs. The participant-directed programs then became available to participants on the Elderly, Blind and Disabled (EBD) and the Children’s HCBS (CHCBS) waivers in 2004.

2006

Colorado implemented Children with Autism Waiver (which expired 2018).

2007

Colorado implemented Children Living with Life-Limiting Illness waiver.

2014

IHSS becomes available to participants on the Spinal Cord Injury (SCI) Waiver when Colorado HB 14-1358 is passed.

2017

Colorado ranks 8th in the United States for quality of care and access to long term services and supports. The AARP’s Foundation Scorecard projects the following Impact of Improved Performance (Quoted directly from the Scorecard):

“If Colorado improved its performance to the level of the average of the top-five-performing states,

  • 158,480 more place-based subsidized units and vouchers would be available to help low-income people with LTSS needs afford housing;
  • 40,203 more people of all ages would receive Medicaid LTSS to help them with daily activities;
  • 12,040 more home health and personal care aides would be available to provide care in the
    community;
  • 7,837 more low-/moderate-income adults with disabilities would have Medicaid coverage;
  • $134,700,000 more would go to home-and community-based services instead of nursing homes.”

Conclusion

Continued advocacy will enable Colorado to remain high on the list of states that provide quality care and services to people with disabilities in their homes and communities.

If you or a loved one need LTSS, The Independence Center is here to help point you in the right direction. Contact our Home Health Office Administrator at 719-471-8181, ext. 130 for help getting started.

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CEO CORNER

Phot of Patricia Yeager in front of purple flowers

Patricia Yeager, Ph.D., CEO

Patricia Yeager, Ph.D., CEO

After providing in-home health services to persons with disabilities in the Pikes Peak region for over thirty years, we decided to stretch our reach further into healthcare. We asked ourselves a few questions. Is it accessible and useable by persons with a wide range of disabilities? Can we “disrupt” the pipeline of people with disabilities going into nursing homes after being in the hospital? Why don’t more people with disabilities use primary care anyway? That might be able to prevent a trip to the hospital or emergency room… What is it with healthcare and people with disabilities?

Over the years, we have conducted several focus groups in our community to learn about barriers. A consistent barrier we heard about was “I can’t get on the table, nor can I get weighed!” And we also heard “The medical staff are uncomfortable around me, and that makes me uncomfortable.” As a result, The IC Fund purchased a hi-low able with weight scale and other accessibility features for Mission Medical Center late last year. In fact, there is an article in this edition of the Independence Times on page 3 that talks about this collaboration. The IC Fund Committee saw what a difference the addition of this accessible table made and decided that we need more Medicaid primary care providers to be accessible for people with disabilities. So in June, we kicked off a campaign to purchase accessible exam tables, Hoyer-style lifts, and hearing loop system to install in primary care providers’ offices. As part of the process, ADA site audits and disability etiquette training will be provided to ensure better accessibility and understanding for people with disabilities. We asked people with disabilities who are on Medicaid or Medicare to nominate their primary care provider, who would receive this accessible exam room equipment. By the time you read this, the contest will be over, but you can http://bit.ly/theicaccessiblehealth to get an update. By the end of the year, we should have all awardees identified and best of all, a map of where all the accessible medical equipment is located. Check the page often and go get a complete health exam – please!

Our community transition program, the one that works to get people out of nursing homes, often finds that a fair number of people in nursing homes don’t really need to be there! The lack of affordable, accessible housing is such a problem, that it takes significant time for people to transition out. This started us thinking about how we might disrupt the flow of people going into nursing homes from the hospital in the first place. Often, it is a medication administration problem, or a cooking/cleaning problem, or an understanding/managing diabetes problem. No one should go to a nursing home for those reasons! So we put together the Hospital to Home pilot program to see if we could change this phenomenon. In May of this year, we started the pilot program at UC Health Memorial Hospital Central, and I am happy to report that we have redirected four people back home, who were on their way to the nursing home. With our Home Health staff, the Independent Living staff, and 4 to 5 community agencies or for-profit providers, we are able to support these individuals so they can recover at home. The IL staff provide a bridge for getting back into community life after their hospital stay.

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