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Center for Personal Assistance Services Bulletin

July 2010 - Volume 7, Issue 3

In this issue:

The Center for Personal Assistance Services provides research, training, dissemination and technical assistance on issues of personal assistance services (PAS) in the United States. Personal assistance services (PAS) refer to help provided to people with disabilities to assist them with tasks essential for daily living. These tasks include bathing, dressing, getting around, toileting, eating, shopping, remembering things, and other activities. PAS, along with assistive technology such as wheelchairs, text readers, and hearing aides, help people with disabilities to participate in activities at home, at work, and in the community.

The purpose of this newsletter is to provide the latest news on issues relating to formal and informal PAS, home & community-based services, the PAS workforce, and workplace PAS within and outside of the Center.

Further detail about the Center staff and advisors can be found at


White House Launches Celebration Of 20th Anniversary Of Americans With Disabilities Act

June 2010, Valerie Jarrett, Senior Advisor to President Obama, kicked off the President's and White House's celebration of the 20th Anniversary of the Americans with Disabilities Act while delivering remarks to over 2,000 people from around the World at the VSA International Festival at the Kennedy Center.

For more information go to:

White House Releases Statement On Anniversary Of Olmstead Decision

On the Anniversary of Olmstead, President Obama Highlights Administration's Actions to Assist Americans with Disabilities.

Last year, on the anniversary of the landmark Supreme Court decision in the case of Olmstead v. L.C., President Obama launched "The Year of Community Living," a new effort to assist Americans with disabilities. One year later, the Administration has taken many steps towards achieving that goal.

"Olmstead was a critical civil rights decision that affirmed a fundamental right for Americans with disabilities - the right to live independently," said President Obama. "Since I launched the 'Year of Community Living,' my Administration has taken a number of important steps to address the needs and concerns of those living with disabilities. And as we mark the 20th anniversary of the Americans with Disabilities Act, we must renew our commitment to uphold the civil rights of those living with disabilities and to fully include all our people in the life of our nation.

For more information go to:

Center Researchers Provide Testimony on Home and Community-Based Services

PAS Center researchers Dr. Steve Kaye and Dr. Mitch LaPlante were invited to give testimony at a May 27 hearing of the Little Hoover Commission in Sacramento, CA.

The Commission, an independent California state oversight agency that investigates state government operations and recommends legislation, conducted the second of two hearings on long-term care in preparation for a report recommending improved strategies for providing home- and community-based services in California.

For more information go to:

Judge Orders State Of Florida To Provide Community Services To Jacksonville Woman At Risk Of Institutionalization

The state of Florida must provide Michele Haddad with services that will enable her to remain in her home, a U.S. District Court in Jacksonville, Florida, ruled. Haddad, who has quadriplegia as a result of a motorcycle accident with a drunk driver in 2007, has successfully resided in the community since the accident, but is at risk of entry into a nursing home due to changes in her caregiver situation.

For more information go to:

Long Term Care Facilities Profits Rise In California

A new study by California's Office of Statewide Health Planning and Development (OSHPD) found that net income among the state's long-term care operators grew from $70 million in 2003 to nearly $448 million in 2007. According to OSHPD, about $250 million of the net income increase is directly related to patient care.

For more information go to:

Spouses Face Challenges In Caring For Themselves And Their Ailing Partners

A Washington Post article on May 25, 2010 highlights the challenges older spouses face in caring for their partners, especially when they have their own age-related health concerns to deal with.

For more information go to:

Budget Pressures Spur Several States To Cut In-Home Care Programs

Many cash-strapped states are cutting spending on in-home health care services for disabled residents to close their mounting budget deficits, the Wall Street Journal reports.

South Carolina has imposed some of the biggest cuts, with some residents seeing their in-home services reduced by as much as half.

For more information go to:

Massachusetts Governor Finally Expands Home and Community-Based Pilot Program

Massachusetts Governor Deval Patrick announced recently that his administration will expand a pilot program that provides free counseling to older adults about alternatives to nursing home care. The program is credited with keeping more than 300 people in their homes and out of expensive nursing homes in one year.

For more information go to:

Developers Must Make Housing Accessible

New York Attorney General Cuomo secures agreements to provide accessible housing for people with disabilities. Under the agreements, the six developers involved must make or offer to make retrofits to apartments and common areas to ensure that people with disabilities have the full use and enjoyment of the facilities. They will also work with an independent expert to certify that future construction of apartment complexes is in compliance with New York State and federal accessibility laws.

For more information go to:

New Information Tool Gives Consumers More Control Over Their Own Health Care

The U.S. Department of Health and Human Services has announced a new website called HealthCare.gov. This new tool lets consumers take control of their health care by connecting them to information about quality, affordable health care coverage.

HealthCare.gov answers questions that relate to people with disabilities and health care, and also has information about insurance plans and community services in every state.

For more information go to:

Research Articles and Reports

Personal Care Services Utilization By Individuals With Developmental Disabilities

This center study by Dr. Charlene Harrington and Dr. Taewoon Kang examines factors associated with the use of personal care services (PCS) and the amount of authorized hours in California in 2004 - 2005. Of those Medicaid-eligible individuals with developmental disabilities living at home, 31% received PCS. When controlled for client need, gender, and age, individuals who were Asian/Pacific Islanders, African Americans, Hispanics, and other races had higher odds of receiving PCS than Whites but were authorized between 16 and 39 hours fewer than Whites.

For more information go to:

Barriers To Use Of Personal Assistance Services (PAS) In Workplace Settings

California's In Home Supportive Services (IHSS) is the largest and fastest-growing publicly-funded home and community-based services (HCBS) program in the state serving over 400,000 elders and people with disabilities. The program provides assistance for activities of daily living for low income individuals who are eligible for Medi-Cal and who meet the program's need criteria. In 2002, California passed the Workforce Inclusion Act to allow the IHSS program to provide services to obtain, retrain, or return to work in order to increase the employment rates of persons with disabilities.

The goal of this study by Mel Neri, Alice Wong and Dr. Charlene Harrington was to examine the implementation of the Workforce Inclusion Act of 2002. Specifically, the study examined the use of IHSS in the workplace and barriers to workplace IHSS, estimated the number of individuals using IHSS in the workplace, and summarized recommendations on how to increase access to IHSS in the workplace.

For more information go to:

California's Proposed Home Care Cuts Will Cost More Than Expected Savings

PHI, along with the Institute for Women and Policy Research, have released a report by Dr. Candace Howes, examining why California's proposal to cut 444,000 elders and people with disabilities from the In-Home Supportive Services program is short-sighted and fiscally irresponsible.

For more information go to:

Two Reports on PAS and HCBS for Minnesota Released

1) Annual report on the use and availability of home and community-based services waivers for persons with disabilities describes county and state use of available resources for four home and community-based service (HCBS) waiver programs.

For more information go to:

2) Personal Care Assistance Services-A Report To The 2010 Minnesota Legislature provides an overview of the recent legislatively mandated changes to PCA services.

For more information go to:

Recent Study Sheds Light On The Increasing Age Of The Direct Care Workforce

This study from PHI predicts that from 2008 to 2018, the number of direct care workers, which includes those in nursing homes, will grow to 4.3 million from 3.2 million. The percentage of older caregivers is projected to grow to 30 percent from 22 percent and highlights the fact that there is little career path for these workers, putting them at risk from great physical strain as they age.

For more information go to:

Study Examines Factors Related To A Successful Transition In The Ohio Medicaid Assisted Living Waiver Program: A Provider's Perspective

The Medicaid Assisted Living Waiver Program began operations in July 2006 as an effort to address the growing need for long-term care service options in the state of Ohio. This study examines the perceptions and observations of participating providers in the Ohio Medicaid Assisted Living Waiver Program and their perspective of the consumer transition experience.

For more information go to:

Report Finds Nursing Homes Cut Staff While Receiving Millions In Funding

California's nursing homes have received $880 million in additional funding from a 2004 state law designed to help hire more caregivers and boost wages. But 232 homes did just the opposite, they either cut staff, paid lower wages or let caregiver levels slip below a state-mandated minimum.

For more information go to:

Hilltop Institute Releases Chart Books on Four Maryland Medicaid Long-Term Care Programs

The Hilltop Institute has just released a new series of chart books, that summarize demographic, service utilization, and expenditure data for state fiscal years 2001 through 2008 on three Maryland Medicaid waiver programs - the Older Adults Waiver, the Living at Home Waiver, and the Autism Waiver - and on nursing facility utilization among Maryland Medicaid recipients.

For more information go to:

Policy Recommendations For Reforming The Nation's Medicaid-Funded Long-Term Supports And Services (LTSS) System

National policymakers and state Medicaid leaders are paying greater attention to better management of LTSS. The reasons are obvious: aging of the baby boom population; severe fiscal pressures; the disproportionate costs of those with serious long-term conditions; an ongoing over-reliance on institutional care; and the fact that LTSS remains almost entirely in the unmanaged fee-for-service system. Yet an array of financial, administrative, bureaucratic, and political obstacles impede states from rebalancing their LTSS programs toward greater emphasis on home-and community-based alternatives.

This brief outlines initial policy recommendations for reforming the nation's Medicaid-funded LTSS system to support more cost-effective and consumer-oriented long-term care options.

For more information go to:

Report Looks At Initiatives Offering Alternatives For Reforming The Delivery Of Medicaid-Funded Long-Term Care

Over the next two decades, analysts project that states will collectively spend nearly $1.6 trillion dollars for long-term care supports and services (LTSS) for elderly and disabled citizens and the federal government will contribute an additional $2.1 trillion, for a total of $3.7 trillion. Current estimates are that more than two-thirds of Americans age 65+ today will need long-term care with an average duration of need of about three years. In response, states are seeking fresh approaches for delivering Medicaid-funded LTSS, with an emphasis on reducing costly institutional care through home- and community-based "aging in place" initiatives.

This report presents an array of innovative initiatives from across the nation offering alternatives for reforming the delivery of Medicaid-funded long-term care.

For more information go to:

The Hilltop Institute Release Four Reports On Medicare And Medicaid

A Framework For State-Level Analysis Of Duals: Interleaving Medicare And Medicaid Data is a resource guide intended for analysts who plan to integrate data on Medicare and Medicaid service use and costs.

For more information go to:

The following three reports explore the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use:

Examining Rate Setting for Medicaid Managed Long-Term Care:

Examining The Medicare Resource Use Of Dually Eligible Medicaid Recipients:

Cross-Payer Effects On Medicare Resource Use: Lessons For Medicaid Administrators:

Report Looks At The Factors That Influence The Success Of Home And Community-Based Services In Keeping Older Adults In Community Settings

To understand factors that influence success of home- and community-based services in keeping older adults in community settings, the report examined the causal relationships among older adults' personal factors, older adults' home- and community-based services use, and older adults' remaining in communities. Findings suggest the importance of encouraging older adults to acknowledge their unmet needs and to seek community-based support services early.

For more information go to:

Narratives Of People With Disabilities In Sweden Who Receive Personal Assistance In Their Homes

The aim of this study was to investigate the experiences of persons with severe functional disabilities who receive personal assistance in their homes, the focus being on their daily life in relation to the ethical principles represented in the Swedish Disability Act: autonomy, integrity, influence and participation. Qualitative interviews were performed with 26 persons and thereafter subjected to qualitative latent content analysis. The experiences of personal assistance were very much in accordance with the said principles, the most important factor being that one is met with understanding.

For more information go to:


New Nursing Home Transparency and Improvement Act

The nursing home transparency provisions are the first comprehensive improvements in nursing home quality since the Omnibus Reconciliation Act of 1987. When the act is fully implemented, the law will provide consumers a substantial amount of new information about individual facilities, most of it from resolutions passed by members of the National Consumer Voice for Quality Long Term Care.

For more information go to:

PHI Produces Fact Sheets on Health Reform and the Direct-Care Workforce

The first in a series of fact sheets, "Health Reform 1" details several federal grant opportunities for states, community colleges, and individual employers that could have a major impact on training and education for the direct-care workforce.

For more information go to:

Maine Enacts Law To Assess Quality Of Direct-Care Jobs

Maine has passed a new law mandating the creation of a work group to review the quality of direct-care jobs within home and community-based programs administered by the state's Department of Health and Human Services (DHHS).

For more information go to:

On the Center Web Page

New Health Reform Page Providing Summaries And Implications For PAS

As a result of the health care reform agenda, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, 2010 and the Health Care and Education Reconciliation Act of 2010 on March 30th. These laws, to take effect over the next four years, includes a large number of health-related implications for PAS users.

This page is divided into the following summary sections:

  • Overall
  • Long term care
  • Medicaid
  • Other
  • Implications

For more information go to:

Transcripts And Archive Available For Recent PAS Center Webinar

On June 30th, the Center for PAS hosted a webinar titled, "What Does the Health Reform Legislation Mean for Long-Term Services and Supports?", presented by Joshua Wiener. The webinar examined the new Patient Protection and Affordable Care Act and the parts of the Act that have an impact on personal assistance service.

For a transcripts and archive of the presentation go to:

2006 Home And Community Based Data And Updated Contact Information

Two sets of information concerning Medicaid home and community based services (HCBS) collected by PAS Center researchers are now viewable by state and for the entire United States on the PAS Center website. First, a series of tables report the most recently available (2006) participant and expenditure data for the three Medicaid HCBS programs:

  • the mandatory home health benefit,
  • the optional state plan personal care services benefit, and
  • optional 1915(c) waivers.

Second, tables report program descriptions and contact information for all Medicaid 1915(c) waiver programs operating.

For more information go to:

State By State Contact Information For Aging And Disability Resource Centers (ADRC)

ADRCs provide a place for the public to get accurate, unbiased information on all aspects of life related to aging or living with a disability.

To find the ADRCs in your state go to:

New Audio Policy Update

In this policy update we present information about the extension of the enhanced Federal Medical Assistance Percentage (FMAP) which is due to expire at the end of this year.

For more information go to:

New Ask Mike Questions And Responses

Recently, Mike Oxford answered questions concerning:

  • Can I get paid by Medicaid to be a CNA for my child?
  • Can I get paid to take care of my Father at home in Arizona?
  • Can a son be an independent provider for his Father?
  • I have been an independent woman all my life, but now I need help.
  • Arizona trying to eliminate my disabled adult son's habilitation hours.
  • Looking to establish a PAS program in Kansas.

To read all of the Ask Mike letters and responses, go to:

New Search And Sort Capabilities For PAS Library Publications

Our PAS library of publications can now be searched and sorted by author, title and date. We hope this provides Center for PAS website users with easier viewing of PAS articles and reports.

For more information go to:

PAS On The Radio

From National Public Radio:

  • Gail Sheehy discusses her book which outlines eight distinct stages of caregiving
  • Margaret Simpson talks about providing respite care for children with disabilities and their families

For more information go to:

Selected Conferences During July, August and September 2010

For more detail about these conferences, go to:


July 08, 2010 Health Reform Webinar #4 in Series: Workforce Provisions
Hosted By: AUCD
Location: Webinars, 4:00-5:00pm Eastern
July 12, 2010 Family Support Navigation: Overview For Spanish Speaking Families
Hosted By: Easter Seals and Wayne State University
Location: Webinar 3 p.m. - 4 p.m. EST
July 12, 2010 "What Can Self-Advocates Do To Get The Jobs Or Experiences They Want" National Conversation On Employment Webinar
Hosted By: The RIOT
Location: Webinar, 3:00 PM ET
July 13, 2010 ADA Update
Hosted By: JAN
Location: Webcast, 2 pm eastern
July 19 - July 22, 2010 20 Years Of The ADA: The Fight Goes On! NCIL Annual Conference On Independent Living
Hosted By: NCIL
Location: Washington, DC
July 20, 2010 2010 ADA Update - 20 Years Later Audio Conference
Hosted By: National Network of ADA Centers
Location: Webinar 2:00 P.M. to 3:30 P.M. EST
July 25 - July 27, 2010 2010 National Summit On Disability Policy 2010: ADA 1990 - 2010
Hosted By: National Council on Disability
Location: Washington, DC.
July 29 - July 31, 2010 Reap What You Sow: Harvesting Support Systems
Hosted By: National Youth Leadership Network
Location: Raleigh, NC.
July 30 - July 31, 2010 2010 NBDA Regional Conference, Southwestern Region
Hosted By: National Black Deaf Advocates
Location: New Orleans, LA


August 04 - August 06, 2010 Transition, Independence And Empowerment: 2010 Annual DisABILITIES Conference
Hosted By: Edinboro University
Location: Edinboro, PA.
August 05 - August 08, 2010 2010 NBDA Regional Conference, Southern Region
Hosted By: National Black Deaf Advocates
Location: Birmingham, AL
August 06 - August 08, 2010 2010 NBDA Regional Conference, Eastern Region
Hosted By: National Black Deaf Advocates
Location: Philadelphia PA
August 08 - August 10, 2010 Reinventing Quality Conference 2010
Hosted By: Research and Training Center on Community Living
Location: Baltimore, MD
August 13, 2010 Employer Best Practices
Hosted By: JAN
Location: Webcast, 2 pm eastern
August 14 - August 17, 2010 American Sociological Association 105th Annual Meeting
Hosted By: American Sociological Association
Location: Atlanta, GA
August 17, 2010 ADA & After School And Daycare Programs For Children With Disabilities
Hosted By: National Network of ADA Centers
Location: Webinar 2:00 P.M. to 3:30 P.M. EST
August 19 - August 22, 2010 2010 NBDA Regional Conference, Midwestern Region
Hosted By: National Black Deaf Advocates
Location: Detroit Michigan
August 25 - August 29, 2010 LEAD 2010 Conference and Training
Hosted By: Leadership Exchange in Arts and Disability
Location: San Diego, CA


September 07 - September 10, 2010 The 23rd Annual National Independent Living Conference
Hosted By: Daniel Memorial Institute and National Independent Living Association
Location: Washington, DC
September 13, 2010 East Coast Conference on Aging
Hosted By: American Society on Aging
Location: Philadelphia, PA
September 23 - September 26, 2010 2010 National SABE Conference
Hosted By: Self Advocates Becoming Empowered (SABE)
Location: Kansas City, MO
September 24, 2010 4th Annual National Concepts In Care Conference
Hosted By: Alzheimer's Foundation of America
Location: Chicago, IL
September 24 - September 25, 2010 5th National Organizational Change Forum
Hosted By: CRP-RCEP
Location: Kansas City, MO
September 26 - September 29, 2010 26th National Home and Community Based Services Conference
Hosted By: NASUA
Location: Atlanta, GA

This document was developed by the Center for Personal Assistance Services, funded by the National Institute on Disability and Rehabilitation Research (NIDDR) of the US Department of Education, grant #H133B031102 & H133B080002. The opinions contained in this publication are those of the grantee/contractor and do not necessarily reflect those of the US Department of Education. Please credit the source and support of federal funds.

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