Washington, Nov. 7 – Many individuals with disabilities choose to receive home and community based services such as personal care attendants instead of living in an institution. Indeed, studies show it is more cost effective to do so than to live in institutionalized settings such as nursing homes where people with disabilities can no longer participate and contribute to society by working and paying taxes.
Yet coverage of personal care attendant services is available only through Medicaid waivers, and many states have extensive waiting lists. This also becomes a barrier to employment for many individuals with disabilities who lose Medicaid services that provide these and other home and community based services if they choose to work. Other people with disabilities who are not eligible for Medicaid are unable to work to begin with due to lack of personal care attendant coverage through private insurance or Medicare. In 2014, of the 7,224,420 individuals with independent living disabilities aged 18 to 64 years living in the community, just 1,146,316 individuals were employed – that is only 15.9 percent.
As part of the #PwDsVote Disability Questionnaire, the nonpartisan nonprofit disability organization RespectAbility asked candidates running for Senate or Governor about their plans to address these issues. Every candidate was given an equal opportunity to address these issues and if they are not listed, it is because they declined to answer.
Many of the candidates also talked about the Disability Integration Act (DIA), which was introduced in the Senate in December 2015 by Sen. Chuck Schumer (D-NY) to ensure that people with disabilities needing help with everyday tasks who previously have been forced into institutions would have the opportunity to instead live in their homes with appropriate aid.
The quotes in this article are the candidates’ answers to question 9 in the gubernatorial/senate questionnaire: “Do you have a plan to provide home and community-based services to people with disabilities who would rather live in their own homes instead of institutions, and have the community attendant supports they need to work? “
Democrats and Republicans agree there is a need for home and community-based services to be available for individuals with disabilities who would rather live in their own homes than in an institution or nursing home.
“Much of our ability to provide community-based services is reliant on the workforce, which supports these services. My recently created Health Care Workforce Commission is working to address how to grow, support and professionalize New Hampshire’s Direct Support Professionals (DSPs),” responded Gov. Maggie Hassan, a Democrat running for the U.S. Senate seat in New Hampshire. “And in the Senate, I will advocate for measures like the Disability Integration Act to expand access to home and community-based services for people with disabilities.”
Republican incumbent Sen. Kelly Ayotte also talked about her support for caregivers in her response, listing her support for the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act and the Home Health Care Planning Improvement Act.
“I have been a leader in the Senate fighting for policies to support family caregivers, who care for family members and loved ones in the comfort of their own homes,” Ayotte responded. “I am a co-founder of the Assisting Caregivers Today Caucus, which works to bring greater awareness to the issues facing family caregivers, including more than 268,000 in New Hampshire.”
Check out all of the candidates’ full answers below:
State Sen. Colin Bonini (DE-R)
“In Delaware, DHSS is actively working with folks that would otherwise be transitioned into nursing homes and other intuitional settings, working very hard to create incentives and support to keep people at home. I would like to continue this effort that and make that one of our priority policy goals.”
Rep. John Carney (DE-D)
“All Delawareans with disabilities should be able to live close to friends and family, live as independently as possible, engage in lives that include productive employment, and live in settings where they can participate in community life. These are the same goals that we all have for ourselves and for our children, and I am committed to working with businesses, non-profit organizations, advocates, and people with disabilities to move Delaware closer to those goals.”
Gov. Steve Bullock (MT-D)
“Supporting Caregivers. We know that family caregivers provide 80% of all caregiving in the United States. In Montana, over 100,000 Montanans are helping to care for adult family members or friends, including people with disabilities. Our long-term care system is dependent on these family caregivers, many of whom are juggling work and caregiving. We also know that being a caregiver can be hard on your health, emotionally and physically. My administration has been working to make sure we coordinate and develop respite services for these family caregivers, and I recently announced that my next budget will include state funding for a respite voucher program that provides funding to caregivers who need financial assistance to arrange for a temporary break from their caregiving responsibilities.”
Ms. Linda Coleman (NC-D) – running for Lt. Gov.
“Home care is one of the best, most efficient methods of care. I will to continue to advocate for the expansion of home care and community-based services to PwDs through the expansion of Medicaid. Increasing the cap on income and asset eligibility as well as providing more funding to attract and retain talented home care workers are key to providing quality care in the home and community. As Lt. Governor, I will build coalitions in state government and expand the training programs in our community colleges.”
Mr. Mike Weinholtz (UT-D)
“Staffing is indeed a problem in Utah, as it no doubt is across the nation. But the state also has a strong tradition of helping all people with a hand up, not just a handout. To this end, I want to empower those with disabilities to make their own decisions and become self-sufficient. Part of this is ensuring that, whenever possible, people are able to stay in a more stable environment such as the home or a community-based center.
Of course, the job of Direct Support Professionals is a demanding one and one that is difficult to fill. However, I believe that can be found by combining the issue of chronic homeless and potentially some of the incarcerated populations into one bucket instead of three or four to help reduce administrative overhead overall, and allowing for more funding for support professionals.
This would also assist with the issue of properly identifying disabled individuals in the community in the first place. Increased cooperation under a single department would allow for those with disabilities to better match up with support professionals, allow for greater self-sufficiency, and reduce overall costs to the state. It is a win-win that, as governor, I hope we can make some real progress on.”
Sec. Sue Minter (VT-D)
“Over two decades ago, Vermont closed its last institution for serving citizens with disabilities. We have a very strong community-based system that provides the highest level of independence possible. Vermont also has a strong system of home health services. Matched with our Choices for Care program, over 50 percent of Vermonters eligible for nursing home care opt instead for home care.”
Lt. Gov. Phil Scott (VT-R)
“During the mid-2000s, when I served in the Vermont State Senate, the federal government granted Vermont a waiver for our long-term care program, Choices for Care. This waiver allowed Medicaid to pay for the setting that was appropriate for each individual – including nursing facilities, home-based care, and enhanced residential home care. This helped those on Medicaid achieve a better quality of life by remaining in the care setting that was most suitable to their needs, while also saving the state resources by better coordinating the provision of care. I was a supporter of this initiative as a member of the Senate. As Governor, I will continue to build on and expand these types of proven models to ensure the provision of the appropriate services to those with disabilities.”
Atty. Gen. Kamala Harris (CA-D)
“Kamala Harris understands the importance of having a job and supports measures that would enable persons with disabilities to have access to community based services, including assistance to get to work everyday. These community based services often cost less than institutional care and allow persons with disabilities to live more comfortably. In the Senate, Kamala Harris will work to ensure that persons with disabilities have access to affordable daily personal care they need, in addition to advocating for reforms to our labor market, including a $15 minimum wage, national paid family leave, more affordable job training and higher education access, and investment in good paying jobs.”
Rep. Loretta Sanchez (CA-D)
“I understand the shortage of community-based workers for people with disabilities and our elderly. Personal care assistants are the crucial link to helping those wanting to stay in their homes. Unfortunately, many who rely on these assistants worry their eligibility will be taken away if they find employment. When elected to the Senate, I plan to work to lift this cap so those with disabilities do not have to choose between employment and personal care assistants.”
Mr. John Carroll (HI-R)
“I have no plan at this present time, but should the need arise in our state, I would address it.”
Rep. Tammy Duckworth (IL-D)
“The availability of quality, affordable alternatives to institutions, in terms of assistance in home care and community attendant supports in the workplace, is vital to the independence of people with disabilities.”
Mr. Patrick Wiesner (KS-D)
“I need more information before I can formulate a comprehensive plan. My goal is for the disabled to live with their families or on their own if possible. My plan will be based on evidence provided by experts in the field.”
Mr. Foster Campbell (LA-D)
“Throughout my career I have supported home and community based services waivers at the state level that allow for choices as working families care for those with severe disabilities. I believe that investment helps families continue to work and be productive and gives the best quality of life to severely disabled citizens. I will continue to fight for home and community based services in the United States Senate, especially for more federal match for state funded programs, including interstate portability for home and community based services.”
Ms. Caroline Fayard (LA-D)
“I support legislation that would waive asset and income restrictions placed by Medicaid for people with documented disabilities that are seeking to transition into the workforce. A more flexible system that incentivizes workforce participation will be positive progress.”
Mr. Abhay Patel (LA-R)
“Healthcare is a very personal choice for us and loved ones. I believe in market-based solutions to reforming our healthcare system. When a market presents itself, in this case, home and community-based services, solutions arise to meet that demand. By repealing and replacing Obamacare with market-based solutions, we can better enable those demands to be met.”
Del. Kathy Szeliga (MD-R)
“I believe we must support people with disabilities who prefer to receive care in home and community-based settings.”
Rep. Chris Van Hollen (MD-D)
“More people are choosing to live in their own home to be more independent and need home and community-based services to address their chronic health conditions. And as the baby-boomers continue to age, this need for home and community-based services is exponentially increasing as resources fail to keep up. Unfortunately, some of these shortfalls include long waiting lists and funding for the program. Another issue is people with disabilities are refraining from seeking competitive employment in order to keep needed benefits. One of the avenues I have taken to help with this issue is to introduce the Transition to Independence Act. Under this bill, individuals with disabilities will be able to work and earn a competitive income and buy in to their state Medicaid system to secure critical supports such as home and community-based services. And under the ABLE law, I introduced with my colleagues, individuals with disabilities are able to save up to a certain amount of their assets in a tax-free savings account while still having home and community-based services.”
Sec. of State Jason Kander (MO-D)
“As Senator, I would support initiatives that would allow those with disabilities to live with dignity and independence in their own homes.”
Rep. Joe Heck (NV-R)
“One of the best ways we can improve quality of life for people with disabilities is ensuring they can live in their own homes on their own terms. I am a proud cosponsor of H.R. 3099, the RAISE Family Caregivers Act, a comprehensive bill that would establish a National Caregiving Strategy to provide resources and support to family caregivers.
In addition, I am a cosponsor of H.R. 4919, Kevin and Avonte’s Law, which reauthorizes the expired Missing Alzheimer’s Disease Patient Alert Program and expands it to include children with autism and other developmental disabilities. The bill authorizes $2 million per year in fiscal years 2017-2021 to provide grants to law enforcement agencies, public safety agencies, and non-profit organizations to promote initiatives that will reduce the risk of injury and death related to wandering.”
Atty. Gen. Catherine Cortez Masto (NV-D)
“In the U.S. Senate I will support proposals that support and expand home and community-based care across all disability populations.”
Sen. Kelly Ayotte (NH-R)
“I have been a leader in the Senate fighting for policies to support family caregivers, who care for family members and loved ones in the comfort of their own homes. I am a co-founder of the Assisting Caregivers Today Caucus, which works to bring greater awareness to the issues facing family caregivers, including more than 268,000 in New Hampshire, and I’ve introduced bipartisan legislation to give a tax credit to working family caregivers for qualified expenses. I also helped introduce the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act, which would develop a national strategy to recognize and support the work of family caregivers. Additionally, I’ve cosponsored the Home Health Care Planning Improvement Act, which would allow nurse practitioners, clinical nurse specialists, and certified nurse midwives to sign plans of care for home health and certify Medicare patients as eligible to receive home health care, thereby increasing access and allowing more individuals to remain in their homes, where they often prefer to receive care.”
Gov. Maggie Hassan (NH-D)
“Much of our ability to provide community-based services is reliant on the workforce which supports these services. My recently created Health Care Workforce Commission is working to address how to grow, support and professionalize New Hampshire’s Direct Support Professionals (DSPs). And in the Senate, I will advocate for measures like the Disability Integration Act to expand access to home and community-based services for people with disabilities.”
Sen. Richard Burr (NC-R)
“I strongly support individuals being able to receive care in their home and in community-based settings. It is understandable why so many people want to receive care in a home or a community-based setting instead of an institution, and I believe we must support people with disabilities being able to receive care in these settings.
I have been a strong supporter of the Program for All-Inclusive Care for the Elderly (PACE), which provides coordinated services to vulnerable individuals in their communities, many of whom are dually eligible for Medicare and Medicaid. I cosponsored legislation (S. 1362) to expand PACE, which was signed into law in November 2015.
Medical research also plays a critical role in developing innovations that will allow people with disabilities to receive care and services in home and community-based settings. I am proud to have led the annual, bipartisan effort in the Senate to ensure robust funding for the National Institutes of Health, which includes the National Institute on Disability and Rehabilitation Research, so that we can improve the quality of life for people with disabilities. In addition, I introduced the Advancing Breakthrough Devices for Patients Act (S. 1077) to ensure that people with disabilities are able to benefit from cutting-edge medical technologies as soon as possible.
Furthermore, I have consistently fought to protect people with disabilities’ access to complex rehab technology wheelchairs and accessories through the Medicare program, including by cosponsoring legislation this Congress like the Patient Access and Medicare Protection Act.”
State Rep. Deborah Ross (NC-D)
“I will work with experts in the community to reform Medicaid, so that people with disabilities can afford to have access to community attendant supports and are not penalized from receiving this support because of their employment status. People with disabilities should be allowed the freedom and independence to work while also being supported by personal care assistants at home when needed.”
Mr. Joe DeMare (OH-G)
“Home health caregivers are an essential part of health systems in countries like France. When we switch to a universal health system, they will be provided.”
Mr. Mark Callahan (OR-R)
“I do not have a specific plan, however, I fully support programs that ensure people with disabilities are able to live in their own homes. A community based living situation, like there is for the retired, would accommodate this perfectly where homes are catered to the needs and abilities of the disabled but as well a community center that would allow for social activities, meals and other things. I do not believe the disabled should be locked up in institutions or hospitals as this does not provide them the quality of life they deserve.”
Mrs. Katie McGinty (PA-D)
“I am a strong believer in giving seniors and people with disabilities the option of receiving care in the comfort of their own homes, while also better supporting their caregivers. In the Senate, I would work to make it easier for people with disabilities to live at home by supporting proposals that incentivize homecare, increase wages for homecare workers, and dedicate resources to the training of homecare workers.”
Mr. Jay Williams (SD-D)
“Once again, I do not have a specific plan, but I do support the idea of providing services to people with disabilities to allow them to live and work in dignity.”
Former U.S. Sen. Russ Feingold (WI-D)
“People with disabilities should not be forced into an institution because of financial need. The Affordable Care Act created some important reforms, such as barring insurers from denying coverage based on a preexisting condition, but it’s just the first step towards realizing the goal of equitable health care. State lines should never be barriers to accessing community attendants, and I am open to proposals for how we can make care accessible in all fifty states. I also voted for the Caregivers and Veterans Omnibus Health Services Act of 2010, which created an assistance program for family caregivers of veterans with disabilities, and I am committed to full implementation of the act.”
RespectAbility has asked all the candidates for Governor and Senator on both sides of the aisle to complete the same questionnaire. We will share responses from additional campaigns as we receive them.
The RespectAbility Report is a nonpartisan political commentary on the 2016 U.S. elections with a focus on disability issues. The RespectAbility Report has covered all of the Democratic and Republican candidates for president, senate and governor. Coverage can be found at https://therespectabilityreport.org/. The RespectAbility Report is nonpartisan and does not endorse candidates.