Jumping Through the Hoops
I left you on a bit of a cliffhanger last week. After Travis completed his 29 hour work assessment performed by a provider agency that Division of Vocational Rehabilitation (DVR) contracted with, it was determined by Team Travis that Travis was not ready to work in a community setting.
Travis’s team members included me, Travis, an employee of the provider agency, the DVR counselor, Travis’s therapist (hired by DVR), and Travis’s case manager from Foothills Gateway, our local community center board.
Last week I wrote about how confusing it was that DVR agreed that Travis was not ready for a community position, but would no longer fund training for Travis in the position that they referred him to for the assessment. This position was not a “real” community position even though it is a retail store within our local community, because it only employed individuals with intellectual/developmental ID/DD disabilities.
I would argue that every work training that DVR placed Travis in thus far was a similar story. A coffee shop run by a provider agency specifically to train ID/DD individuals with the goal of the employees to move on to maybe being a barista or kitchen worker in a locally owned or franchised coffee shop or similar community business.
Another DVR placement was at a snack counter at a bus transit center. Again run by a provider agency that works with the ID/DD population specifically, training individuals on job skills.
It is still Travis’s goal to work a job within the community. He is not ready. Think back to the outcomes of his previous positions. They did not end well. If Travis has the support of an agency who works specifically with ID/DD individuals, and has not been considered a “good fit” because of lack of focus, mental health issues, and behavioral issues, how can his team in good conscience say he should be looking for a position in the community? A position in which he is not going to be offered that level of support.
If it is still his goal to work in the community, then DVR should fund getting him to that point. Or should they?
Let’s visit that idea for a moment. The DVR Individualized Plan for Employment (IPE) states the following:
Achieving Your Selected Employment Outcome
“After the IPE is complete and you obtain a suitable job in your chosen occupation, your service record will be closed when the following conditions are met:
The employment outcome you achieve is in the most integrated setting possible.
The job is consistent with your strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice.
You have maintained your employment outcome for at least 90 days, and
You and your DVR counselor agree that the job is stable and you are performing well.”
Obviously, Travis was not at a point of completion on his IPE. Yet DVR did not want to support him in a position that the provider agency offered with 1:1 job training. This was a position that Travis was interested in pursuing, at the time. This position was not in the most integrated setting possible. But what if Travis was able to learn to make jewelry in this setting that led him to a position within the community. Or even his own business of making and selling jewelry?
What if with time, jewelry making became a strength for Travis? And he was making the choice to give it a shot.
Why would DVR say they would not fund a position they introduced Travis to? Is it possible that based on his history with them over the past three and a half years they didn’t believe the additional funding was going to make a difference in his employability? DVR sent a letter stating they were closing Travis’s file because he was no longer interested in finding a community job. Only he was. And he had not met their conditions for closing his file.
After the DVR file closed, the Social Security Administration (SSA) sent me a letter as Travis’s representative payee. They were notified of a change in Travis’s job support services. Per the letter from the SSA, “This change might affect your protection from regular medical reviews. We may do medical reviews on your case if you are receiving cash benefits from Social Security, and you do not have an employment services provider or you are not making progress in the Ticket to Work Program.”
Basically the letter goes on to say that if you continue to work with DVR or get support from another Employment Network you will keep receiving protection from medical reviews. Which makes sense, right?
Remember when DVR first approved Travis for their program? In my blog titled, “Is it Worth it?”, I write about the DVR waiting list process. An individual is assigned an order of selection priority classification when deemed eligible. Eligible individuals with the most significant disabilities are served first.
Travis was placed in the “Persons with the most significant disabilities” category. These categories are based on the expected areas of need, number of services, and length of time services are needed.
If Travis was placed in the “Persons with the most significant disabilities” category by DVR, doesn’t it stand to reason that he still qualifies for SSI support? SSI believed so at the time. That is why they do not conduct a medical review while an individual is receiving services with DVR.
If Travis’s needs were such that DVR struggled to help him and ultimately closed his file, doesn’t it stand to reason that he still qualifies for SSI support?
If agencies that provide services to individuals with disabilities, with mission statements that revolve around supporting such individuals, deem that Travis is not a “good fit” for positions with full support from their trained employees, doesn’t it stand to reason that he still qualifies for SSI support?
Apparently not. Within a few weeks we received the paperwork from SSA that they were conducting a full medical review. Which feels like applying all over again. SSA had me sign several releases. So that they could talk to Travis’s psychiatrist. And therapist. His doctor. His case manager. Also wanted to talk to the provider agencies that had worked to help Travis become more employable. All three of them.
To what end? Did they think that Travis magically got better and employable in the last few weeks? As it turned out, he was approved to continue his SSI benefits. An SSA staff person had to send out a folder of paperwork to all the earlier mentioned doctors and case managers. I received two packets. Exactly the same. I had to fill out one as the mother of Travis, and one as the representative payee. I also had to fill out a packet for Travis. Because he cannot fill out a questionnaire.
Once all the paperwork is completed and returned a staff member has to review all of the information and make a decision.
I get that SSA wants to prevent fraud. At the same time I believe that there are some cases where resources are being wasted with this process. I promise you that it was never our dream or Travis’s that he qualify for SSI one day.
The SSI benefit for 2020 is $783 per month. Who would choose to live at this level of poverty? My argument is way less than some Americans believe.
Because Travis qualifies for SSI he automatically receives Medicaid. All of the supported living services (SLS) that Travis receives through the Colorado waiver is funded by Medicaid. I describe how this program works in an earlier blog, “Another One Bites the Dust”.
We did not appeal the DVR decision to close the file. I asked the question in my “Is it Worth it?” blog. Is it worth jumping through all the DVR hoops? And is jumping through all of these hoops doing more damage than good? Frankly, the remainder of Team Travis decided that the answer was no. It was no longer worth jumping through the hoops.
Travis did continue to work making jewelry. Travis has a SLS budget that is determined by a scale that I explained in a previous blog. Each year we have a Service Plan meeting where Team Travis decides the best way to spend that budget.
Travis has a nurse that comes by once per week that checks on him and fills his prescription medication box. He also gives Travis an injection once per month of one of his medications. He also has a housecleaner come by once per week. Travis used to have a provider come by and help him with homemaker services. This provider helped Travis with grocery shopping and meal preparation. He also used to have a provider that did community services with Travis. He would take Travis swimming, frisbee golfing, or to listen to live music downtown. He introduced Travis to different activities available within the community.
Now that DVR is no longer funding Travis’s 1:1 job training, the cost had to be picked up within the SLS budget through the Colorado waiver. The job coaching is billed at approximately $55 per hour. Travis works four hours per week.
Do you know what that means? There is no longer room in the budget for the homemaker or community services. It also means that I am back to doing the bulk of shopping and cooking. I simply cannot leave it to him. If I did he would be eating boxed frozen junk food, cereal and pistachios.
I think that DVR is probably successful in helping some individuals find a job that they are able to perform. Travis was just not one of them.
I asked the question above about whether DVR should keep funding Travis’s job training. Their plan states that it will continue until the desired employment outcomes are met. DVR spent thousands of dollars trying to help Travis. But I believe the system is broken. Remember I said that individuals with the most significant disabilities are served first?
I think they have it backwards. I believe DVR should help the individuals that are more likely to have a positive outcome first. Individuals with the most significant disabilities are going to be the hardest to serve. They should not be made to jump through this hoop in order to receive the benefits that provide their services.
We want Travis to find a job that he enjoys. We want him to become responsible for at least a portion of his care. We believe that getting out of the house and interacting with others, and working in a position that is meaningful to him could help lessen his depression. That is why we agreed to give up some supports to afford the job coaching.
Keep reading to find out if that decision turned out to be a good investment.
“If you obsess over whether you are making the right decision, you are basically assuming that the universe will reward you for one thing and punish you for another. The universe has no fixed agenda. Once you make any decision, it works around that decision. There is no right or wrong, only a series of possibilities that shift with each thought, feeling, and action that you experience.” - Author Unknown