There has been a growing sentiment that the low participation rate of people with disabilities in the workforce is unacceptable and that people with developmental disabilities can and will work given opportunities for preparation and supports. There are incentives for people to enter the workforce without losing the benefits they need to survive until they are self-sufficient. The National Association of Persons Supporting Employment 1st (APSE) began a national dialogue in 2009 titled “Employment First” with the vision that Employment in the general workforce is the first and preferred outcome in the provision of publicly funded services for all working age citizens with disabilities, regardless of level of disability.
Iowa is not one of the states that has adopted an Employment First Policy through legislation or policy directive. Probably more important to Iowans, there has been an ongoing conversation with a growing number of stakeholders about expectations that Iowans with disabilities will work in the community at the prevailing wage. The conversation is gaining momentum due to the Mental Health and Disability Services (MHDS) redesign workgroup recommendations, recent interpretations of the Federal Department of Justice related to the expectation of work and an information bulletin from the Center for Medicare & Medicaid Services (CMS) in September 2011.
Discussions in the Mental Health and Disability Redesign workgroups related to core services and resulted in recommendations consistent with the employment first vision:
The US Department of Justice recently made clear that it interprets the integration mandate of the Americans with Disabilities Act (ADA), established in the Olmstead case, to apply to all “services, programs and activities” of a public entity, including segregated, non-residential employment and vocational programs such as sheltered workshops.”
CMS is the federal funding authority for Medicaid waivers which provide many of the core services Iowans with intellectual disabilities receive. CMS emphasized the importance of employment in the lives of people with disabilities and wrote language to support state efforts to increase employment opportunities and meaningful community integration for HCBS waiver participants. CMS wrote the goal of the agency is to promote integrated employment options through the waiver program and explained that pre-vocational services are a time limited service to help someone obtain competitive employment.
Iowa State Fiscal Year 2010 (SSFY10) is the last year for which there is information on spending for employment preparation services. Iowa Medicaid and counties spent $42,887,153.00 in (SFY10) on work services for adults with disabilities. Twenty one percent (21%) of these funds were spent on community based services while 79% was spent on facility-based services.
The Iowa Developmental Disabilities Council (DD Council) has an objective in its 5 year plan to increase funding for community based employment supports from 21% to 50% of the total public dollars spent on employment. The DD Council looks forward to working with stakeholders and partners in this effort because it requires changes at the
individual, local and state levels.
—David R. VanNingen, Hope Haven Inc.
I applaud the vision that employment in the general workforce is the first and preferred outcome… for all working age citizens with disabilities. That vision should be embraced as a value, a stand. Another stand to be simultaneously embraced is to assure that people with disabilities have access to a host of employment opportunities and choices. Those choices should include type and place of employment, hours worked, etc. As we strive to better provide employment opportunities we must assure that policies expand not limit employment access and choice. Thus my caution: as we develop strategies to live out these values we must be mindful of unintended consequences. The elimination of sub-minimum wage may eliminate access to work. The elimination of facility based employment may be contrary to the value of choice. Our current systems limit choice, which should not be the consequence of the supports going forward.
Data alone may not tell the complete story. Some consumers spend part of the day in community-based employment (CBE) and part in facility-based employement (FBE), referenced data and current rate structures may not reflect combined employment settings or actual costs. The goal of 50% of the total employment expenditures for CBE may have an unintended result: the system could spend less than at the present time and still meet the 50% goal. The result could be that fewer people have access to employment support.
—Aaron Anderson, Roger Girard, Koki Nakagawa & Nathaniel Pierson
Members of the Iowa Developmental Disabilities Council (DD Council) share varying perspectives on facility based employment for individuals with disabilities. Four of the newly appointed members to the DD Council recently spoke about their work experiences in facility based and community based settings.
For Roger and Nathaniel, facility based employment was a stepping stone to community based employment. Roger works at a video rental store which allows him to spend on his interests, including movies, music, and buying cookbooks. He began his career at Goodwill where he learned the customer services skills necessary for his job at the video store. “I worked at Goodwill to learn about work and the skills necessary to hold a job,” Roger said. “It’s basically skills training.”
Nathaniel noted that employment opportunities in places like sheltered workshops serve an important purpose for some. “Workshops need to stay open because for some, it is the only place they can go. Some people’s disabilities are too serious and require more supervision.” Nathaniel began his employment in a workshop where he says he learned important skills. He now works two jobs in the community. He says he misses his friends in the workshop but enjoys the money he makes too much to go back. He likes to buy fishing equipment for one of his favorite activities.
Aaron works at a thrift store and enjoys being in the community because it allows him to use his mind and think and it also allows him to socialize with his co-workers and the customers.
Koki went to work directly from high school. He works at a Wal-Mart in customer services. Koki pays bills and when he can, he likes to attend advocacy conferences for which he pays for registration and travel expenses. He enjoys working in retail and appreciates the interaction he has with customers.
Like all working adults, Aaron, Roger, Nathaniel and Koki enjoy payday. They pay their share of taxes, complain about paying them and realize it’s a part of life. Work is a means for them to make money to enjoy life in the community with family and friends. Work is also a means to pay for their leisure interests and activities.
—Bill Stumpf, Father and team nurse for persons with physical and intellectual disablities
I am the father of a 22 year old son with an intellectual disability. I am also employed as a nurse for an organization that provides services to persons with significant intellectual and physical disabilities. Given this, I am able to see the employment issue from a broad perspective. While I agree with the overall “philosophy” and “in the perfect world” I too support the position that all people enter the workforce without losing the benefits they need until they become self-sufficient. However, what if time doesn’t allow for the perfect situation? Where do they go? What do they do? What happens if they have both significant intellectual and physical disabilities? Many also have chronic health issues and are often just trying to make it through the day without requiring medical intervention.
My son works in a vocational training environment. He loves the work he does. He earns a paycheck and pays taxes. Over time, he may transition into competitive employment. I am concerned that some may not be able to move beyond a pre-vocational setting to earn a prevailing wage. Everyone, including people with and without disabilities build skills and progress at different rates.
Funding for most employment services is typically insufficient. If no additional dollars are allocated, many agencies that provide these services will be forced to close if they are unable to pay wages at or above minimum wage.
—Sherry O. Becker, North Iowa Vocational Center, Inc., Mason City, Iowa
My commitment to increasing job placement and competitive employment outcomes for people with disabilities started in 1986 when I was hired to implement one of the early Iowa supported employment grants. Ironically, I landed the job after being a stay-at-home mom so I was in a unique position to appreciate just how much working impacts self-esteem and quality of life.
One of the basic tenets of supported employment is the belief that everyone can work and contribute. I take that one step further, everyone should work and contribute. We all have equal rights and responsibilities; to be as self-sufficient as possible by earning a living wage, to be tax paying citizens and to contribute to the greater good.
Our current system of employment services and supports is not consistently aligned with those
beliefs, but I am proud of our state for taking steps to change the situation. Work groups are convening to redefine services and reallocate resources to improve employment outcomes so Iowans with disabilities can exercise the freedoms and choices available to all citizens.