Provider cut limits community choice; puts people at risk

Betty Schwieterman
Associate Director of Systems Advocacy

SEATTLE - Six thousand people who depend on in-home care agency providers are targeted for a change in service that may put them at risk of harm or institutionalization.  

The state intends to move those currently receiving agency provider services to individual provider programs, on assessment of cognitive ability.  This means that as the state determines, adults who receive provider services will now need to find and manage their own providers, instead of working with a community agency to hire, fire, recruit and train providers. 

People who are currently doing well in the community with the services they have are worried. according to Gretchen Thatcher of Ellensburg, who uses provider services.

 “This move is limiting our options. In rural areas there are not enough providers, if you cut out options it makes us much more vulnerable.”

Over 49,000 people live in their own homes and receive in-home, state-paid supports from either an agency or individual provider. They receive assistance with activities of daily living such as personal hygiene, toileting, bathing, dressing, cooking, and eating. They may also receive assistance from the provider with medications or transportation to medical appointments and household tasks such as shopping, laundry, and housework. These services allow a person to remain in their own home and avoid costly nursing home or institutional care. 

"It is not about whether we can manage our providers; it is about making sure we have a provider when we need one. I had an individual provider who didn't show up and I was looking at spending the night in my wheelchair," said Thatcher.

Up until November 2010, people receiving in-home services from the state had a choice and could go through a community agency to find a provider, or hire a provider individually.

The flexibility in the system allowed people to find the supports that work for them, based on unique needs including location, worker availability, schedule, past neglect, abuse or exploitation by a provider, experience in directing their care, need for worker oversight, and other factors. The system also allowed some people who needed a variety of workers to use both Agency and Individual Providers.

As part of budget cutting, the plan is to switch 6,000 people to Individual Provider services. These people would no longer be able to receive services from an Agency Provider based on the State’s assessment of their cognitive ability.  This is short-sighted, according to Thatcher.

“It is not about whether we can manage our providers; it is about making sure we have a provider when we need one. I have to use agency providers because I can’t always find good individual providers.  I had an individual provider who didn’t show up and I was looking at spending the night in my wheelchair.”  Gretchen Thatcher

The State’s assessment plan for moving people to individual provider services is based on a cognitive ability score and whether there is someone else in the household to manage the services. It does not take into consideration:

  • Whether the person is actually able to recruit, hire, direct and supervise their worker,
  • Whether there is increased harm to the person caused by a switch or disruption of  services,
  • Whether the person can manage the administrative aspects and paperwork involved in hiring an individual provider,
  • Whether appropriate individual providers are available to work for the person, especially for people who live in less populated parts of the state. 
  • Whether the person uses an agency provider because of past neglect, abuse or financial exploitation by individual providers,
  • Whether the person has a secure back-up system in place in case the individual provider quits, is sick or cannot come to work,
  • Whether the quality of life is affected by the change in service, or
  • Whether the risk of institutionalization or move to a nursing home will increase.

PAS-Port for Change, a grassroots organization that seeks to improve the quality, reliability and availability of Personal Assistance Services, has long advocated for choice and options in the system. PAS-Port advocates that people who want to recruit, hire and supervise their own providers should be able to do so. They propose peer training options, so interested individuals learn how to manage their own providers.  The current system does not provide much support for people who have individual providers. There is no formal peer training program for persons hiring the provider, there is no system to handle disputes or complaints. There is less accountability for the individual provider as there is no agency oversight. 

PAS-Port believes that if the state really wants more people to use individual providers they will need to invest more in that system in order to make it a strong, viable option for more people.

Areas they say need improvement include: workforce development in rural areas, a peer training system for people who use Individual Providers; better accountability and quality assurance, including complaint and satisfaction surveys. PAS-Port also advocates for all in-home providers to be bonded and insured.

As the state works to reduce its budget for in-home services, Thatcher and other advocates ask who really will pay for these cuts. People use agency providers for many reasons. The state must give consideration to each person’s circumstance.

Limiting options for people in the community puts people at risk of a higher level of care, which is more costly, and carries less freedom, according to PAS-Port.

The state’s toll is a financial one, but people who use the services pay in loss of choice, freedom and independent living.

Community living