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Maryland offers "The New Directions Waiver" as a means of self-directing state and federal Medicaid dollars for individuals who qualify for supports due to their disability.

This offers the disabled individual the opportunity to use those dollars to best meet their own unique needs. However, it comes with the responsibility to create a plan, a budget, and find your own resources to make the plan a reality.

No centralized source of resources exists. The purpose of this blog is to direct others to resources in our communities and to provide one example of a self-directed plan. (*Caution: The self-directed plan described at the beginning of this blog is for an individual with a 5/5 needs rating, the highest possible rating in Maryland, and therefore the highest budget possible. Most will have a lower rating and a lower budget to work with.) It is also to share firsthand knowledge of experiences that may assist others who self-direct services.

Comments are welcome. Please share your knowledge with others.

Tuesday, November 24, 2009

Thankful at Thanksgiving

On a bad day, it is easy to get hung up on the little things that don't work as well as I would like. I have to keep reminding myself that in the Big Picture, this adult program is working fabulously.
The supervising nurse visited on Saturday. She said V's blood pressure was 110/60. When the dental cleaning was done under general anesthesia 3 months ago, the nurse commented on how fast V's blood oxygen returned to normal. She was impressed. I see V's clothes fitting more loosely now than 6 months ago, in a good way, and I know that all of these things are the result of all the exercise that V is getting each day when she goes into the community. I see that she has a great appetite, and sleeps through the night. I see that she is smiling so much more now than a year ago and seems so much more peaceful. What more can a parent want than health and happiness for their child. I am thankful this week for the ability to see that V is well-fed with nutritious home-cooked food, well-cared for by dentists, nurses, therapists, doctors and support staff, and well-loved by her family. The behavior analyst commented on the dramatic improvement in V's quality of life over the past year during her most recent visit. V's support staff who have worked with her for the past 4 years commented recently on how much calmer and happier V is now than when she was in school. Ironically, I see more progress in skills and cooperation with therapists now than was ever reported within the structure of school.
Why is this the case? Why can our speech therapist get one hour of cooperative work with V now, when V would rarely work more than 15 minutes with a speech therapist at school? Is it because the work is now done in V's home and in the community? Is it because the current therapist has discovered what re-inforcers work or what activities V enjoys doing during sessions or just a good personality match? I don't know. Maybe the success is the result of all of these things working together.
What we know now, for sure, is that engaging in a power struggle with V does not work, but patience does. Demands do not work, but negotiation does. A rigid schedule does not work, but having flexibility does work. Pro-active anticipation of problems can prevent a lot of wasted time later spent resolving problems. When V is calm and happy, she learns and retains her knowledge and is able to show what she knows.
We have come a long way, but there is still lots of room for growth. I am thankful for the opportunity to be in the front row to witness these changes for the better and to be a part of them.

Tuesday, November 10, 2009

Disability Scoop Article today....

Visit this link to read the article today; http://www.disabilityscoop.com/2009/11/10/autism-moms-stress/6121/
This article says that a study of mothers with autistic children suffer from the same chronic stress levels as a combat soldier. Can you relate to that?
This article says that mothers of autistic adolescents and young adults are interrupted at work on average once out of every 4 days, as compared to once out of every 10 days for mothers of kids without disabilities. Well, I can easily see that one, for sure!
I recall one year when I taught at an elementary school and would receive frequent mid-day calls from V's school, asking me to come take her home because she had "thrown up". V wasn't sick when this happened, she was upset. Something at school would set off a tantrum. Crying would cause sinus drainage, that would set off coughing, that would set off her gag reflex and whatever was in her stomach would come up. When I took her home and missed work following these incidents, she would be fine the rest of the day. She had no virus, no fever, and no further incidents of stomach upset the rest of the day. I learned to ask the school nurse if her vomit had followed upon the heels of a tantrum, and if it had I asked them to allow her rest, change her clothes and then let her return to class if she had no further symptoms. I was a single mom, I had a job to do, and coming to take V home to play was reinforcing the behavior of vomiting after tantrums, a habit I did not want to encourage for obvious reasons. I received resistance to my request and pressure to come and take her home each time. I held firm, insisting that if she had no fever, no other symptoms of illness and no further stomach upset, there was no reason to take her out of school. The incidents declined in frequency and eventually were no longer a problem.
It is hard to be a reliable employee if you are a parent of a child, or dependent adult, with health or emotional problems. I eventually left my employment when the inability of support staff to get her on a school bus in the morning resulted in frequent morning calls to my school asking me to leave my classroom in the middle of teaching a lesson and come take V to school after the bus left without her. My daughter's demands on my time at work were unfair to my employer, my students, and caused me stress because of the conflict between meeting my daughter's needs and meeting my employer's needs.
As a result, I have sacrificed a good salary and benefits to be available to give my daughter the best possible care. Our level of debt is higher and savings are lower as a result. I only had the choice because I remarried. I don't know what I would have done without my husband's support. I think this is why many disabled adolescents end up in residential care instead of with their families. These are heartbreaking choices.

We are not alone with these dilemmas. These problems are receiving more attention now and, maybe will be followed by more support, eventually. I don't think that will happen until our economy has stabilized, and until then supports may actually be lost because of funding shortages. Hold on if you are struggling with these issues. Things get worse but then they do get better again.

Sunday, November 8, 2009

Hard times for Maryland

Local agencies that provide services to disabled residents with funding from DDA have taken a 2 percent cut in funding recently. One agency advises us that as a result they are consolidating group homes to reduce costs, and cutting out mid-day transportation to supported employment for clients, among many other cost cutting measures. Will a 2 percent cut to New Directions budgets soon follow? I would not be surprised and I am thinking about where I will reduce services for V if this should happen.
Further, the state unemployment fund is depleted because so many citizens have been on unemployment benefits for so long through this recession. The consequence is that my husband, who is a small business owner in Maryland, just received a notice from the state that his contribution to the unemployment fund for his one employee will be increased 6 times his current rate. If his contribution for his one employee is going to go from 200.00 a year to 1,000 or more, than I am imagining the impact of this on V's budget, as her caregivers are 5 employees that are paid from her DDA budget. State and federal taxes, and unemployment contributions are paid for these employees from her DDA budget as well. So, if we currently pay about 1,000 in unemployment contributions for these 5 employees, and we have to pay 6 times as much in the coming year, that will further reduce funds from the budget that are available to pay for other services that V currently receives. I am going to need to discuss this with our fiscal management agency.
For those, like V, who are too disabled to work and rely on SSI for all income, there was no cost of living increase this year from last.
The recession is hitting disability services here in Maryland, as it probably is all over the country.