PCA program needs innovation, key changes

Over the past few weeks, the personal care attendant (PCA) program has had a lot of attention. There has been a lot of scrutiny as a result of the Minnesota Legislative Auditor’s report and our state and national current budget crisis.

As a conservative, I do believe in limiting the size of government. My positions are often not popular in the disability community. However, the proposals and the audit report leave me with many questions.

First, I have serious concerns about the legislative audit recommendations. As a CPA, I understand the nature of audits. I also understand their limits. Audits cannot detect every instance of fraud. To suggest otherwise would be foolhardy. Nevertheless, did it really tell us anything we didn’t already suspect? The sad fact is that there are people out there that would take advantage of the most vulnerable in society. Perhaps what we did find out is that we don’t have the right systems in place to flag, and investigate potential problem billings in the program.

It is important to note that investigation is the key. Where there is blatant fraud, then those guilty should be charged and prosecuted. In the same way, where there is a misunderstanding or lack of care following the rules, corrective action should be taken. However, I am deeply troubled by the recommendation that care be supervised by a qualified health care professional. For those of us who believe in the independent living (IL) model, this is a step backwards. Are we to surrender control over to some third party? Are we to put ourselves at risk of more patronization, having decisions being made for us, and forced services that we do not want or need? Equally troubling are comments by certain legislators questioning whether PCA services actually keep people out of institutions. On the surface such a comment is so ridiculous, it’s not even worthy of rebuttal. Yet in some ways it shows ignorance of the abilities and contributions people with disabilities make each and every day. Unfortunately, the past attitude of “be realistic” keeps rearing its head. As I work with younger people with disabilities, it concerns me that, this generation, with real hopes and dreams, could have those dreams shattered by what someone else thinks is best for them.

In addition, I note that the bulk of the budget cuts fall disproportionably on the disabled. Have people with disabilities been reduced to dollar signs? In the first place, true conservatism demands an across-the-board reduction in government in tough economic times, such as we face today. I realize everyone is out there saying, “Don’t cut my program.” The sad reality is, we are allowing the most vulnerable to bear most of the burden. Why? Because they cost too much? Because we think they might be a drain on resources, as I have heard on the bus a couple times on my way to work? It has been said that a society is measured by how it cares for the weakest in that society. Based on all proposals I have seen, we do not measure up.

I submit that now is the time to look to innovation to deal with the PCA program. Perhaps it is time to revisit the independent living model. Under this model, the user of the service is in control of every aspect of the supportive services needed to maintain independence. PCA choice is a step in the right direction. However, certain improvements can be made. One example is the assessment and monitoring of services. It would be my preference that this would be eliminated. But I can see where it is needed to safeguard the taxpayer. Therefore, instead of going through some third-party which adds costs as well as decreases independence, recipient choice of professional should be built in. As far as assessment, who would know the person better than his or her own family doctor? The process can take place at an annual physical, saving extra costs for sending someone out to do an assessment.

There will be those who will argue that not everyone has the ability to handle this responsibility. Granted, for those people a more traditional approach may be necessary. However, I would also note that everyone is entitled to have someone act as a supportive person, whether it is a friend, family member, minister or advocate.

It has been said, “Nothing about me, without me.” These words have for too long, been just a slogan. The time is now to make them part of policy. I believe that if we do this, we can build a cost-effective program that truly meets the needs of the people it intends to serve.

Scott Dehn was born with Cerebral Palsy and is a passionate advocate for the Independent Living Model. He served on the State Rehabilitation Council from 1999-2005. He currently serves as a director for Community Involvement programs and the Metropolitan Center for Independent Living. He also serves as an adapted sports official for the MN State High School League