The adult years can bring a whole new set of challenges for families. Thankfully PWCF is here to help. We recommend you stay connected with us, read our online and printed communications, and attend our Annual State Conference, webinars and trainings held throughout the year so that you stay informed and empowered.
If your child is or is approaching 18 and you have not already secured Conservatorship we strongly recommend that you begin working on that right away. Upon reaching the age of 18 your adult child should be eligible for SSI and Medi-Cal (California’s version of Medicaid) even if they were not eligible as a minor, as well as apply for Social Security benefits.
Social Security Benefits
Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes). It is designed to help aged, blind, and disabled people who have little or no income, and it provides cash to meet basic needs for food, clothing, and shelter for more information and visit the SSA website for more information about SSI benefits in general.
Children with a diagnosis of PWS under age 18 can get Social Security Income (SSI) benefits if they meet the Social Security’s definition of disability for children and there are limited income and resources in the household. More information about eligibility is available at the Social Security website. Visit the SSA website for more information about SSI benefits for children under age 18. Share the booklet or share the link with your child’s physician to help them understand how to complete their required section on the SSI application.
Adults with a diagnosis of PWS age 18 and older can get SSI if they meet Social Security’s definition which includes not earning more than a specific amount of income per month (the amount changes each year) and not being able to work without the support of supervision or a job coach. PWCF advocates that by definition, adults with PWS meet these criteria. Visit the SSA website for more information and to apply for SSI benefits. Applying for SSI benefits can be tricky. PWCF will do our best to help you through the process.
CalABLE is a savings and investment plan offered by the state of California to individuals with disabilities. Eligible individuals, family, friends, and employers can contribute up to $15,000 a year and as much as $100,000 total without affecting the account beneficiary’s public disability benefits, such as SSI and Medi-Cal. Earnings on qualified withdrawals from a CalABLE account are federal and California state tax-free. Visit the CalABLE website to learn more.
HCBS Rules & Regulations Impact the Health & Safety of Adults with PWS
There are new Home and Community-Based Services (HCBS) Rules and Regulations that significantly affect group homes, supported living providers, day programs, vocational work sites, and any provider that receives Federal funding, most often paid via the Regional Center system. Arguably the most significant provision is that “individuals have freedom and support to control their schedules and activities and have access to food any time.”
This provision is life-threatening to persons with PWS. We now know that even just one overeating episode can lead to death from choking, stomach or bowel rupture, or stomach or bowel necrosis. Therefore, persons with PWS cannot have free access to food and in fact need an environment where food is securely restricted with locks at all times. Without proper and very specific documentation, however, providers will be required to provide your loved with with food at their request even if it endangers their health and safety.
PWCF’s HCBS Task Force has been working closely with the Centers for Medicare and Medicaid Services (CMS), California’s Community Care Licensing (CCL), California’s Department of Developmental Services (DDS), and various PWS specialists throughout the country to develop tools that will help families and providers provide a safe environment for adults with PWS in their out-of-home placement, work or day program and recreational settings, and all other community settings.
The key to creating this safe environment is to have all of the individual’s PWS symptoms and health and safety needs documented in their Individual Program Plan (IPP). The new HCBS Rules and Regulations place tremendous emphasis on meeting the wants, wishes and dreams of the disabled individual as they are expressed at the IPP meeting; this is called Person-Centered Planning (PCP). The individual’s wants, wishes and dreams are to be written into the IPP document and the IPP Team’s job is to design a program that meets those expressed wants, wishes and dreams as closely as PC-possible. Without detailed written documentation in the individual’s Person-Centered Planned Individual Program Plan (PCP-IPP), providers will have no legal choice but to allow your loved one to have unfettered access to food whenever they request it. The PC-IPP is a legal document; whatever is written in the IPP must be implemented and whatever is not written in the IPP can not be implemented.
Now more than ever before, the Person-Centered IPP must be written with extreme attention to detail and foresight.
To help families and providers obtain this critical documentation, PWCF’s HCBS Task Force has developed a host of new tools, all of which are listed below and in the Yellow Box to the right.
PERSON-CENTERED IPP CHEAT SHEET
Now more than ever before, creating a detailed and appropriate Individual Program Plan is critically important. Every service and aspect of care your loved one receives from any entity that is funded in any way by the Regional Center system and/or Medicare and/or Medi-Cal must comply with the new HCBS Rules and Regulations. Every aspect and detail of the delivery of that service must be clearly written in the PCP/IPP. If it’s not included or described in the IPP, service providers can’t/won’t do it. PWCF has created a new template PCP/IPP Cheat Sheet to help you know what to include in your loved one’s PCP/IPP. We have also created new tools that you can add to your PCP/IPP, including a Physician’s Note and Individual Agreements for locking food and securing door and window exits.
PHYSICIANS NOTE SYMPTOM AND TREATMENT CHECKLIST
The Physician’s Note is a new and critically important tool developed to meet some of the new documentation requirements. The Physician’s Note is to be completed by you and one of your loved one’s physicians. At your next Regional Center IPP meeting, discuss the Physician’s Note and have it entered in the PCP/IPP. The signed Physician’s Note should be shared with every service provider including the residential provider, day program provider, vocational work site provider, recreational program provider, and volunteer site administrator to help them better understand each symptom your loved one experiences and the necessary treatment or management strategies. The Physician’s Note is available in written form and a PDF format for easy emailing.
INDIVIDUAL AGREEMENT REGARDING FOOD AND LOCKS
Another new tool developed to help you meet health and safety documentation requirements is the Individual Agreement Regarding Food and Locks. This new tool is an “agreement” with the individual with PWS that he or she may not have access to unauthorized food, even and especially when expressing emotional upset, and is to be incorporated into the PCP/IPP and distributed to all professional providers. This Agreement document is recommended because new Federal and State regulations lean heavily toward meeting the expressed wants and wishes of the disabled individual who, in the case of PWS will likely at some point request food outside their snack and meal schedule. This Agreement is not a legally binding contract but does serve as additional documentation to help professional providers not give food to your loved one if your loved one requests or demands it.
INDIVIDUAL AGREEMENT REGARDING ELOPEMENT AND LOCKS
If your loved one has a history of eloping or running away, this new Agreement can help ensure their health and safety. Like the Agreement Regarding Food, this new tool serves as documentation that your loved one authorizes the doors and windows are locked to prevent them from eloping. The Agreement Regarding Elopement and Locks should be incorporated into the PCP/IPP and distributed to all professional providers.
In the eyes of the law a person who is 18 years or older is deemed an adult capable of handling their own affairs and making all of their own decisions. There is no legal protection of an adult who has PWS or any developmental disability unless there is some legal arrangement in place. In California, this legal arrangement is called a Conservatorship.
Once your loved one with PWS turns 18 you as their parent or care provider have no legal rights if you don’t have Conservatorship. If your loved one runs away or chooses to live somewhere dangerous, you have no legal right to keep him or her safe. If your loved one is hospitalized you have no legal right to direct medical care or even receive information from the doctors. If your loved one enters into a contract or charges money on a credit card, they are legally obligated to pay the debt or incur legal consequences. If your loved one steals food or other items from a store, you have no legal input to their defense. Conservatorship gives you the legal authority to help your loved one make important life decisions and ensure their health and safety.
Read CONSERVATORSHIP FAQS to learn more about Conservatorship and how to obtain it. Provide all attorneys and other professionals a copy of FACTS ABOUT PWS CONSERVATORSHIP ATTORNEYS NEED TO KNOW. Your Regional Center Case Coordinator can help you start the process.
Will and Special Needs Trust
A Will allows you to direct the distribution of your property and leave assets to your children, grandchildren, other heirs, or charities. If you die without a Will, the State of California will determine how to distribute your estate and assets, not you.
If your loved one with PWS has or inherits any assets, including life insurance or retirement benefits, that total more than $2,000 he or she will be ineligible for Social Security benefits and Medi-Cal. Assets your loved one with PWS received from Medi-Cal are subject to immediate repayment for care they previously received. Medicare may be the only health care benefit your loved one receives which does not offer the same benefits as Medi-Cal. Assets left to others to care for your loved one could be lost to creditors, litigation, divorce, etc.
A Special Needs Trust allows your family to avoid probate and the accompanying delay, court costs and attorney fees, allows you to leave money for your loved one’s care without disqualifying them from government benefits, and will allow extra money every month to make his or her life more wonderful. Without a Will and a Special Needs Trust there is no guaranteed security or protection.
Both your Will and Special Needs Trust should be written with an attorney who specializes in these documents. If the Special Needs Trust is not written correctly, it can’t protect your loved one. While PWCF does not endorse or recommend any organization or attorney, the following organizations may be helpful:
The new HCBS Rules and Regulations give adults with PWS and others with disabilities enormous rights to control their lives. Without written documentation in the format accepted by CMS, DDS and the Regional Center these rights actually prohibit parents, care providers, and even conservators from overruling them, even when they are dangerous to your loved one. Therefore PWCF encourages parents, care providers and conservators to:
- Immediately complete the Physician’s Note and provide it to your loved one’s “main” physician to review and sign;
- Talk with your loved one about the Agreement Regarding Food and Locks and, if appropriate, the Agreement Regarding Elopement and Locks, and ask them to sign the Agreement(s);
- At your next IPP meeting with your Regional Center Service Coordinator, add the Physician’s Note and appropriate Agreement(s) as part of your Person-Centered IPP;
- Secure Conservatorship if you haven’t already done so;
- Create your Will and Special Needs Trust if you haven’t already done so.
Now more than ever, parents, conservators, and care providers must play an active role at all Person-Centered Planning IPP meetings. Review all of your Regional Center reports as soon as you receive them and immediately make any necessary corrections or clarifications.
Please know that PWCF is here to assist and support you, your loved one and your family. Contact the PWCF Office with any questions or to speak with any member of PWCF’s HCBS Task Force: Lisa Graziano, M.A., Chair, Diane Kavrell, Tom McRae, Austin de Lone, Jonah Steinhart