Workplace Personal Assistance Services and
Supported Employment: Service Supply and
Quality
Susan Stoddard, PhD, FAICP
for AcademyHealth
Disability Research Interest Group
June 29, 2010
Boston
WPAS & SE
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This work was supported by the National Institute on
Disability and Rehabilitation Research (NIDRR):
Rehabilitation Research and Training Center on
Personal Assistance Services PASCENTER
(University of California San Francisco and InfoUse)
Rehabilitation Research and Training Center on
Vocational Rehabilitation (UMass Boston Institute for
Community Inclusion and InfoUse)
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“…PAS is part of the accommodation
spectrum, and there is currently a growing
awareness of the needs for PAS at work.”
Center on an Aging Society, Issue Brief: Workers Affected by Chronic
Conditions: How can workplace policies and programs help?
Georgetown University www.aging-society.org
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Objectives
• Definitions
• Understand personal assistance services in the
workplace (WPAS) and how it differs from Supported
Employment (SE)
• The Policy Context
• Use of SE and WPAS in Vocational Rehabilitation
• Findings on use of WPAS including examples of
employer practice
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Definitions: PAS, WPAS
PAS is defined as “a range of services provided by 1 or more persons
designed to assist an individual with a disability to perform daily living
activities on or off the job that the individual would typically perform
without assistance if the individual did not have a disability.”Ticket-to-Work and
Work Incentives Improvement Act of 1999
Workplace Personal Assistance Services (Workplace PAS) include taskrelated assistance at work, such as readers, interpreters, help with lifting
or reaching, re-assignment of non-essential duties to co-workers, and
other help related to performing work tasks and personal care-related
assistance such as helping someone with toileting, eating, or drinking
while at work.From the Center for Personal Assistance Services at University of California, San Francisco.
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SE: DD Act Definition
• Supported employment evolved as an alternative to
sheltered employment.
• 1984 amendment to the Developmental Disabilities
Act. In the DD Act, supported work is
– paid employment for persons with DD for whom competitive
employment at or above minimum wage is unlikely, and who,
because of their disability, need intensive, ongoing support
in a work setting:
– Is conducted in a variety of settings, particularly in settings
where persons without disabilities are employed
– Is supported by any activity needed to sustain paid work by
persons with disabilities, including supervision, training and
transportation.
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SE: Rehab Act Definition
• 1986 reauthorization of the Rehabilitation Act
– In the Rehabilitation Act, Supported Employment means
competitive work in integrated work settings, or employment
work settings in which individuals are working toward
competitive work, consistent with the strengths, resources
priorities, concerns, abilities and choice of the individuals, for
individuals with most significant disabilities,
• for whom competitive employment has not traditionally
occurred,
• or for whom competitive employment has been interrupted or
intermittent as a result of a significant disability, or
– Certain transitional employment (e.g. for individuals with
disabilities due to mental illness)
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Distinctions between WPAS and SE
• (source: Wisconsin Department of Human
Services)
• Distinguishes between personal care
assistance and personal performance
– Personal care assistance is needed regardless of
if at home, at work elsewhere (e.g. eating,
toileting)
– Personal performance assistance (what we have
called task-related assistance) involves help with
job tasks in partnership with the employee
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Difference between Job coaching
and WPAS
(From Wisconsin Department of Human Services)
• Job coaching involves training and instruction so that
people learn to perform the job tasks independently
• Job coaching is intended to be time-limited and faded
out over time
• If ongoing work support is needed, they need
WPPAS not long-term job coaching
• WPPAS involves partial assistance with the
completion of specific tasks; there is not the
expectation that the employee will be able to perform
all the aspects independently.
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WPAS services include:
1. Work task related assistance
ex. readers, interpreters, help with lifting or reaching,
re-assignment of non-essential duties to co-workers, etc.
2. Workplace personal care related
ex. helping someone to access the restroom, eating, or
drinking while at work, etc.
Formal PAS is provided by a person who is paid.
Informal PAS is provided without pay by a family member,
friend, co-worker, volunteer, etc..
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Examples of workplace personal assistance
services
• Readers, interpreters
• A family member coming into the workplace to assist
an employee with lunch
• A co-worker filing forms for the employee
• A co-worker reading daily memos to the employee
• A person paid by the employer to travel with the
employee on a business trip
• Communication Access Real-time Translation
(CART) during employee training
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Not workplace PAS
• Help getting dressed and ready for work
• A volunteer providing transportation to and
from work
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Workplace Accommodation of People with Disabilities
Need
Receive
accommodation accommodation
Overall
15.6%
12.2%
PA for job tasks
1.1%
0.7%
Reader or
interpreter
0.2%
0.1%
Job Coach
0.6%
0.6%
Zwerling et.al.(2003), Workplace Accommodations for People with
Disabilities: NHIS-D 1994-1995, JOEM, V. 45, Number 5, May 2003
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Tracking changes in workplace PAS
policy
• An Accommodation Under the Americans
with Disabilities Act
• State Medicaid Infrastructure Grant (MIG) and
Waiver Funding
• State Vocational Rehabilitation Agency Direct
Funding
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ADA
• Covers employers with 15 or more employees
• Covers applicants and employees if they meet the
ADA definition of disability and they are qualified for
the position
• ADA specifically excludes personal care PAS from
the employer responsibility
Silverstein, R. (2003). Policy Brief: The Applicability of the ADA to
Personal Assistance in the Workplace. Boston, MA: The Institute for
Community Inclusion.
While the ADA specifically addresses task related assistance on
the job some people need both task and personal assistance to
succeed in the workplace.
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Medicaid Infrastructure Grants (MIG): Ticket to Work
and Work Incentives Improvement Act of 1999
Encourages states to adopt the option of allowing individuals with
disabilities to purchase Medicaid coverage that is necessary to
enable such individuals to maintain employment. (“Buy-in”) For
instance, in California, they have changed the rules for using
InHome Support Services hours, to allow use of hours at work.
(but did not increase the hours)
TWWIIA definition is broader than the ADA language: “a range of
services provided by one or more persons designed to assist an
individual with a disability to perform daily living activities on or
off the job that the individual would typically perform if the
individual did not have a disability. Such services shall be
designed to increase the individual’s control in life and ability to
perform everyday activities on or off the job.”
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Services reimbursable under
Medicaid
• Medicaid state plans and waivers generally
fund personal care services (ADLs, IADLs)
• Job-related tasks may fall within the
employer’s responsibility
• Utah EPAS program: uses ADL and IDL
definitions for guidance in distinguishing
between reimbursable and non-reimbursable
services. EPAS is assistance with personal
tasks at work vs assistance with purely workrelated tasks.
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State Vocational Rehabilitation Program
•Supported Employment Services are more established.
In 2008, 39,000 of the 356,000 VR agency consumers
exiting after a plan for service (11.9%) had supported
employment goals.
•18.1% (64,194) received on the job support services
including job coaching
•But only .3 % of consumers received either PAS
services or reader services. 1.3% received interpreter
services (and we don’t know if these services were at
work or at home) Over 64% received counseling and
guidance.
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SE in VR
• The Community Rehabilitation Providers
system is much more established for SE services
• Separate funding is identified in the Rehabilitation Act
for SE
• State agencies are required to report on plans for SE
in their State Plans
• WPAS on the other hand is simply one of many
possible services that could be provided
• Some SE CRPs may provide WPAS
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PASCenter findings about WPAS in the
workplace: Phone Interviews
• 21 Employers
• 19 Employment service providers including
Community Rehabilitation Programs (CRPs)
• 20 PAS users
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PAS at work may be requested..
• At time of hire
• At return to work after injury or illness
• Change in abilities of the worker (aging,
injury, illness
• Note: Employers are limited in the ability to
ask about need for accommodation as a part
of interviewing or reviewing
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• Attitudes and processes can inhibit accommodation
requests
– “If (my) needs change I go back to HR. I would
feel uncomfortable to go to co-workers continually
if my situation got worse.”
– One person whose needs changed said of her
new PA, “I’m not about to ask them (the
employer) to pay her. I pay her $50/week out of
my pocket extra.”
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Organization response to employee
request
• Centralized processes
– More formal, but removes cost disincentive for supervisor
rated on budget goals.
– Human resource office
– “Diversity consultant”
• Decentralized processes
– With immediate supervisor or other work unit manager
– More informal, more immediate, but may be intimidating,
may cause barriers to requests.
• “Affinity Groups” of employees with common
interests or needs.
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• An organizational “diversity consultant” described the
process: “An employee comes to me for an
accommodation. I acquire what is needed. For
example, in one case I billed VR. In other cases, I
asked the tool shop to create the needed
accommodation. In the case of people needing
JAWS screen-reading software, I purchased it.”
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Those most likely to receive
accommodations:
College grads,
older workers,
Full-time workers, and
self-employed workers
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Arranging different types
of PAS
• Task-related assistance - companies are very familiar
with this; arrangements generally follow ADA
• Personal care - companies not aware of these needs
and they generally do not arrange at all, leaving
employee to arrange
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Arrangement Examples
PAS negotiated in employment contracts
Arranged in return to work negotiation
Arranged for PAS when agreed to telecommuting
Arranged for 2 hours/day (but not flexible enough to
connect with task needs)
• Conference call with employer, ILC, VR
•
•
•
•
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Employee Strategies for Arranging Personal
Care
• Personal assistants that multi-task: e.g. Full time
assistant who does personal care plus work tasks (filing,
setting up materials)
• Personal care only when traveling
• Personal care only as informal co-worker support
• Family member (sister) provides care and secretarial
work (arranged with employer)
• Works at home and husband provides accommodations
(unpaid)
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How is workplace PAS paid for?
• Combination of employer pay and personal pay (one or
the other or both)
• Blue Cross (Medical insurance)
• 250% program (Working Disabled Program) allows public
payment for PA hours
• Keep income, hours low enough to stay on public
payments
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Hours and Costs
• The 20 WPAS users reported an average of
49.1 paid hours of PAS, including 17.3 hours
of paid WPAS. They used an additional 15.5
hours of unpaid PAS, and 6 hours of unpaid
WPAS.
• Average personal cost was $148 per week,
with a range from 0 to $500 for PAS, and
$34.50 average for WPAS (range 0 to $250
per week)
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Who pays?
• Most used more than one source of payment.
–
–
–
–
11 reported that employers paid for WPAS,
7 reported Medicaid payment,
15 used some public benefits,
10 reported personal payment and of these 8 also
used other sources.
– One user’s PAS is paid by Blue Cross, another by
a state grant.
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Written policies?
• Some employers have written policies regarding AT and
PAS, others do not
• AT processes more developed than PAS processes.
Many PAS processes follow those established for AT.
• Case by case basis only. Go to a specialist who would
determine need, solution
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Co-workers
• Lack of understanding sometimes. Complain that the
PA isn’t doing enough work.
• Resentment of assignments to provide care or
assistance
• Lack of back-up in informal care arrangements
• Need for awareness training for co-workers (or
worker may be blamed for such things as irregular
paratransit schedules, need for breaks,etc.)
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Barriers
•
•
•
•
•
•
•
•
Perceived costs to employer
Perceived costs to work unit
Risk/insurance, especially for personal care
Co-worker and supervisor attitude
Employee attitude and preparation
Waiting time for accommodations
Space needs for additional person
Security clearance requirements
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Promising practices case studies:
Criteria
• has been in place for at least six months
• has made a difference in either hiring or
retaining workers with disabilities
• transferable to other organizations
• consumer-sensitive:
– easy for the worker to request the assistance
needed
– provides for consumer self-determination
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Case Studies
• Seven case studies of promising practices in WPAS
have been published on the PASCENTER website
– Support Services Assistants - California Department of Rehabilitation
– Outsourced PAS to a qualified agency - Connecticut Bureau of
Rehabilitation Services
– Shared PAS - Granite State Independent Living
– Security Clearance for PA - Horizon Air Industries, Inc.
– Multi-disciplinary support team - Large multifaceted financial services
company
– Orientation with PAS - Microsoft
– Pool Program of Full-time Equivalent Holds - Social Security
Administration
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Support services assistant:
California Department of Rehabilitation
• Shared services
• Position in State Personnel Board classification
system since 1978
• Any employee who needs work-related
accommodation is eligible for an assistant
• Services routinely provided to people in a wide range
of job classifications at all levels
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Outsourced PAS to a qualified agency:
Connecticut Bureau of Rehabilitation
Services
• Non-profit agency recruits, hires, trains, places and
schedules the PAs (functions as a staffing agency)
• PAs provide task-related and personal-care related
PAS, but not medical tasks
• PAs receive benefits including medical, dental,
pension plan, and the vacation and sick benefits are
at the same level as state employees.
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Shared PAS:
Granite State Independent Living Center
• Full time staff position providing task
assistance and personal care
• Shared by employees with disabilities
• PAS provision is the priority for this position,
which also provides clerical work
• Eliminates waiting time for arranging a
personal PA
• Cost-effective since the position is shared
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Security clearance for PA
Horizon Air Industries Inc.
• Need for security clearance in the workplace
is a barrier for a person using a PA
• PA can assist employees in restricted areas if
the PA has a security clearance
• PAs go through the same clearance process
as outside contractors such as food service,
cleaning, etc.
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Multidisciplinary support team:
(Large financial services company)
• Work accommodation program supports stay-at-work
and return-to-work
• Multidisciplinary work accommodations group of ten:
occupational health nurses, vocational rehabilitation
consultants, mental health specialists, Human
Resources professionals, and an intake coordinator.
• Provide a variety of PAS including interpreters,
readers
• Over 2,000 work accommodations annually including
assistive technology, reassignment of marginal job
tasks, flexible schedules.
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Orientation with PAS:
Microsoft
• Orient new or relocated employees with
blindness/visual impairments to workplace and home
environments
• Services arranged by experienced diversity specialist
with ongoing relationships with community providers,
enabling immediate implementation
• PAS is contracted though independent contactors
• Funded by central accommodations fund, eliminating
cost disincentives in individual departments
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Pool program of “FTE Holds”:
Social Security Administration
• Pool of job slots, “FTE Holds,” paid centrally
• Job slots assigned to local offices to hire and provide
PAs
• May be shared
• Renewable, time-limited appointments with benefits
• Work related tasks, some personal care
• 244 assistants assist 363 employees (2.3% of the
SSA workforce) with severe disability: 165 readers,
68 Pas, 11 interpreters.
• Also assist visitors and do general office work
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Future directions
• Expand the provision of WPAS through CRPs and
other providers
• Include WPAS services in purchasing codes
• Expand sources of funding for WPAS
• Educate employers on cost-effective examples of
providing WPAS as a work accommodation
• Explore trade-off between WPAS,SE and AT
• Foster organizational cultures that support diversity
• Nurture informal WPAS through a culture of
partnership and support
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Partnership and flexibility
• It is important for employees and employers to work
in partnership to find workplace accommodation
solutions. Rather than an adversarial situation where
an employee might demand an accommodation, the
best solutions can come where both employee and
employer contribute to the solution. By not limiting
the solutions to minimum legal requirements but
going “beyond the ADA,” providing personal care
solutions may be possible. (from remarks by Sharon
Rennert, US EEOC, 9/15/05)
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Contact Information:
Susan Stoddard, PhD, FAICP
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Sustoddard@gmail.com
www.pascenter.org
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