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The Voucher System

It has become clear that taxpayers at both the federal and state levels do not wish to assume any greater tax load. On the other hand, most feel that "worthy" individuals, particularly the disabled, should be granted needed services. Although this tends to be an oversimplification, most people will agree, according to Ken Schwarzentraub (1980), Housing Consultant in the California Housing and Community Development Agency, that a much greater percentage of the existing dollars in the system should go directly to individuals who are disabled.

The voucher system is one mechanism to increase direct consumer participation by placing more decision-making control in the hands of service recipients. Vouchers can be used to identify and select needed service on behalf of handicapped persons. From an accounting perspective, a voucher transfers the issues from one of fiscal to programmatic compliance. In the opinion of many of us, a voucher payment system would eliminate many of the forced choices currently existing.

We know that residential services are particularly vulnerable due to funding fluctuations, inflation, appreciation of shelter costs, and the absence of a career development program which ensures qualified staff. The voucher system could alleviate some of our current funding problems in residential service because the fiscal reporting procedure would be strengthened within the system. Equitable distribution is one of the strong points of the voucher system, and once this occurs, the opportunities for creative problem solving would be greater.

Voucher systems are not new. Existing voucher programs include the Food Stamp Program (Department of Agriculture), the Section 8 Rent Subsidy Program (Department of Housing and Urban Development), and the Title II Social Services Program of Homemaker-Chore Services. The common points of these programs are that: 1) the individual must have less than a certain income level; 2) the assistance can only be used for a specific product or service; and 3) there is a ceiling on individual expenditures. The advantages of voucher payment are an equitable distribution of service dollars; greater recipient control over how money is spent; provision of incentives for good planning; possible stimulation of the service delivery system; easier fiscal auditing; greater potential to provide fiscal incentives for achievement of client independence; and possible reduction of administrative costs.

Legislation and programs exist in California that reflect concern for greater decision making authority by consumers. These include the Independent Living Centers for persons with physical disabilities, the Community Residential Treatment System for individuals with Mental Disabilities, and the Regional Centers System and Community Living Continuum Projects for individuals with Developmental Special Needs. These service systems could be conduits for implementation of the voucher systems.

One standard objection to voucher systems for severely retarded persons is that recipients of vouchers are not capable of being decision makers. If this is a problem, it is usually because consumers have not had opportunities to make service decisions. All of us would agree that a backup system is needed in the case of highly dependent persons. This could be accomplished within the context of the individual program plan (IPP). It is imperative that the IPPs be fully operational for the voucher system to work. Fully operational means that the IPP was produced through consensus at a case conference. A fully operational IPP also means that measurable outcomes and timelines have been established. Moreover, it means that agencies are capable of delivering services in a timely and consistent manner.

When a service is not available, a group of individuals/families should be able to obtain it if they are armed with a voucher system that ensures payment. Essentially, any service that can be stated objectively in terms of measurable outcomes can be funded by a voucher. While there are services which do not lend themselves to being described objectively, most components can be vouchered. While this voucher system has not yet been field tested, Dr. David Loberg, Director of Developmental Services, has intimated that he would favor a pilot project. With the persistent strong support of the Under Secretary of Health and Human Services and the California State Council, it is expected that a limited trial program might be implemented by 1984 or sooner.

The LaJolla Plan

As Chairman of the Residential and Living Arrangements Committee for the State Council for 3 years, I examined some 20 different types of living arrangement modalities, but for some reason which I did not immediately recognize, none of these appealed to me as viable options for my son. It later occurred to me that what his mother and I wanted was pretty much what he had right now--except for the companionship of a peer and the freedom for us that having an attendant care provider would bring. We also wanted him living close enough that we could visit, but we lived in an area that might be called "a high rent" district. It was not easy to find an available unit which would meet the constraints of the Section 8 Fair Market Rental ceilings. After studying the situation, I discovered that it would be possible to obtain housing for my son and others like him in a number of ways.

One option was to identify city owned land and petition the Housing Authority to make it available for Iow-income housing. At the same time, I had to submit an application for a Section 8 "after care certificate." Such certificates were sparsely allotted and whenever they became available, they had to be utilized within 60 days. Another option was to find someone who already had a living arrangement they might be willing to share in return for the rental income and for being employed as a part time careprovider. This situation, too, required considerable searching. If one were fortunate enough to find such an arrangement, there was always the possibility that the individual might tire of the arrangement. It lacked permanency.

The option I finally chose to pursue involved diligence. I watched the papers to discover a developer who was about to construct a new housing development and needed the approval (because of a special request) of the coastal commission or the building department, both of which had the right to impose special conditions on the builder in granting him the special permission he was seeking (e.g., to demolish low-income dwellings or increase density). I found that usually, a specific percentage of the units must be made available for low/moderate-income families as rentals for an extended period of time. Because builders are reluctant to become "landlords" I felt they would be receptive to offers by a recognized non-profit organization to accept that responsibility. The respective commission must consider allowing the sale of these units to the recommended non-profit organization, but most likely will agree to transfer the responsibility to them. This allows the non-profit group to apply to a number of funding sources if they are financially unable to meet the minimum terms negotiated. The maximum price will be fixed by the HUD formula but it is also possible to get the developer to accept "modified" terms in his anxiety to be relieved of this responsibility. Many extras may be negotiated, if the climate is right. With this plan in mind, I located a builder and began negotiations.

The next step was to contact the Regional Center or local placement agency, to find persons interested in such an arrangement and to seek agency assistance to match compatible housemates. The agency can also assist with additional programs (revenue) and coordination, as well as with appropriate day programs and transportation if required.

The details in coordinating this plan can be as variable as the individuals involved and the restrictions of the local resources. Because most service delivery systems are fragmented, it is important to learn how to function like an ombudsman, or to find one to act for disabled people. The advent of the Continuity Foundation assistance plan will help developmentally delayed persons when the parent or current "protector" is no longer available to do so. The advent of the voucher system will provide the flexibility to co-mingle funds from a variety of sources to accomplish the desired services.

The resources currently available in most states from local and federal sources, in my opinion, are sufficient that with proper coordination and management, severely and profoundly handicapped people can live in their home community. Comparable parity for community living arrangements with that which state institutions receive would guarantee the supportive services the most disabled might require. There is ample reason to believe that the quality of life for all disabled would be vastly improved.

Conclusion

The most outstanding disabilities event of the '70s has been the movement towards deinstitutionalization. The challenge of the '80s undoubtedly will be to provide services to support community living for more severely handicapped people. In the face of ever-tightening budgets and ever-growing numbers of persons eligible for aid, and the ever-increasing costs for homes, personnel and energy, we will have to look to the future with an eye towards innovation as we have never done before. Certainly, all of the areas touched on in this chapter will help make the system more comprehensive and responsive.

Having been actively involved in seeking ways to improve the quality of life and extend opportunities to advance the potential of our disabled, I feel qualified to state that there are three major steps necessary to bring this about. First, it is time parents and all advocates recognize that we must stop competing with one another by lobbying for benefits for certain disabilities. Instead, we must seek collective action to meet the needs of all of our disabled children.

Secondly, the united effort of all concerned should focus on bringing about what I call "an era of enlightenment," fostering campaigns to inform the public, educators, medical practitioners and other professionals--particularly the media--about rights, needs and expectations.

Third--but by no means least--is the need to let our legislators and local government officials know what voting power we possess and demand that they take action to guarantee that the resources necessary for our community living needs are available without stigma or hardship.

Even with all of this, the concerns of parents would not be completely resolved. However, a lot of us would sleep better at night, knowing that our children are finally being recognized as "people" despite their limitations.

We have --
	acquired guilt complexes learned to live with ongoing rejection developed defensive attitudes been subjected to a myriad of programs of continuing education become dependent on emotional support
But we also have --
	rejoiced in minuscule advances become more understanding of others increased our recognition of the true values of life developed into closer knit families (those of us whose marriages have survived) learned to share and show our love
We have become the strongest people on earth!

References

Apolloni, T. & Roeher, A. G. An approach to improving guardianship, conservatorship
	and trust services for highly dependent persons: The Continuity Foundation.
	Rohnert Park, CA: California Institute on Human Services, 198l.

	Co-authored for A New Look at Guardianship, published by Philllip H. 
	Brookes, Inc.

Bissell, N. E.  A special educator study on professional approaches with parents:
	Communicating with parents of exceptional children.  Department of 
	Special Education and School Psychology, University of Cincinnati, Cincinnati,
	OH: 1976

Des Jardins, C. How to organize an effective parent group. Chicago, IL: 
	Coordinating Council for Handicapped Children, 1971.

Kagan, J. Letter to the editor. Harpers, March 1967

Stout I. W., & Langdon, G. Parent-teacher relationships. What Research Says to the
	Teacher, 1958, 16.

Schwarzentraub, K.  A working conference to plan the future of respite services in 
	California: A five year plan: The potential value of a voucher system in the
	delivery of respite services.  Asilomar, CA: December, 1980.

Wolfensberger, W., & Kurtz, R. A.  Management of the family of the mentally 
	retarded. Chicago, IL: Follett, 1969.