The 56 hour soft cap for personal assistance will put individual's at risk of needing to be moved into a residential setting and out of their family home because the family no longer has access to the support they need. I work with a Community Service Board in Virginia and have several individual's who receive more than 56 PA hours per week and that is the main reason that they have been able to remain in the family home and did not have to move into a group home. The 56 hours are also not always limited to one staff member and a lot of families have multiple staff working with their individual. The gap in services due to the cap will result in families in exploring other services that will be more costly in the long run compared to PA. However, not everyone is eligible for in-home, group day, community engagement, etc. due to medical and behavioral needs that are too extensive. These services require the individual to be able to develop new skills and some individual's do not have that capability due to their disability. Also, some individual's do not want to participate in those services and that should be their right since we try to be person-centered.

I know there is also concern of families using their child with a waiver to be paid. However, that is such a small percentage of families we serve. I know in our CSB, if a parent/family member indicates they are committing fraud and/or only using their child for money, we immediately address it with the proper channels. It is not something that is ignored or dismissed and shouldn't prevent the families that are not abusing the situation from receiving the support they need to care for their individual.

I do feel like it is important to mention how this could financially affect the family members who are paid caregivers and aren't committing fraud/abusing the system. I have a few families who had to quit their job to be able to care for their individual and became the paid staff person. The 56 hours soft cap would cut the families hours which would cause financial instability which would directly affect the individual. The family may no longer be able to pay their rent/mortgage which would cause the individual to be at risk of homelessness. Even if the staff member does not live with the individual, the cut in hours may result in them being unable to work with the individual due to the cut in pay. Most families have tried multiple services in the past and had outside staff come in, but it did not effectively meet the needs of the individual's due to staffing issues, outside staff not being properly trained to handle the extensive behavioral needs (even with TC services), had multiple bad experiences (including abuse and neglect), and sometimes it is the individual's preference that their family member is their staff person. 

If a soft cap were to take place, other changes would need to implemented first. There are not always services available that could fill the "gap" with reduction in PA hours and that should be addressed first before any cap is implemented. For the majority of Virginia, services available like CE, GD, and IHR are severely limited and PA is the only service that may be accessible to the individual. I think a good alternative is that instead of 56 hours, make it higher like 80 hours a day or increase the cap if the individual has multiple staff people.

I think these concerns should be taken in consideration when creating the exceptions criteria if the soft cap is implemented. I do strongly believe that other alternatives may be better solution that would not negatively affect an individual. Support Coordinators and Community Services Board who work with individuals first hand would be the best people to consult in order to find those alternatives.