Disability Thinking Weekday: 12/12/24

Home care, special education, and a Cracker Barrel followup

Three more disability links for Thursday, December 12, 2024.

1. Expanding in-home care coverage is a needed evolution of Medicare

Gopi Shah Goda and Courtney Harold Van Houtven, Brookings Institution - October 28, 2024

Shared by subscriber Tom Defayette

“Expanding coverage of paid home care through Medicare would provide access to paid home care to an estimated 15 million Medicare beneficiaries and is estimated to increase the budget of the Medicare program by $40 billion, or 4%.”

Since Donald Trump won the election and not Kamala Harris, it seems quite a bit less likely that we will see home care added to Medicare anytime soon. It would have been a long shot even if Harris had won. Still, making paid home care available to people through Medicare, as it already is for people on Medicaid, is a disability and aging policy goal worth working toward. Actually, maybe there should be two main goals: adding home care to Medicare, and fully funding home care for Medicaid, so all who are already eligible for home care under Medicaid and are on waiting lists for services can get them. Neither of these two goals are enough on their own. They need to be at least planned for in tandem, even if they would have to remain separate programs.

Question for readers outside the U.S.: How weird is it that Americans are always talking about two health care programs that sound almost exactly the same — Medicare and Medicaid?

2. How a staffing shortage can make special education jobs more dangerous

Camille Phillips, National Public Radio - December 5, 2024

“Fred was pushed by a high school student who has a cognitive disability. He fell and hit his head, and it led to a brain bleed … He died 10 days later without ever waking up.”

I’m deeply conflicted about this article. The problem seems real, not like a fake moral panic. And at least one of the teachers quoted in the piece does out of her way to note that disabled kids are no more violent, statistically, than other students. So the piece doesn’t seem crafted to stoke fear and resentment of disabled kids in public schools. But knowing how many people already believe that disabled students are a huge problem for schools, an article focusing on special education teachers who have been badly hurt and even killed on the job seems damaging — even if it’s technically true in all of its details. Everyone involved in the article seems to emphasize that the solution is better staffing — not more segregation or harsher punishments. And that’s encouraging. But I worry that too many readers will miss that point, and conclude instead that this is all further evidence that “mainstreaming” of kids with disabilities has “gone too far” — a sentiment always close to the surface.

3. Cracker Barrel dismisses 3 workers after 'unacceptable' handling of special education students

Greta Cross, USA Today - December 10, 2024

“Cracker Barrel said dismissing the workers from the company was the "best path forward," a spokesperson told USA TODAY, adding that senior executives on Monday met with district leadership, teachers and parents to discuss how the group was treated at the restaurant.”

It’s possible that the employees fired really are individually responsible for mistreating that group of disabled students. I don’t find that hard to imagine. It’s also possible that they have been sacrificed to cover for a company that has failed to train staff on serving disabled customers. That would ring true, too. It’s also possible that it’s a combination of both things. But my guess is that the parent protests and bad reviews on Yelp might be the most effective antidote to this situation.

Question: When businesses discriminate against disabled customers, what are the most effective responses and remedies?

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As explained in the December 2 edition, this newsletter is moving from Substack to Ghost on January 1, 2025. I had asked for people to help me with the approximately $400 in moving expenses, by renewing their paid subscriptions early. Unfortunately, Substack doesn’t seem to allow this. So there are two options if you want to provide some extra support for the move:

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