Options of Linn County: Is the facility for intellectually disabled an affordable option?

Take a tour of the Options of Linn County's sheltered workshop and day program for adults with intellectual disabilities and see if you can set emotions aside.

John Harris, chairman of the Linn County Board of Supervisors, said it's difficult for him to do.

Even so, Harris and his four supervisor colleagues are faced with the potential prospect of having to chart a new path for the 40-plus-year-old program, in no small part because Linn County is the only county among Iowa's 99 counties with such a public-sector facility with a public-sector, unionized work force serving this disabled population.

"Whether you're a Democrat clear on this end of the spectrum or a Republican clear on this end, when you go through that area (the Options facility in Cedar Rapids), you see people that profoundly need help," Harris, a Republican, said.

"And you come out thinking this is a really good thing. Linn County needs to keep doing this. This is a worthwhile effort. … It needs to be in some way preserved."

At the same time, Jim Nagel, director of Options, said if there change in the air for Options and its 230 adult clients it is, in some way, because of this emotionless truth: "The person who writes the check is totally different from the person doing the service."

Sufficiently ominous though not imminent are the forces that confront the Linn County Board of Supervisors and the county's Options program that the supervisors have created an Options Future Planning Task Force.

Some central questions for the task force are these:

• How much are federal, state and local governments willing or able to pay to provide human services to those with mental health and development disabilities?
• Does the human services field have room for public-sector facilities such as Options in which employees are paid public-sector wages and provided public-sector health care and retirement benefits?
• Or is the trend to, in a way, de-professionalize the human services field with a pay scale that invites employee turnover and encourages those seeking human-services careers to look elsewhere?

Nagel said he has attended conferences in the human-services field during which directors of private and not-for-profit agencies have said that some number of their employees qualify for some of the same low-income entitlement benefits as the clientele they serve.

Some smaller communities in Iowa lose human-services workers to convenience-store jobs because the stores pay more, he said.

"Human services is one of the only fields where the state mandates that we take care of citizens with disabilities. But it also is one of the only fields where you almost have to have bake sales to get enough money to do the job you've been mandated to do," Nagel said.

According to Harris, Nagel and Supervisor Ben Rogers, the nub of the issue is significant, and it starts with money.

They said Linn County anticipates that both federal and state funding programs are contemplating the implementation of a flat-rate payment program based on the average statewide cost to provide direct services such as Linn County provides at the Options program.

The math, they conceded, doesn't seem to favor Options in its present form.

Nagel estimated that the average employee wage in Iowa is about $11 an hour for those who provide services such as those provided at Options compared to the Options's average hourly wage rate of close to $21 an hour.

Linn County's cost per Options employee is about $30 an hour when the county's public-sector benefit package is factored in, he added.

"That's the difference," Supervisor Rogers said. "And if Medicaid says they'll only reimburse at the average state rate and the state rate is $11 and we pay $30 (including benefits), there's a $20-an-hour gap that we can't fill … ."

At the same time, Rogers and colleague Supervisor Brent Oleson said a state law put in place in 1996 limits the amount of local property-tax revenue that counties can use to help fund services for mental health and developmental disabilities.

"Our hands are tied," said Oleson.

Even so, Oleson said one possibility for Linn County is to ask the Iowa Legislature in its upcoming session to permit Linn County to use more local revenue for the Options program so the $4-million-a-year program budget could continue, even if cuts in state and federal funds come to pass.

Supervisor Harris, though, is less cheerful about that prospect, saying he doubted that the Iowa Legislature would make changes to favor just Linn County, the only one of Iowa's counties to offer a public-sector, higher-cost program such as Options for the intellectually disabled.

And it's not as if funding is the only challenge to Options.

Supervisors Harris, Rogers and Oleson said the U.S. Supreme Court, in a 1999 case Olmstead v. L.C., ruled that two female residents in a mental health institute should be placed in community programs and not segregated from the community in an institution.

In some states now, the ruling is being used to rethink sheltered workshops such as Options's and programs like Options' day center for adults with the most severe intellectual disabilities who can't work. About half of the Options's population of 230 clients spends weekdays in the work center and half in the nonwork area of the facility.

Another issue is the pay for those who work in sheltered workshops - pay that is based on a piece-rate comparison to the time it takes for a non-disabled person to do the task.

Pat Airy, president and CEO of Goodwill of the Heartland that has work centers in Iowa City and Cedar Rapids and services in 19 counties, said Goodwill, too, is paying attention to discussions taking place nationwide about "facility-based training" for the disabled.

Linn County's Rogers said any plan to change the county's Options program might mean that programs offered by Goodwill and other providers such as REM Iowa might need to ramp up. At the same time, though, Oleson said the other providers may be facing their own pressures to change.

All these newly arriving challenges at Options are coming just a little more than two years after the program moved into a new $15.3 million Linn County Community Services Center at 1240 26th Ave. Ct. SW, which the Options program shares with Linn County's Community Services Department.

The building was built largely with federal disaster funds from the Federal Emergency Management Agency and state I-JOBS funds to replace the previous Options facility destroyed in the 2008 flood.

In a recent tour of the facility, Charlie Cummins, son of the late Gazette sports writer and WMT sportscaster Tait Cummins, said he continued to enjoy coming to the Options facility as he has for years.

In the Options workshop, Patrick Whitworth, son of Peggy Whitworth, the recently deceased former executive director at Brucemore, said he also enjoyed his time at Options, though he was barely willing to take time from the work tasks in front of him.

"I have lots of work to do. I have to come here for my paycheck," he said.

Chris VanHorbeck, one of six Options employees in one workshop area for about 80 Options clients, said she believes that her job and the program for the clients are facing a threat.

VanHorbeck, who is the union representative on the county's Options Future Planning Task Force, said her 24 years of service at Options makes her the least senior of the five other employees in the workshop. She called the job as "physically and mentally demanding" as it is "fulfilling."

"It's important for people with disabilities to have a consistent lifestyle," VanHorbeck said. "They work. They have a paycheck. It's important to them."

Supervisors Harris, Rogers and Oleson said long-term, experienced, relatively well-paid Options employees such as VanHorbeck are one of the unique and valuable assets that Options has to offer.

"That's why I'm proud of Options," Oleson said. "We have the very best-trained employees."

Harris said the Options's pay and benefit package translates into little employee turnover in a human-services industry that he said can see a lot of turnover.

"It's much better for the folks receiving the services that they see the same person every day when they come to Options," Harris said. "I think in some cases those workers who we trust to work with our less fortunate are treated by some companies as commodities because of the high turnover and maybe because there's a larger work force that is willing to take these jobs, at least for a short period of time."

Rogers, who began his professional career as a youth care worker for two years at the Four Oaks program in Cedar Rapids, said the $18,000 salary a year at Four Oaks was acceptable to start out a career and to work a job he loved.

"But it's really hard to do that job at that salary and know it's not going to get much higher than that," Rogers said.

The challenges that come with the relatively higher pay at Options, he said, may need to be viewed in a larger context: "Do we value people who want to go into this industry? Is this something they would go get a degree in or their master's degree in?"

Jim Ernst, president and CEO of not-for-profit Four Oaks children and family services program, manages 854 employees statewide in 14 locations, about half of whom are under age 30. At Four Oaks, he estimated that many of the direct service employees earn between $12 and $15 an hour, and many of those have bachelor's degrees, he said.

Work schedules, he added, can be challenging, including evening and weekend work.

"There's no question, just because of the salary and schedules, turnover is an issue," Ernst said.

He said, too, that the revenue for not-for-profits comes from government programs, "and, in general, those rates don't achieve the salary levels for direct service staff that I wish they could," he said.

This fall, Dan Strellner, president of Abbe Inc. in Cedar Rapids, completed the closing of one of his agency's programs, the Abbe Center for Community Care in Linn County. The close saw 60 full-time union employees lose their jobs and 76 residential mental-health clients moved into other facilities.

Some of the employees found work at other Abbe programs, none of which has a union work force, he said.

Strellner said it can be difficult to fill positions in human services in general and particularly in health care and long-term care.

"Lower wages contribute to that," he said.

Linn County not only has seen the union work force at the Abbe Center lose its union jobs, but the county also decided not reopen its youth shelter with county employees after it was damaged in the Flood of 2008.

In addition, Linn County has lost four union employees in an Options payee program and 15 others in a Supported Community Living program.

As a result, longtime Options employee VanHorbeck does feel the pressure for herself, but more for Options clients, she said.

"This is important," VanHorbeck said. "I just want people to see that these guys are important. We just can drop the ball on them.

"I've seen the payee office shut down. I've seen the SCL program shut down. I've seen the Abbe Center. It's like, when our these guys going to get a break?"