Sunday, November 13, 2016

So I'm At The Gym This Morning... OR Community Integration Tips for Mentally Disabled Individuals

I mentioned earlier this week that one of the for-profit managed care organizations (MCOs) that took over Iowa's Medicaid system earlier this year just provided free gym membership to recipients covered by them. Many of these Medicaid recipients are mentally disabled individuals whom I know (my oldest boy included) and the gym happens to be the one that I belong to. It's a good idea, in theory. The MCO is banking on the idea that it will be cheaper for them to purchase several gym memberships (presumably at a reduced group rate) and less money on medical costs related to obesity, diabetes, heart disease, etc.).

The problem is that most of the people that I know who are on Medicaid are there because they have chronic and lifelong disabilities. Including -- and most significantly -- intellectual disabilities. In other words, these are folks who have IQs at or below 70. Most of them don't read or write. Their ability to problem solve and process situations isn't always the greatest. Some don't speak. Most require supervision most or all of the time at home or at work. And the system doesn't want to pay for that supervision, so most of them go with less than they need and are left to the mercies of the general public.

So I'm at the gym this morning. A clearly disabled young man was attempting to take advantage of his new MCO-funded gym membership. It's clear that nobody walked him through with his new membership or helped him prepare. He was wearing jeans and a shirt. He showered before his workout -- while wearing all of his clothes. He had no towel. He had no change of clothing. He had no staff support. The gym ended up pulling him off of a machine and sending him away for a while because he was leaving a trail of water behind him. Unfortunately, he left before I could get involved.

Let's get this clear. I'm not blaming the gym. They were trying to get the young man to identify a phone number for a family member or support staff, but he couldn't provide them with that information. And they couldn't let him run around dripping with water. It wasn't safe for him or anyone else at the gym

I don't know this young man. I don't know if he has case management services or if he has a supported community living (SCL) provider or if his SCL provider is an hourly provider or if it provides daily supports. I do know that he belongs to an MCO and that he just joined my gym because of this value-added benefit. So I don't know if he has an individual case plan that addresses going to the gym.

But it should. He needs help right now. Maybe someday he can be independent at the gym. But he's not now.

So here is my sample ISP goal for those whose clients just joined the gym for the first time. I use the name "Joseph" here, but it could be any name. I don't do case management anymore, so some of the wording and structure might have changed over the past five years. Adjust accordingly.

Goal #1: Joseph wants to learn how to fully access his new gym membership on his own by November 30, 2017.
Objective #1: Joseph will independently pack his gym bag and take it with him to the gym every time by January 1, 2017.
Action Steps: Joseph will do an inventory of his gym supplies (i.e., t-shirts, shorts and/or sweat pants, tennis shoes, deodorant, padlock, towel, gym bag) by 11/30/16 with help from his SCL staff. He will contact his payee for spending money to purchase any needed items. Joseph will develop a list at his home and review it before each trip to the gym to make sure that he doesn't forget anything. Staff will assist Joseph with finding a padlock (preferably one with a key instead of a number key) and will help him develop strategies for keeping his padlock key safe and secure during workouts.
Objective #2: Joseph will learn how to independently access the gym locker room by March 1, 2017.
Action Steps: With SCL staff assistance, Joseph will learn how to use the locker rooms at the gym. He will change from his street clothes to his workout clothes in the locker room and then place all of his items in a locker. He will secure his personal items in his locker with his padlock and place his key in his pocket. After working out, Joseph will undress and take a shower. He will use his towel to dry himself off and change back into his street clothes before leaving the gym.
Objective #3: Joseph will learn how to safely utilize the exercise equipment, gradually reducing his reliance on SCL staff by November 2017.
Action Steps: With the assistance of SCL staff, Joseph will schedule a time with one of the gym's personal trainers. He will use the trainer to learn how to safely use the exercise equipment -- both the weights and the machines. Joseph will access funds from her payee to pay for time with the trainer if this is not a free service offered by the gym. Joseph will develop a workout schedule with the help of his SCL staff and utilize his equipment. His SCL staff will provide verbal instructions and reminders on how to safely utilize exercise equipment, gradually reducing the number of prompts over the course of the year. Joseph will schedule refresher appointments with the trainer if he or his staff observe areas where he struggles with using the equipment.
Objective #4: Joseph will receive ongoing input from his service team regarding his progress and challenges. This will continue over the course of the year.

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