Regional Thinking (Part 3)

If you have been keeping up with my recent posts (check out Regional Thinking Part 1 and Part 2) on the discrepancies between what the State of Colorado spends on I/DD services for its own operations versus what it spends on community providers, I hope you will recognize that so far I have just acted as a reporter sharing the facts.

For this installment, however, I’d like to start speculating on the future.

I’m not the only one looking to the future, of course. So is the State. At an April meeting of the Grand Junction Regional Center Advisory Group, the Executive Director of Colorado’s Department of Human Services (CDHS) set a goal to ensure that the needs of people who require Intermediate Care Facility (ICF) services on the Western Slope will be met for at least the next 20 years.

Now, I have to make an assumption before moving forward. If the State has publicly indicated its willingness to meet the needs of people requiring ICF residential services on the Western Slope, they surely would make that commitment to similar individuals they serve across the State. Here’s a recent census of that State-wide population: 153 people live in ICFs operated by DHS in Grand Junction and Wheat Ridge, and 105 people live in Home and Community Based Services (HCBS) Waiver super funded homes operated by DHS in Pueblo and Grand Junction.

With those numbers set, it is time for some forward thinking and arithmetic. The next three paragraphs below may be unpleasant to readers of fiction, but they are important if we really want to look to the future and understand what the future holds if we follow the State’s train of thought.

Colorado’s current population is 5,541,000. Recent population growth in the State is about 1.5%, or 83,000 people per year. Prevalence of Intellectual and Developmental Disabilities (I/DD) across the country has generally been stated to be about 1%. 1% of the 83,000 new Colorado population calculates to 830 new people with I/DD in Colorado every year. As shown above, the State, through CDHS, serves 258 people who require a more expensive level of care (ICFs or HCBS Waiver super funded homes). This is equivalent to about 2.5% of adults receiving waiver level services on Colorado.

Now let’s attach a caboose to the DHS train of thought: 2.5% of the 830 new people with I/DD in Colorado every year is about 20 new people, every year, who will require the more expensive level of care provided by CDHS. As I stated in my previous post on this topic, the State is currently planning to build four new homes in community settings, replacing homes on its Grand Junction Regional Center Campus, at a cost of $12 million, or $3 million per home.

Looking at projected population growth and the commitment from CDHS to meeting the significant needs of these individuals, that equals three new homes at a cost of $9 million every year. That figure is simply for construction costs, and doesn’t include the daily cost of services, which I’ll conservatively put at $400 per day per person for this exercise (Why conservative? The FY 2014-15 daily rate paid for residents of the Grand Junction Regional Center campus was $1,135, which was $441 more than the daily rate of $694 paid for residents of the Wheat Ridge Regional Center campus). The daily $400 figure would add an additional $2.9 million in costs every year. (Just a very important side note: Imagine! is paid an average of about $175 per day for people living in community homes where many were previous residents of a Regional Center service).

The grand total? Just under $12 million new expenditures every year by DHS! This is on top of the incredible numbers reported in the previous two Regional Thinking posts.

One caveat – the somewhat conservative figure of population growth used above does not take into account that the population growth will include people of all ages, not just adults needing support. However, children who have those levels of need will still have those levels of need when they become adults, meaning it is likely that in the long term the numbers hold up.

Once again, please let me emphasize that I’m not opposed in any way to spending money on serving our fellow citizens with I/DD. However, by any measure, the State’s apparent preferred business model isn’t sustainable, especially considering that Colorado has typically been rated at very nearly the bottom in the nation when it comes to fiscal effort for I/DD services.

So I ask: Why are we here? Who is responsible for these decisions? Is there a growth strategy? Who will pay for that? Or an exit strategy? Believe me, I could go on and on. Let’s see if we can wrap our hands around this next time. Stay tuned.

Then again, what do I know?