Regional Thinking (Part 4)

I’ve been sharing my thoughts on this blog the discrepancies between what the State of Colorado spends on intellectual and developmental disabilities (I/DD) services for its own operations versus what it spends on community providers for the past few weeks (click to see Regional Thinking: Part 1, Part 2, and Part 3).

Today I’d like to explore just how we got to this point, and figure I could take some clues from journalists and discuss the four “Ws” - the Who, Why, Where, and What of the situation.

Who

The “Who” are the people who have been responsible for the design and oversight of our system of funding and delivering I/DD services in the past, as well as the people who are doing those activities now.

With all due respect, I want to be clear that I am not questioning any person’s (or government’s) motives, or disparaging their commitment to our fellow citizens with disabilities. But I do want to point out that the I/DD influencers and decision makers tend to have, by their very make up, a short-term view when it comes to exploring system design and/or redesign for lifetimes.

For example, legislators and government administrators, because of the nature of their positions, operate in an environment of regularly designed turnover. The urge for immediate and temporary action, irrespective of a long term strategy or well defined outcomes, can be very powerful in this group.

And families – be it mothers and fathers or sisters and brothers - naturally tend toward viewing the issues facing the I/DD world through the lens of their loved ones’ experiences, needs, goals, and desires. Logic would state, however, that the needs of the many outweigh the needs of the few. Apologies to Spock. All are important, however establishing the preferred business model of the State should be done through the eyes of the many, not the few.

So the main drivers and decision makers of a statewide design are hampered by limitations: limitations of time, limitations of data, and limitations of knowledge. And that takes us to the . . .

Why

Why do these limitations make for a lack of strategic planning? Because they are using temporary solutions to solve a long term challenge. This has resulted in a patchwork of partial solutions, regulatory distractions, committees, and task forces, as well as cost-shifting rather than addressing costs. This has resulted in, at best, inefficiency and redundancy, and, at worst, contradictory rules and regulations that stifle progress. One example demonstrating that principle: the multiple shifts by the State over the years in living arrangements for adults with I/DD and the expectation of parents’ roles in those arrangements.

Sometimes those making decisions seem to be confused by the “where” of services, but to me that answer has been established for quite some time now:

Where

Services should be community based. Simple as that. How we get there remains the what:

What

This has been the crux of all of these recent Regional Thinking blog posts. What is the best, most efficient, and most equitable way to deliver community-based services? The State’s actions would tell you that they rely on a preferred business model. But I have already demonstrated how that model isn’t sustainable.

Maybe it’s time to take the decadent training wheels off this bicycle. We live in a country where market drives success. Riders will never make improvements to a bicycle that continues to have regulatory training wheels attached. Leaders are afraid that a sole provider of last resort will hold the State hostage to unbearable rates. (Oops - we already have that). Rather, the market of 400 providers will balance rates and service designs on an individual basis. Creativity will be rewarded and cost savings realized and reasonable rates will ensue. The shared effort by specialized providers will make the term provider of last resort obsolete.

Speaking of resorts: During FY 2014-15 the daily rate paid for residents of the Wheat Ridge Regional Center campus was $694, while an average of about $175 per day was paid to Imagine! for people living in community homes and receiving a similar level of care.

What can $694 a day purchase? Well, in Boulder, you would be able to enjoy a stay at the St. Julien Hotel, including breakfast, housekeeping, turndown service access to a pool and spa, free transportation within 2-mile radius, free WiFi, and you’d still have a couple hundred bucks left over to take your Direct Service Professional to dinner on the Pearl Street Mall. Clearly the reason we don’t opt for this is regulatory; Medicaid won’t cover WiFi (I know what you are thinking) even though in 2017 access to the internet would seem like a basic necessity for anyone who wants to engage in community.

Watching from the nosebleed seats isn’t fun and frankly I don’t enjoy writing these posts. But it is past time to completely rethink the Who, What, Where, and Why of services in our State. $694 a day and it can’t cover WiFi? Really?

Then again, what do I know?