The video above is a perfect representation of the issue facing the world of funding and delivering services in the field of developmental disabilities.
The round hole represents Medicaid. The square peg represents the needs of those we serve. And service providers are Gordon.
Here’s how it seems to work for those of us in the DD field: If the needs of the individuals we serve (square peg) don’t match Medicaid’s funding mechanism (round hole) then service providers (Gordon) are put in the unfortunate position of trying to make the fit anyway. Like Gordon discovers in the video, providers don’t have much leeway when it comes to changing individual needs, nor do they have much of a voice when it comes to changing the funding mechanism, so they end up stuck in the round hole themselves.
So what can we do? Well, I happen to think we can address the issue from all sides.
1) We have to admit that the round hole of Medicaid acting as the funding mechanism for DD systems simply won’t work for long-term care, and find a new system better suited to the needs of those we serve.
2) We can’t change the square peg of individual needs, but we can do a much better job of getting better data in order to understand needs in the aggregate, and then use demand management principles to address those needs.
3) Providers (and Gordon) need to be more creative and thoughtful as they look at new ideas and explore new service delivery options.
Then again, what do I know?