Setting The Bar

Stop me if you’ve heard this one.

Two guys walk into a bar.

You’d think the second guy would have ducked after seeing the first one do it.

Now, if whoever put the bar up in the first place put it up high enough that no one would bump into it, there would be no need for me to torture you with that terrible joke. But, they didn’t set the bar high enough.

Unfortunately, I’ve been seeing a lot of that lately in my field – the bar not being set high enough. The regulations surrounding how we fund and deliver services in our State are designed to meet the lowest common denominator, and tend to be one-size-fits-all in a field where every individual served has unique needs.

I understand the reality of the situation – a regulatory agency needs to use the lowest common denominator when making the rules. They don’t have a choice.

Those of us in the field providing the services, however, don’t have to accept that the lowest expectations are all we need to meet. No, I believe we need to shoot much higher

I also believe that aiming our sights higher has always been a driving force at Imagine! – the idea that we can do better, that we don’t have to accept the status quo, and that we don’t need to allow others to set the bar for us. These ideas serve as the motivating forces for everything we do. Our commitment to excellence is something that has been recognized by other organizations locally, nationally, and even internationally. It makes me proud to say I work for Imagine!.

However, we must be ever vigilant against becoming complacent and accepting that meeting the standards set by the State is all we need to do to be “successful.” In an era of ever decreasing resources available to provide services, coupled with a steadily increasing demand for those services, it would be easy to capitulate and accept the lowered bar of expectations.

One of my goals as CEO of this great organization is to not let that happen. I want the bar set high for all of our constituents – our employees, our families, our funders, our providers, and most of all, the individuals we serve. I don’t want it to ever become accepted that doing the least is enough.

Yes, we are facing challenging times. That’s not an excuse to lower the bar, however, and I have no intention of doing so.

I usually end my blog posts with the phrase, “Then again, what do I know?” But of this I am certain - as we move toward the close of another year, we at Imagine! can’t, and won’t, allow external forces to cause us to lose our focus on achieving greatness. I urge everyone associated with Imagine! to join me in that commitment.

Good News Friday!

Sometimes, the best way to learn about an organization like Imagine! is to hear from the people the organization serves. The story below initially appeared in the Longmont Times-Call on Sunday, November 14, 2010. I think you’ll find what Mike has written captures the mission of Imagine! in a way that I could never even dream of. Great work, Mike.

To see the original article, click here.

To see more of what the CORE-Longmont Reviewers have written, click here.

Living With Disability: The Way I See It

By Mike Williams of the CORE-Longmont Reviewers

For those of you who don’t know me, my name is Mike Williams, and I am one of the CORE-Longmont Reviewers. The topic of my article is how society views the disabled community.

You know, folks, sometimes society makes me sick with the way they view us: the disabled community. Everywhere I go, there is always someone giving a disabled person a hard time by giving them a dirty look, cracking a joke about that person or just talking about them behind their back.

Folks, I don’t know you, nor do you know me, but allow me to tell you a little about myself: I am 25 years old, and I was born with autism. I can’t even begin to tell you how badly it hurt me with the way society treated me.

Thankfully, Colorado has an agency dedicated to helping those with disabilities. It is called Imagine!, a nonprofit organization based in Lafayette. I have been a client for seven years.

Not only does Imagine! help those with disabilities, but it also has helped thousands of clients to learn to live on their own. Sadly, some of their clients may never know what independent living is like due to their disabilities. Luckily, Imagine! has homes for them, be it a group home or with care providers. Imagine! also helps its clients find gainful employment through Labor Source, which teaches individuals work-related skills by working on a work crew.

Imagine! has many day programs, so the client isn’t always sitting around being bored. One of the day programs is called CORE: Community, Opportunity, Relationship, Education. There are two of these day programs. One is in Boulder and the other in Longmont. CORE offers many different classes, such as music, cooking, hiking, swimming, and (my personal favorite) photography.

If you have any questions about Imagine! or its services, visit www.imaginecolorado.org.

Until next time, your friend Mike Williams.

Insurance Agent

Why do we have car insurance? Or safety features on our cars? Because most everyone agrees that incidents such as those in the video below are a matter of when, not if, and we want to make sure we have planned accordingly.



If we didn’t think these incidents were likely to happen, would we have mandated insurance, or regulated safety features on cars? Heck no. These are examples of planning for what would otherwise be emergencies. It is interesting that we are OK with mandating and paying for insurance policies and safety features on cars.

I bring this up because this very logical and practical approach to planning seems absent in the way services for individuals with intellectual disabilities are funded and delivered in the State of Colorado.

The regulations we have seem to be directed towards the “ifs,” and tend to ignore the “whens.” As a result, a great deal time, effort, and resources are spent reacting to “emergencies” that are really a result of poor planning. It is not an “emergency” if there is a high probability of an event occurring. The “emergency” in this case is an adult with an intellectual disability, who has no support available, and no ability to fend for himself. The number of people in this situation in Colorado is growing. Barring any change, that trend will continue.

The citizens of Colorado, including the people we serve, need to know that because of the unwillingness to plan for our future, we are looking at the likelihood of an ever increasing number of adults with intellectual disabilities who have absolutely no services available to them, and no ability to fend for themselves. Where are the mandated airbags? Where is the mandated insurance policy? We do it for registered vehicles without batting an eye.

I don’t want to speculate where people without a safety net might end up.

Probably we’ll see examples of very unfortunate outcomes. And of course, no one will win in those scenarios – not the State, not taxpayers, not local communities, not the families, and certainly not the individuals who need the services.

It is not too late to change this course. But changing will involve creative thinking and a true commitment to ensuring we are creating a system of air bags, door locks, head rests and insurance policies that meets the needs of the individuals we serve. I hope we can make it happen.

Then again, what do I know?

Because I Said So

Remember asking your parents permission for what seemed perfectly sensible to you and getting the answer, “No?” And then asking, “Why not?” And then the inevitable response, “Because I said so.”

I still get that feeling when seeking answers from the various Colorado Departments and Divisions.

Unlike my parents, I don’t share unconditional love with State public servants, however I harbor no ill feelings and we do share mutual respect. When asking questions, from one Department, I often hear, “We will have to check with another Department.” Translation: “I’ll ask you father.” Sometimes when a question is posed, I often hear, “The federal regulations won’t allow it.” Translation: “Because I said so.”

Let me give you an example. In Colorado in 2006, the developmental disabilities service system shifted from a quasi-managed care system to a fee-for-service system. Before this shift, Community Centered Boards (CCBs) like Imagine! had a certain amount of leeway in how they used the funds provided to them, allowing them to be creative and innovative with how services were delivered.

Since the shift, resources are no longer viewed as tools designed to provide services to help people with developmental disabilities engage in their communities, they are instead viewed as insurance “benefits” payments based on a standard fee schedule throughout the State. As a result, we tend to direct our services to meet regulations rather than to meet the needs of the individuals we serve. Unfortunately, that often means we provide a lower quality service for the same costs (or often much higher costs) than we did before.

When we have pressed the State Department heads to consider other rate setting methodologies (such as geographic modifiers based of the cost of doing business), or suggest a shift away from the costly fee-for service, we are told the same thing – that the shift was made to meet requirements set by the federal Centers for Medicare and Medicaid (CMS). Translation: “Because I said so.”

An article from the Poughkeepsie Journal increases my curiosity. Here’s a brief synopsis (although you should really read the article, it is fascinating): The New York State Office People With Developmental Disabilities (OPWDD) is defending its $4,556 per-person daily rate at nine state institutions as "reasonable” in response to revelations in June in the Journal. (I know! …Upon my first reading, I thought the daily rate was a typo.) The rate, paid half each by the state and federal governments (similar to Colorado and some other states), is four times higher than any other nationwide and about four times the actual cost of care. For comparison, the average institutional rate in Colorado is around $606 per day, and the average community rate in Colorado is around $172 per day.

Now, I’m not pointing this out to say that providers in Colorado should be getting $4,500 per day for anyone, regardless of their needs – that would be hard to justify, and quite frankly, absurd.

Rather, what I’d like to point out is that there was a paragraph in the story that really hit home to me. Remember, a community based service is typically preferred, and funded by a different set of rules, funding mechanisms, and odd restrictions that, according to one of the three regulatory agents, insist the dollars must track all the way to the individual benefiting from the funded service. Have a look:

The state's argument in support of the rate . . . notes pointedly that the rate-setting formula was approved at every step by the federal Centers for Medicare & Medicaid Services. Fifteen pages of rate calculations, institutional payments and "cost-finding worksheets" were also provided to make the state's case, which contends that the money has helped pioneer a successful system of community care of the disabled and pays for other services beyond institutional care.

Did you get that? They are saying that when justifying funds for institutional care CMS in fact is willing to allow NY, and other states, to utilize the funds for services other than those intended for the specific individual. Now this piece of information is not news to me. The daily rate however, is an eye opener – and should be for anyone. Oddly enough it seems OK for the New York tax payers, OPWDD, and CMS. Apparently someone in Poughkeepsie is worked up in a lather.

With my parents, I said, “But you let Bobby do it, why can’t I?”

“Bobby is older,” might be the come back. Well, institutional care is older, less preferred, and funded on a level that is inconceivable.

And people wonder why families, providers, and advocates are frustrated with the Medicaid systems.

Believe it or not, I’m not trying to point fingers at anyone. I just want to ask the question, why are things the way they are? Why do we have the system we have? Who is going to answer the questions? Who will be held accountable? Who will be willing to step up and say, “Yes, we can change and make this system better?” The fact of the matter is that information in this day and age is readily available, and should be to those who are seeking it. Got a question? Google it.

“Because I said so,” will not work anymore.

Then again, what do I know?

Good News Friday!

On Friday, Nov. 5, approximately 250 people crowded into the Dairy Center for the Arts in Boulder for an art show opening and performance by participants in Imagine!'s C.O.R.E./Labor Source classes.

Imagine! C.O.R.E./Labor Source Presents consisted of an Open House/Art Exhibit, with original art work and photography, and a live performance, which included poetry readings, short spoken presentations, musical interludes, dance, and theatrical pieces.

Almost one fourth of the art on display was sold at the reception and post performance gathering. More was sold earlier this week.

Artist and Bob and Judy Charles SmartHome resident Gerald was ecstatic to learn that one of his pieces, a calligraphy, became subject to a silent bidding. The demand was so high that after the original was sold, C.O.R.E./Labor Source agreed to make six more prints so others could purchase and enjoy the piece.

The packed house gave a long, enthusiastic standing ovation at the end of the performance. The hour long performance was very emotional, filled with laughter and the welling of tears in the eyes of some people in attendance.

Even if you missed the performance, there’s still a chance to see the art, which will be on display at the Dairy Center through Friday, December 10.

Congratulations to the C.O.R.E./Labor Source staff members who worked so hard to bring this creative extravaganza to life, and of course, congratulations to all the talented participants!

Good News Friday!

This past Wednesday, Left Hand Brewing Company and Instant Imprints hosted a fundraiser for Imagine! at Left Hand Brewing Company in Longmont. Left Hand donated $1.00 per pint of beer sold, and Instant Imprints donated special Left Hand/Imagine! t-shirts, which were sold during the evening, with proceeds going to Imagine! as well.

In all, more than $500 was raised for Imagine!’s programs and services!

Thanks to Eric Wallace, an Imagine! Foundation board member and president of Left Hand Brewing Company, and Forrest Fleming, an Imagine! Foundation board member and owner of Instant Imprints, for organizing the event.

Extra special thanks to all who showed up to support people with developmental disabilities.

Collaboration Part II

And speaking of nets - one thought keeps coming to mind – we need to work together to improve the safety net for the people we serve who have the most difficult needs to meet.

Let me explain a little further. For a long time, Community Centered Boards (CCBs) in Colorado were the presumptive provider of last resort for individuals who had needs that no other provider could meet. The fact of the matter is CCB is function that specifically does not include providing services. Coincidently, Imagine! is also a leading provider of services and also struggles to meet the needs of some of Colorado’s most vulnerable citizens.

Unfortunately, a combination of dwindling resources and regulatory changes have made the task of serving individuals with complex needs much more difficult in recent years, even for leading service providers. And if the best leading providers can’t do it, there is no other safety net for serving these folks. In most scenarios, the lack of a safety net means there are few alternatives, and in those alternatives no one wins – not the State, not the taxpayers, not the local communities, and certainly not the individuals who so desperately need services.

So I have begun the effort to reach out to all of our local service providers and other organizations to see if we can pool our knowledge and resources to ensure that even the individuals in our community with the most challenging needs are able to develop the skills and tools they need to become productive and contributing members of society. If all the right players are on board, I believe we can make this happen.

Then again, what do I know?

Collaboration Part I

One theme I keep coming back to time and again in this blog is the need for collaboration among all of the organizations who are responsible for determining how services for individuals with one or more developmental disabilities are funded and delivered.

At Imagine!, we have embraced collaboration whole-heartedly. In just the past few months, I can think of several local and national organizations that we have collaborated with to improve the way we do business in one way or another, including the Human Services Alliance of Boulder County, the Mental Health Center Serving Boulder and Broomfield Counties, Moving to End Sexual Assault (MESA), and the American Network of Community Options and Resources (ANCOR), just to name a few.

It’s not just disability-specific organizations we collaborate with, either. Every day, we collaborate with local school districts, recreation centers, businesses, and governments to improve our service delivery.

And our SmartHome project? We at Imagine! are so indebted to the many partners who have helped make our dream of using technology as a cost effective way of delivering services. You can check out a list of all of our partners here.

Part of being willing to truly collaborate is demonstrating a commitment to transparency, and we are doing that as well. For example, anyone who is interested can take a tour of the Charles SmartHome in Boulder to see first hand how technology is improving the lives of the residents living there – you can even sign up to take a tour online.

Another example of our willingness to be open and share what we do can be seen in our documents website. This site is loaded with non-proprietary, non-consumer information-related Imagine! documents. You can check it out here. Could anyone who wants to go in to our documents website and see what we’re doing? Of course. We even encourage it. If another organization thinks something we are doing is an effective way to improve the quality or efficiency of their own service delivery, then by all means borrow it, copy it, or re-use it.

If you think I am bragging here about how great Imagine! is, you would be dead wrong. This is nothing more than what an average not-for-profit needs to do during times of financial uncertainty. We’re no where near where we need to be in terms of collaboration. We may be throwing a wide net, but the holes in the net are too big. We need a net with a finer weave that will produce “mass collaboration.” The effort we need will connect us to every business, every government entity, and every family in every neighborhood. This is our challenge.

Then again, what do I know?