Thursday, August 20, 2015

Good Economy, Not Mutually Beneficial

A brief history lesson.

When I first entered the field of serving individuals with intellectual and developmental disabilities (I/DD), it was generally agreed that successful outcomes meant that the individuals we served were able to live separately from their parents upon reaching adulthood; sort of the expectation we have of all young adults. Residential services were set up to support the philosophy that as adults, individuals with I/DD were able to live their own lives separate from their families. The most common living situations for adults with I/DD living away from their parents or other family members at the time were group homes – anywhere from two to ten individuals living together. While this was certainly a positive move away from institutions, the end result was still congregate settings where people lived together on the basis of their disability instead of common interests.

As time went on, and the costs of supporting both the transition into and maintenance of an adult who lived separately from family changed, so did the definition of success. Having younger adults with I/DD stay with their families as long as possible became the goal, and having individuals living separate from their families as adults become a “last resort” option, essentially considered an unsuccessful outcome. For those individuals who weren’t able to stay with their families, the preferred residential setting became host homes – an attempt to recreate a family type setting outside of the natural family.

It should be noted that during this time of trying to create a family type residential setting for those adults who couldn’t stay with their actual family, the idea that the actual families could or should be paid to provide services was considered absurd in many circles. So we were paying to reconstruct something that we were unwilling to pay for when it occurred naturally.

Recently, however, that attitude has changed as well. The family care model, where family members are paid to provide services for their loved one with an intellectual disability, may very well become the predominant model, and the model that is considered the most successful possible outcome from a cost standpoint (at least as it pertains to their living situations).

Now, I’m not saying I agree with the current philosophy when it comes to services, but it is what it is and we at Imagine! do everything we can to provide top quality services within that model.

But in Colorado, now even that low cost approach is at risk, and the reason is ironic: the economy in our state is so strong that funding for services can’t keep up. “How on earth is this possible?” you might ask. Colorado’s Taxpayer’s Bill of Rights (TABOR) Amendment dictates that state budget builders make difficult decisions. Under TABOR, state and local governments cannot raise tax rates without voter approval and cannot spend revenues collected under existing tax rates without voter approval if revenues grow faster than the rate of inflation and population growth. Revenue in excess of the TABOR limit, commonly referred to as the "TABOR surplus," must be refunded to taxpayers, unless voters approve a revenue change as an offset in a referendum.

This current year saw the cost of living rise 2.7% while budget builders chose to pay providers for service 1.7% rate increases. This simply knocks providers out of competition for the work force. Right now we are in a situation where revenues are in excess of TABOR limits, and therefore some revenue is set to be returned. Unfortunately, the growth in revenues parallels a growth in the need for services of all kinds – services such as fixing infrastructure needs like roads and bridges, funding education, and yes, services for individuals with I/DD. But when the need outpaces the limits set by our state constitution, Colorado becomes its own puzzle– so much of its revenue is already earmarked for specific purposes it has very little flexibility when it comes to meeting its demands.

One scenario has been proposed by Governor Hickenlooper. According to this Denver Post article,
Gov. Hickenlooper wants to exempt the hospital provider fee from state revenue collections under TABOR. If the fee were removed from TABOR, Colorado's revenues would fall under the cap and the state would have $200 million more to spend on road projects and classrooms (and maybe I/DD services – though he didn’t say that).

Now, it’s not for me to judge (at least in this posting) if he is right or not. But I will say this – we are suddenly looking at a rather severe funding crisis when it comes to serving people with I/DD. Capacity will be overwhelmed by the demand. Without an adjustment, I can envision the next year or two being extremely challenging for those who accept services from providers in Colorado. Significant areas of service are at risk.

If we can’t go back to a service philosophy that looks at adult independence as a priority, at least let’s make sure we are giving family caregivers who continue to take care of their loved ones well into adulthood the kind of resources they need to ensure a quality of life for all.

Then again, what do I know?

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