Often I will speak to parents and advocates in our system, and one of the most frequent concerns that they express is their belief that the way an individual’s needs are assessed creates an unequal and unfair system of distributing funds and delivering services.
I am very sympathetic to their concerns, but I think focusing on assessment tools can potentially blind us to the bigger picture – the fact that services are tracked, billed, and paid for using what are known as “units of service.” This is where the real unfairness comes from.
I’m going to use a food truck at a festival analogy to describe how I see the flaws in our pay-per-unit of service system in Colorado. (This is ridiculous, but I feel like
Pat Paulsen explaining communism here).
Imagine a food truck at a festival. We’ll call it Francisco’s Famous Cuban Sandwiches. Francisco is only allowed to sell Cuban sandwiches, and only to five specific types of customers. The customers each pay for the sandwich with a chip they receive when they enter the festival. One chip equals one sandwich.
So far, seems simple enough. But let’s add a layer of complexity. The people receiving the sandwiches have very different needs and desires when it comes to sandwiches. One person is a vegan, one is a vegetarian, one is a
lacto ovo pescatarian, one plays on the offensive line of a football team, and one is a sumo wrestler.
Despite the variable food intake needs of each person, each person gets one chip and that one chip gets them one Cuban sandwich. The festival thinks this is a pretty nice scenario. The first three people listed above have dietary restrictions that make eating a Cuban sandwich distasteful to them (at best), and the last two probably need a lot more to eat beyond a single sandwich.
So the people getting the sandwiches (services) are stuck with getting something they don’t want or doesn’t meet their needs. But guess what? Francisco isn’t happy either.
Why? Because Francisco has to turn in the chips he gets for making sandwiches to the festival operators in order to get paid. And the chips aren’t all valued the same. Instead, the chips are worth different amounts depending on the person who is cashing it in for a sandwich. The vegan’s chip is worth $3, the vegetarian’s chip is worth $5, the lacto ovo pescatarian’s chip is worth $8, the offensive lineman’s chip is worth $15, and the sumo wrestler’s chip is worth $20. It costs Francisco $10 to make the sandwich, and what he’s paid depends on who’s giving him the chip.
Naturally, this frustrates Francisco, but he’s a realist. He will do everything he can to sell sandwiches to the football player and the sumo wrestler, because he can make money feeding them, while at the same time doing everything he can to avoid selling sandwiches to the three varieties of vegetarians because he loses money when he cooks for them.
Are you hungry yet? How about confused? I know who is not confused in Colorado: people being turned away by providers because their chips aren’t buying them the sandwich they want or need. But that is basically how both the Support Living Services (SLS) and Comprehensive Services (COMP) are arranged in Colorado. People aren’t getting what they need because their units of service are like chips in the festival. Everyone is dissatisfied, and eventually it will come to a head. I don’t like to be this sort of prognosticator, but I fear that eventually we will see a crisis as the ridiculousness of the system across the board creates angry families. Crises are costly and unnecessary, particularly when they can be predicted and avoided.
Perhaps we can avoid this future, but discussion about change should really start with the way services are quantified and paid for in our festival. Maybe, just maybe, there will come a time when we can all have the sandwich we want, and Francisco can cook for everyone.
Then again, what do I know?
