Tuesday, January 24, 2006

Choice and Choices, Part II

The process of filtering the client's IPP through vendor codes has two major costs. The most important is to the well-being of the client. This post will explore the less important cost, to the efficiency of the system.

To recap, the process of planning and purchasing support in California's developmental system begins with the client, those the client cares to have input and the service coordinator from the Regional Center, as well as any professional support providers in place to review the clients preferences, their disabilities and to plan for whatever support will mitigate the effects of the disabilities on the individual's aspiration. Good start if done correctly.

The next step is generally to attribute the supports to certain vendor codes based on matching needs with codes, but primarily based on Regional Center POS policies. At this point, the plan becomes centered on the vendors not the clients. The efficiency cost is this: If the POS policies are taken as gospel and they too often are, there can be a gap in resources which can only be bridged by purchasing the wrong support for too much money.

Here's an example off the top of my head but not theoretical. If a Regional Center tries to contain costs by limiting units of service available based on vendor codes, one can imagine (or name) a client whose needs exceed the provisions of the POS policy. If, as often happens, the regional center seeks to maintain those policies rather than make an exception, a client can fail to live in their own home, leading to a group home which leads to a day program which typically requires transportation. The result is, and this happens frequently in this system that when $5000 per year in support doesn't suffice to maintain a client in their own home, plan B costs closer to $40,000 per year while providing the wrong services for the client.

The response often made by people defending POS policies by vendor code is that they make exceptions when following the policy will lead to the client's living in a more restrictive setting. Heck, we're required by law. Anyone who works directly with clients knows how rarely this is the case. We go through this process. There is typically a long road into crisis and a longer one back from the brink. Clients in our program have died, ruined their credit or lost their health before the evidence that the POS policies were deficient became clear enough for the exception. The client who died now costs the State nothing. The others now cost the state roughly 6-8 times what the adequate level of support would have cost.

The result is that the system does not behave like a continuous array of supports to be tailored to the client's needs and preferences. It flows like lumpy oatmeal and people get involved in day programs they neither need nor want because the group home they didn't want to live in requires it. This is a costly problem that merits fixing for the sake of the budget if not for the sake of the clients.

9 comments:

MobiusMan said...

Knowledge is of two kinds.
We know a subject ourselves,
or we know where we can find information upon it.
(Samuel Johnson)
This dad
this son
must be doing something right as the last few weeks have had the System Lords and the Gatekeepers applying an inordinate amount of pressure upon us as we "just" try to live in our community, our town with an expectation that an 11 year old boy with low incidence disabilities belongs with his family........not THE group/congregate facilities offered and proferred.
There's something happening here
What it is ain't exactly clear
Government waste, of dollars appear
To try to make us NOT care

United we stand
To always care
And expect
Compassion
Humanity and
Assistance
Any standards less than that are no standards at all

The Cartographers of old were correct in drawing California as an Island for they must have known that special needs families would inhabit a place/location not connected to the mainland....difficult to locate, hard to navigate to/from, and seen by very few if any general/mainlanders.... easy to imagine not existing at all.
But we do exist.
We Are.

DP and SQ....MM and his son find this system soooo screwed up that we pass the baton tonight for it has tired us out for the moment, but after a good night's sleep(or not in case of a sometimes sleep disordered son and sleep deprived dad).....we will expect you to pass the baton back in a day or week or two.......We refuse to opt out or be co-opted in this system...this is the hardest thing a dad or mom will endure and it can/will/does get even harder....BUT...as a home bound professional....I continue to help other parent and professionals navigate the systems and ofttimes come back with success stories
Let's inspire one another in the challenge of this all for substantive and real ways to design and build better supports.........

My son's needs call out
into the darkness of the night and slowly into the early morning hours
Later

DareDevil said...

nice post

PARCA said...

Doug,

I've read some of your blogs. Are you aware of the corruption in many of the regional centers? Here are some tidbits that need to get out to the public:

One RC director just gave themself a 30% increase and hired a relative to a unnecessary job.

One RC manager gets involved in every sale of homes, picks who gets the homes and is reported to get a kickback on every sale. DDS is supposed to be investigating the allegations. Yeah. Sure.

One RC helped a well-off family install a pool in their home - seems the child would benefit from swimming lessons.

One RC is helping a family pay for board and care of a horse.

One RC is paying the highest rate in the entire county because the parents are both attorneys and threaten to sue each time.

At many RCs if a careprovider speaks up, they are almost immediately put out of business.

Some RCs will bring you almost to the point of bankruptsy before giving you your first client. Why? Because when you are almost broke, you will take any client offered.

Many RCs are placing clients in totally inappropriate homes. But everyone already knew this.

Parents are often told their are no openings, while good careproviders are sitting empty.

One RC has been selling off careprovider program designs to anyone interested for $500 each. Wow. What a savings.

Some directors are known to be setting up other non-profit entities within their RC that will virtually guarantee them a rather large retirement as the director with absolutely no work involved.

Nepotism and favoritism is rampant in RCs. Just check and see. One RC director hires everyone from his home state. Has them fly in if they don't want to move to California. Taxpayer money being used wisely?

One RC director has paid off two managers that got tired of the crap a rather large severance package. Seems one manager got a 2 year payoff. To keep quiet? Even private companies don't pay that much.

Interested in more. Let me know. Blog: Parca1

PARCA said...

Doug,

I've read some of your blogs. Are you aware of the corruption in many of the regional centers? Here are some tidbits that need to get out to the public:

One RC director just gave themself a 30% increase and hired a relative to a unnecessary job.

One RC manager gets involved in every sale of homes, picks who gets the homes and is reported to get a kickback on every sale. DDS is supposed to be investigating the allegations. Yeah. Sure.

One RC helped a well-off family install a pool in their home - seems the child would benefit from swimming lessons.

One RC is helping a family pay for board and care of a horse.

One RC is paying the highest rate in the entire county because the parents are both attorneys and threaten to sue each time.

At many RCs if a careprovider speaks up, they are almost immediately put out of business.

Some RCs will bring you almost to the point of bankruptsy before giving you your first client. Why? Because when you are almost broke, you will take any client offered.

Many RCs are placing clients in totally inappropriate homes. But everyone already knew this.

Parents are often told their are no openings, while good careproviders are sitting empty.

One RC has been selling off careprovider program designs to anyone interested for $500 each. Wow. What a savings.

Some directors are known to be setting up other non-profit entities within their RC that will virtually guarantee them a rather large retirement as the director with absolutely no work involved.

Nepotism and favoritism is rampant in RCs. Just check and see. One RC director hires everyone from his home state. Has them fly in if they don't want to move to California. Taxpayer money being used wisely?

One RC director has paid off two managers that got tired of the crap a rather large severance package. Seems one manager got a 2 year payoff. To keep quiet? Even private companies don't pay that much.

Interested in more. Let me know. Blog: Parca1

Doug said...

Mobius Man, I appreciate the Samuel Johnson quote, I hadn't heard it before. And the poem, although I regret what you're going through. I know XXXX appreciates your care and I hope that working together we can make things better for him.

Daredevil, Spam is always appreciated. Salaam.

PARCA, welcome. What makes you say that a deputy family resource center person in unnecessary. I understand what you're saying. My preferred approach would be to address the errors in the design of our system that allow foolishness to prosper at the expense of helping clients.

PARCA said...

Doug, I don't understand your comment about a deputy family resource. Please explain. Actually, I am interested in cleaning up this system. Frank D. Lanterman would probably be rolling over in his grave if he knew what is currently going on in this system. Did you read the article Assemblyman Raymond Haynes wrote in March 2005? It was called "Fear and Loating ..." Everything he says in the article is true. We are seeing injustices in this system that are appalling. Some families are getting more than is necessary, while others are being denied even minor services. DDS seems oblivious to the entire process. Especially when the RC involved is making sure to put money back into the coffers each year.

Here's an example. Reviewed a client chart. The client's parents are a business owner and an attorney. The child currently receives over 200 hours of respite each month, plus over 30 hours of tutoring each week. I know of single mothers with a developmentally disabled child who are lucky to get 12 hours of respite each month. Whatever is proposed to put more control over the regional center system, I am in favor of.

Did you know there is currently an investigator in Sacramento looking into charges of corruption. It is probably a joke. They don't really care about the corruption. Especially when the regional center involved in keeping costs down. Who cares if the little person is denied services.

Keep up your good work and let me know if you come up with any ideas on approaches we can take to address these issues. I have been trying to get families involved in this mess. We need a more powerful lobby that will put more controls on this system.

PARCA

Doug said...

Parca, when you made your reference to an RC director giving a relative an unnecessary job I thought you might be referring to one whose daughter became a deputy director at the Family Resource Center attached to that RC.

And I agree with you, that DDS seems to be much harder on RCs that have trouble budgeting than those that just don't serve clients well, although I'll give them the benefit of the doubt that this is because of difficulty quantifying anything that doesn't have columns.

For that reason, I really believe that more accountability and more measuring of outcomes is a big part of the cure. Let the RCs that are uncommitted to the entitlement they exist to implement and unpleasant to their partners answer for results.

PARCA said...

Doug - regarding that job with the RC, right job title, wrong relative. I understood it was a sister who had recent retired from another job. Now she is getting a salary and running the resource center, which was vacant for years. Wow! Probably doesn't even have to go to work all the time.

Here's another one for you. In one regional center, the director has brought in several friends from out of state. One even worked from the other state. Great, this person gets to fly back and forth and hold down a big job. Taxpayer money at work again.

Did you know that when a manager left the RC several years ago, he was given 2 years severance. Another manager left last year. Wouldn't say how much he got, but said he didn't have to worry for a while. How is it that a nonprofit agency can afford to pay such large severance packages when private, for profit companies don't even consider paying that much?

In another RC, employee recently picketed the director, chanting to remove that person. This was after the director refused to even speak to the union or consider giving raises. Yeah, maybe they don't need raise, but then why did the director give themself a 30% increase.

PARCA

PARCA said...

mobiusman - I feel for you. I have worked with many families and it is so sad how little empathy they actually receive from others. I will also add some stories of wonder and beauty that I have experienced with some of the consumers I have worked with on my blog. Some have remained my friends and I love them with all my heart. I can promise you that there are some of us out there that have given more than we have received, but what we have received has been priceless. I have loved working with these families and consumers and hurt deeply that my decision is to run from this screwed up system before it destroys me. I find it hard to believe that my spouse and I have given so much of our time and loved each of our consumers. However, the regional centers have made it so impossibly difficult and painful, that one must get out. I wish you and your family the best of luck.

PARCA