Wednesday, February 08, 2006

Administration

I think our system has a funny relationship with administration. On the one hand, it's almost a tenet of faith that administrative costs deprive the clients. On the other, the State and Regional Centers sure seem to come up with a lot of ideas for vendors to do more of it. There are a few things that stand out to me about the role of administration in our system.

The first is this: Our system derives its efficiency and effectiveness from the individualism in the service planning. In theory always and in reality sometimes, services provided are so well matched with the client and his or her situation that there is no waste and yet every disability-related need is met. OK, right, but the point is, the matching of service to need and the flexibility to treat each client individually clearly requires more management that one-size-fits-all solutions. Add to that our emphasis on integration and services being located in the home and in the community and it becomes clear that the quality-assurance and communications functions of administration are more demanding and more productive than in standardized, facility-based models of care.

The second thing that stands out is this: Administration and management interfere with the process by which individuals and their staff find their own way. Quality Assurance, service planning and coordination are all interventions in the organic process of person-centered support. Administration may be necessary or beneficial but it can easily be stultifying, invasive and counter-productive. Like this entire system, cost-benefit analysis should be applied to both administration and the regulations and policies that promote administration to make sure we do the optimum amount of administration the best way possible. I should clarify that by analysis I mean analysis and nothing that begins with "I think" like this post did.

4 comments:

PARCA said...

Doug,

Thanks for pushing for change. This system is on the verge of going down the toilet. I personally know of several careproviders ready to throw in the towel. They are tired of the abuse and unethical activities on the part of some of the regional centers. Did you know that an investigator is currently housed at DDS in Sacramento with the purpose of investigation allegations of abuse that were brought up last year by a group of careproviders, families and vendors in Orange County. Some of the allegations:

RC personnel are taking money from careproviders for special treatment.

RC personnel are getting way too involved in the sale of homes, actually picking out who gets the home, how much they have to pay and then receiving a kickback.

RC personnel are setting up new careproviders. They will misrepresent regulations and then slam down on the careprovider when they make a mistake.

Homes are being plagued by unethical employees that are setting them up. They steal files and documents and then the RC comes in and audits those same documents. Sounds like collusion to me.

One RC is alleged to be selling program designs for $500 to new providers. Wow, what a great way to make a few bucks on the side.

Doug said...

Parca, we all do what we're able for change. I blog. No need for thanks.

I don't know any facts about RCOC, and don't work with them but the reputation among providers is pretty dismal. I know a lot of providers in the trap of not wanting to turn their backs on OC clients but not wanting to continue working there. I had a similar problem with a different Regional Center and I'll never take another referral from that one until the top three levels of management there are gone. It would be a massive "reform" if Regional Centers that serve clients badly were held as quickly accountable as the ones that budget poorly.

PARCA said...

Doug,

I, fortunately or unfortunately, have worked with the majority of the regional centers in Southern California in one way or another. Frankly, the only ones that seem to be ethical are San Gabriel Pomona and Westside. For San Gabriel Pomona, the director is adamant that there will be no gifts accepted and he or she (I think he) is trying to do a good job. Unfortunately, there are so many regional centers down here that are not doing a good job, the Southern California is a poor excuse of the system.

Blogging helps get some of the information out there, but we need to do more. I really believe that this system is in danger of collapsing if this continues. In OC, the president of Rescoalition is trying to get changes in the system. His goal is to get more funding. But, for those who really understand the corruption, more funding will be followed by more regulations, more audits, more manipulation, etc. This will mean that for every dollar the State gives to the careproviders, the unethical, corrupt regional center directors will find another way to get money back from the careproviders. Then they will see that they are just losing more than before.

Remember the increase meant for employees. Well, first of all, communication was poor as usual. Many homes never even understood the increase and the money never made it to the staff. Others just ignored the increase and kept the extra money. Those that did follow the regulations found that for every dollar mandated to go to the staff, the cost to the careprovider was about 20-25%. So for every dollar received, the careprovider lost about 25 cents.

In OC, even if there is an overall increase to the careproviders, the director of OC is bent on reaching his political goals and uses audits to balance his budget and look good for DDS. Any increase will surely cause him to increase his audits and most careproviders find it is easier to just pay the regional center back that go thru the process of fair hearings. Some rights careproviders have. The costs associated with trying to protect yourself can be greater than most can afford so they just write a check and hope to make it through. This is just what OC wants.

Keep up your blogging.

PARCA

Doug said...

Parca, that's the reputation among providers for that Regional Center. I agree that SGPRC seems very ethical and I've experienced nothing at ELARC that I'd call unethical. We used to work with (and be vendored by) other RCs that I did find too morally or philosophically compromised to work honestly with.

I agree, the pass-through was tricky. Not to perseverate endlessly, but we really need a lot more accountability, transparency and clarity in this system or else I agree with you that increased funding is unlikely to help.