Thursday, April 20, 2006

Money and Reform

Lately I've been getting crosswise of friends, colleagues and conspirators over my baffling opposition to better funding for our system. I thought I'd clarify to you, dear reader since I feel kindly towards you unlike those rascals. But, I do believe this as well: The gap between how the system functions and how it should is greater than the gap between current funding and optimum funding. Add to that the great truth of life and government: that money is the enemy of reform.

It's not so much that I believe rates are high enough, but that I suspect a lot of funding isn't helping people with disabilities. I don't know how much, but I further suspect that much of the wasted many is not otherwise neutral but harmful. Redundant people signing off on client's choices. Quality evaluations that serve no particular purpose but around which client lives and agency practices are disrupted. Fiscal controls which repeat other ones and serve as a break on the system's ability to respond to change, challenge and opportunity. Systems of accountability which can be safely ignored by participants but which, again, disrupt beneficial processes.

It's a funny thing to me: All the best advocates I've known, when near home complain about dismal behavior by regional centers, scurrilous crimes by vendors, the lack of challenge for success. The lack of punishment for failure. And yet, we arrive in Sacramento and face the legislature and administration and say "we need more money," not mentioning any of the problems that bothered us in our homes and businesses.

I do believe the following:
*Self-perpetuating boards implementing public entitlements was a bad idea and has produced predictable consequences.
*The fact that all information regarding the quality of support options is universally not just subjective but idiosyncratic and anecdotal produces inefficiency and limits rational choice well beyond what any end user or tax payer should have to bear.
*Some massive amount of creativity is squelched by fear-driven decision-making by people marginal to the life of the end-user.

If all this is true, then to focus on funding over reform betrays everything we claim to believe and everyone we say we love in this system.

2 comments:

PARCA said...

Yeah! Doug. I totally agree with your assessment. The funding is NOT going where it needs to go. I have been trying to get people to focus on the unethical and excessive control over the lives of these clients that totally negates what they and their families desire in the form of support. Careproviders were successful in getting an additional 3% increase. But are they too ignorant to ignore that regional centers and DDS will just find a way to get it back. Here are some of the ways they will reduce this 3% by 5% or more. First, the audits will increase. RCOC is notorious for audits that basically steal back what the Lanterman Act states they are to pay for - service. They fake out the audits and when a careprovider tries to fight with appeals, they threaten until the careprovider just pays. And DDS is in support of this tactic. Yet no one is attacking the person in DDS who is giving support to these fraudulent audit practices. So the 3% just got reduced.

Then they hold back the funding that was promised. For example, you are told a highly behavioral client will receive one-to-one. Well, sure. But who can provide 1-1 services at $8.00 per hour (especially when other careproviders are getting $15). With the payroll costs, overtime, etc. the 3% just got reduced against.

Then, what about the funding for clients not going to day program. They now require a program design to provide services during the day. You write the program, submit it, it goes through review, is returned for revisions, etc. Months later you get approval (at $8.50) and guess what. You just lost some more money from that 3%.

Then you lose a client. Even though clients are waiting for your home, regional center makes you wait. Now you are definitely losing money.

So, wake up! Those careproviders who think the 3% is going to help them meet the cost increase with gasoline prices, worker's comp, etc. will find out that DDS and RCs are just going to get it back some other way.

Good luck.

PARCA said...

Doug,

Thought you should know so you can pass on the information. DDS was very sneaky and added a requirement for behavior consultants that they need to have completed 12 semester units in Applied Behavior Analysis 30 months from May 2004 to qualify as a behavior consultant.

No one was told. Now regional centers are asking for the certificates and telling careproviders that their behavior consultant may not qualify as a consultant.

First: Never has a licensed professional been told that they have to complete 12 semester units to do a job they are already been doing. If their is a perceived need of additional training, licensed professionals are given lots of advance warning that they need additional CEUs and then several providers jump on the bandwagon and make affordable classes available.

Second: Advance warning is always given. And if someone is already experienced, they are usually exempted from the requirement. Case in point: recent graduates were exempted from the one time requirement for psychologists to get CEUs for aids training and geriatric training. If they had taken classes in their PhD program.

Third: In checking the availability of this training, we discovered that ABA training is offered in only 2 colleges in CA and one college had to cancel their courses because the professor left. Now the only college offering this training is National University. This training is not cheap at over $5,000. And, how can any professional complete 12 semester units before November 2006?

Once again, DDS and RCs are manipulating the system to their own advantage and the disadvantage of the clients. Are they really trying to push out hundreds of well-trained and experienced professional in favor of bachelor level trainees with 12 units in ABA who have learned to count behaviors and haven't the first clue about the complexities of human nature, medication management, communication approaches. ABA is fine to count the number of times a client hits themself in the head and in what situation, but how does it help understanding that their are so many other variables that someone at their level cannot even begin to understand.

Shame on DDS and RCs for this travesty.