But, maybe in the midst of the coming catastrophe, there will be opportunities to talk about accountability, transparency and adding features to the system that will make it smarter. Here's my new year's list of topics I hope will be seriously discussed.
1. Those of us with client-level perspectives know that the regulations guiding this system are routinely not followed. In the end, we need to decide if we believe that a client-centered system is truly more valuable and more cost-effective. If we do, we need spare and judicious regulations routinely followed with consequences for those who ignore the rights of clients to guide their program plans.
2. Efficiency, the economic concept, unlike the political euphemism, "efficiency," is the heart of justice. In an efficient system, some of us would lose our jobs but those most vulnerable in the system including clients, direct-care workers and families would be likelier to benefit from the money and effort spent. The honest definition of efficiency is the value added for the cost expended. Skilled and management workers need to understand that a more efficient system might need some of us less, but moral individuals should be ready to be counted in that number. I can still fix old cars and might get my roping back with practice.
3. The system needs to get much, much smarter. We don't measure and track outcomes. At the policy level there is no hopeful way to direct resources where they will help the most. At the client level, there is no reliable way to choose the most helpful support among alternatives. The cost of neglecting the intelligence of our delivery model will be tragic this year. If vendors, regional centers, unions or other stakeholders seek to delay or deter transparent evaluation and easy access to information about quality, they deserve to be ignored or over-run. It is a very late hour to start this conversation in earnest.
4. There is real magic available in self-directed services. The regulations are too many and the funding too sparse for some people to benefit but for those who can make it work, significantly lower costs and better quality of life will likely be the rule rather than the exception. The silver line around the gathering squall is that SDS will appeal to many who have been leery of it. First chance we get, though, those eligibility criteria should be revisited and relaxed.
5. Be kind to the grouchy, negative, critical and portly.
Best wishes to all of you in the new year.