Tuesday, January 22, 2008

Brand New Same Old?

A good friend wrote to me with a comment on my previous post below.  

The email read, in part, "ok-- i agree with your points- but trust me - sds will end up being mostly same old same old.

This is worth discussing. I invite my friends who lurk here, cross post to list servers, and/or read out of a sense of friendly obligation to discuss this in the comments section. Comments can be left anonymously but on the off-chance a conversation actually develops here, I ask for this: If you comment anonymously, please use a pseudonym or unique signature so participants can respond to your comment with some form of address.

Five reasons to think self-directed services, SDS, will be a new, more valuable and more efficient model of service delivery:

1.  Program design belongs to the person or family served.  A client-centered design is not guaranteed but it should be the most natural result.  In the traditional model, the wisdom, insight, bias and preference of the service provider and service coordinator are the most likely guidance.
2.  To the extent that accountability and oversight are transferred away from the regional center to the people served, inefficiencies in defining, assessing and assuring quality are significantly reduced.  These inefficiencies in the traditional model widely deplete fiscal resources, human resources and efficacy.
3.  Layers of overhead can be eliminated.  Vendorization of service providers, reporting requirements, worker's compensation, mandatory reporting, employer liability, general liability are all provider costs that can be eliminated or reduced under SDS, especially where the client does not use a co-employer agency.  Insurance for SDS clients is a brilliant investment for SDS dollars where staffing is involved.
4.  To the extent that decision-making is located in the client's home, rather than in the broker and/or regional center, the iterative reviews of client choices that inhibit both creativity and dispatch can be reduced.  For those of you who were reading during the series on Value Stream Management which began here, this represents an efficiency improvement referred to as making the value stream flow.
5.  As neighbors and system civilians replace agencies in the provision of some supports, natural supports in the community can be constructed and strengthened.

Five reasons to suspect that SDS will turn into the same old corruption we're saddled with now:

1.  The development of the regulations followed the same process of speculative problem-solving that many feel inhibits creativity and thins the robustness of supported living.  I have argued here that regulations for the system have been overwritten, undercomplied with and often ambiguous, detracting from the very virtues of efficiency, market-driven discipline and individualism that characterized the original intent and intelligence of the Lanterman Act. These regulations are well-intended, thoughtful and smart but it is probably the nature of regulation writers to see regulations in too positive a light and, what's more, California regulators have to harmonize with the habits of federal lawgivers.  There is no reason, based on available drafts of the upcoming regulations to think SDS won't be over-regulated, stiffening the flexibility we look to for a better model.
2.  While brilliant people have made sincere and thoughtful cases for the exclusion of people being served in congregate settings and allowances have been made to overcome that criterion, the concern remains that the most costly, least person-centered and most confining parts of the system have been protected from the reforms involved.  This also means those who can benefit the most from SDS will be excluded.  This creates two risks: The first, that salutary results will be diminished, reducing enthusiasm and advocacy the program will need to survive or thrive.  The second, that as the more individualized and person-centered supports grow leaner, the already expansive portion of advocacy and consultation offered by bulkier, less responsive agencies continues to grow.
3.  Scoundrels are scoundrels wherever they gather.  The regulations leave a lot of room for regional center input and control.  There's no certainty that service brokers will function as envisioned.  The same bad habits that attenuate the virtues of the current system can easily thrive in the new system.
4.  While some regional centers, including the five pilot sites and San Gabriel/Pomona have shown commendable enthusiasm for the new program, it will not be difficult for regional centers leery of SDS at the management level to undermine, redefine and/or disincline the engagement of the program.
5.  The spontaneous occurrence of idiocy remains a distinct possibility.  By idiocy, I offer this example.  Stupidity that limits the flexibility of service models intended to provide responsive, person-centered care and justified by incomprehensible paeans to quality, person-centeredness and "the principles of the New Day conference" not only occur but find limited resistance and meet little reason.  If Westside and Orange County regional centers can do it to ILS, they can repeat with SDS.  Two or three years out, look for regional centers to propose converting SDS into a formal congregate steeplechase and be met with a resounding "um."

Your turn.  Discuss.

32 comments:

Anonymous said...

Doug and colleagues
SDS will end up being for the most part people buying the same old stuff re-packaged, possibly, then before; it doesn't have to be that way- but the reality is that most people just buy what is available and do not take the time to really develop person-centered approaches; i know that doug thinks this will work, but he also picked the cowboys to win it all
jeff

ALS said...

The concept is great but the funding is iffy now and will get worse. Regional Centers are so sunk in their own "expertise" that they will sabotage the process from the get-go. Ann

Julie said...

If I wasn't so jaded, I'd be excited by the possibility of clients having more control/say and the idea there'd be a more efficient service option. But in addition to concerns about everything written in the second half of Doug's note, why start out with a 10% reduction in POS dollars and the need to hire a service broker out of POS money?
Why should regional center get paid the same amount when the service broker is actually doing the most time consuming aspect of service coordination? Like Ann, I think the concept is great, but like Jeff, I think it will mostly come out like repackaging!

Doug said...

Thank you all for participating, oh wisest of my friends.

Jeff, I'm curious: If it doesn't have to be that way, how do you think it can not be that way? I have never picked the Cowboys to win it all in my life, but I did have Green Bay beating the Pats in the Superbowl so your point, that I'm an idiot, is supported.

Ann, I have an easier time with your second point than the first. People who use funding to be things like adaptive equipment, housing or food will find the budget poor in many cases but saving 10% on staff is a cakewalk if there's no co-employer.

Julie, like with Ann, your second point I get absolutely. The easiest way to measure if SDS is working is that, by definition, regional centers and other service providers have less to do. You are absolutely right that if control is going to the client, some portion of the service coordinator's job is going to the client and some to the broker. If there are no RC staffing cuts, SDS didn't work. Likewise with agencies.

As to the 10% cuts consider the following things that would not be ethical now that are under SDS:
1: Offering a lower rate or rebate to the person for tolerating cost saving measures, especially around scheduling.
2: Letting the client be solely responsible for the performance of their staff and eliminating supervisory oversight, grievance procedures, and agency training.
3: Worker's compensation for 24-hour staffing costing $200 per year regardless of staff wages.
4: Eliminating all or most supporting paperwork including Individual Service Plans, Progress reports, daily notes, etc.
Sound like 10% to you?

Granted, all these things would be a catastrophe for many clients but I think it's better to ask whether SDS can work for some people in the system than to ask if it will work for all. I think no one has claimed it will work for everyone.

Lastly, I do plan to ask similar questions of anyone I can get to leave a pro-SDS comments.

Thank you all for answering my plea.

Anonymous said...

SDS is a brillant concept but it is much more complex. you need person-centered planning, person-centered support, circles of support, the right people supporting the right people and doing the right things and then doing it consistently, and then you need to retain them so they don't leave; you need to have all of the pieces of the puzzle in place for good things to happen. can it happen---of course. but i fear that it will not be what it could have been because of the lack of people taking seriously the person-centered thinking that is required; finding the right people, keeping them, etc. but who knows.

stanley said...

dont do blogs...so hope following format is ok


re: This [SDS] is worth discussing

COMMENT: Indeed worth discussing...SDS could be the much needed vehicle to reform the system...return to the original intent of Lanterman...especially IF;

if we heed the Five reasons to suspect that SDS will turn into the same old corruption we*re saddled with now...and

and do not follow the slippery go along to get along road paved with good intentions that lead to the current illusion of a model system some advocates say we have...

BTW SDS seems similar to Microboards concept.

stanley seigler


ref xxxxxxxx
Redacted version of dougs original blog
For complete context pls see original at:
http://arribails.blogspot.com/atom.xml

[doug say]
This is worth discussing.

Five reasons to think self-directed services, SDS, will be a new, more valuable and more efficient model of service delivery:

1.Program design belongs to the person or family served.

2. Accountability and oversight are transferred away from the regional center to the people served.

3. Layers of overhead can be eliminated.

4. Decision-making is located in the client*s home.

5. As neighbors and system civilians replace agencies in the provision of some supports, natural supports in the community can be constructed and strengthened.

Five reasons to suspect that SDS will turn into the same old corruption we*re saddled with now:

1. The development of the regulations followed the same process of speculative problem-solving that many feel inhibits creativity

2. the concern remains that the most costly, least person-centered and most confining parts of the system have been protected from the reforms involved.

3. Scoundrels are scoundrels wherever they gather. The same bad habits that attenuate the virtues of the current system can easily thrive in the new system.

4. it will not be difficult for regional centers leery of SDS at the management level to undermine, redefine and/or disincline the engagement of the program.

5. The spontaneous occurrence of idiocy remains a distinct possibility.

Doug said...

Anonymous Anonymous, do you still think people who choose for themselves need all that support formally or do you think it might happen naturally?

Stan, the format is just grand and I think you're right to see similarities with Microboards, especially when you consider the mandatory service broker and the fiscal services manager. I agree with your assessment that in many ways, SDS is like setting reset on the Lanterman Act. I'm curious what you think the signposts on the primrose path look like.

stephanie said...

I believe SDS will be a great service delivery for a number of people, especially parents with minor children. Like with SLS, some regional centers/providers/support brokers will do a fantastic job while others will not. It is not just regional centers who are 'sunk in their own expertise'--providers get sunk, too. The 10% reduction in POS is not a big deal, from my perspective. Only 65% of the typical POS dollar goes toward staff wages and benefits--the rest goes to overhead. The SDS dollar will go farther. One time purchases, like adaptive equipment, are paid for outside of the SDS budget, so that should not be a drawn down against the SDS dollar. More importantly, SDS will put families and individuals with developmental disabilities into the driver seat. that should be revolutionary! And if families and individuals don't end up in the driver seat we should all take responsibility and not blame RCs, DDS, providers, etc. I

Doug said...

Thank you for your comment, Stephanie, and welcome. I doubt anyone who commented above you would disagree that providers also get stuck in their expertise, but hopefully that's less of an issue with SDS.

Two questions, though: Only one-time purchases are likely to be exempted from the SDS formula. Do you think SDS will work for families whose support is primarily regular purchases of consumer goods or is already unvendorized support?

Second, does it concern you that under the Lanterman Act, clients and families are already in the driver's seat? I think the SDS skeptics, some seen here, worry that SDS is no more person-centered than the IPP was supposed to be and so expect a similar result. My hope is that if SDS succeeds often enough the momentum will keep it from becoming another IPP.

Anonymous said...

Doug
Good people can do good things within the current system; people who don't know or don't care or don't think it is possible- will screw up sds as easily as they would have screwed up the ipp process- sds is not a panacea it will only work when people knowing what they want and how to make it happen. it is not the big thing everyone thinks it is = at least for the most part
jeff

Stephanie said...

I think jeff is right. SDS is not the cure all for our system. I think one reason SDS should be more person centered is that the issue of funding is off the table. Participants will know what kind of funding they have to work with. Don't you think one reason why person-centered IPPs don't always happen is because RCs can't print money?! I think RCs try to do a good job, within somewhat unreasonable limits. Such as person-centered IPPs and IFSPs without having the funding necessary to implement everything. Then add on to that other constraints, such as rate freezes, and it's a wonder anything happens! P.s. I don't understand your first question.

Doug said...

Jeff, I'm not sure SDS won't be pretty darn good, subject to every caveat you made. I agree up to the last point.

Stephanie, you make an excellent point about taking funding off the table and I sympathize with the tough position regional centers are being handed an open-ended obligation and a defined pot of money. But I'm slightly notorious for my belief that the funding of regional centers and providers are a small part of the problem and approximately none of the reason IPPs aren't more person-centered. I generally think the system we want might be cheaper than the one we have. Person-centered planning is cheaper and less time-consuming than xeroxed IPPd and repetitive arguing. I think our failure to separate what works well from what doesn't work well, be it policy, practice or provider and the fact that clients and families have no good place to learn about that is why IPPs are so generic and services frustrating. For most families and clients the sole source for information is an overworked Service Coordinator who sees only a small portion of what's available or providers with a similarly parochial experience. To whatever extent I'm blessed to be involved in building SDS, public information will be a priority.

The point of the first question is that I agree that services like SLS, ILS and supported employment will be easy to duplicate in SDS at lower cost with better wages and higher quality. And I agree that the last draft of the regulations I saw made an exception, as you said, for high-cost durable equipment like electric wheelchairs or speaking systems. But I've known clients and families who primarily used regional center funding for diapers or private generic services, like home healthcare or dentistry or tuition. Items like that, it's hard to see saving 10% on.

Obviously, though, as long as SDS is voluntary it doesn't have to work for everyone any more than SLS does. Besides, I promised to question people who came in on the pro side equally to the con side.

Anonymous said...

doug
your commitment to consumers and families choosing what they want even if it is wrong seems to be an error on your part. i think sls and se is or should be the only services available to people- day wasting, group homes, etc. should be eliminated as hazardous to your health-- whether people want them or not - who cares--- they are places that are never person-centered and should be eliminated
jeff
i hope this prompts another response from you

Doug said...

Jeff, no need to hope, you knew it would and you knew what it would be. Who defines wrong? Who defines value? What does either word mean if it doesn't make sense to the person you want to correct and burden with support?

I would be more enthusiastic about SLS being a universal service if the people running the big SLS agencies weren't such unsaved reprobates.

Anonymous said...

In America we do not support 100% choice - you can not have sex with children under 18; you can not hit your kid without the state coming in and doing something; you can not withhold medical treatment on religous reasons for children-- we should not allow institutions, groups homes, day wasting programs, segregated programs - they are "unequal" and will always be unequal. Public dollars should be used based on good solid public policy- what stupid rich people do with their sons and daughters with private money is an entirely different issue- if the Kennedy's sent their sister/aunt off to Wisconsin with private money then while i think it is wrong it is consistent with good public policy. it would be wrong to use public funds to segregate, isolate, congregate people of disabilities using public dollars.
as you can tell, i am spending energy writing this blog then to help people in my agency. so i will sign off now. thanks- have a great weekend
jeff

Doug said...

Jeff, you too. It still leaves open the question of whether the value added by our services should be defined by policy-makers or people served. I think the value of our services is best defined by the people who are supposed to enjoy it.

Incidentally, my staff and clients would love for me to spend more energy blogging. Have a great weekend yourself.

Anonymous said...

Why can't the value added of the services be defined by BOTH the people who use the services and by policy makers?

Doug said...

Anonymous, thank you for your question. And you're right, clearly, policy-makers do define value and so do clients. But I think it is impossible for policy-makers to define what is valuable to clients and families. If I had to pick my top-five inefficiencies in our system, one would absolutely be repetitive attempts to get the people served to embrace what they don't want.

Jeff is right that policy-makers, as representatives of the California taxpayer could, without being guilty of evil, refuse to pay for any congregate support. But, they can't do that without changing the part of the Lanterman Act that says people should live according to their own choices, that the client should be the leading member of the ID team, or that we're looking for cost-efficient solutions to mediate the effects of disabilities.

None of this, by the way, should be taken to mean I think highly of congregate services. I don't run one and can't imagine I ever would.

Andy said...

DOUG WROTE: "The spontaneous occurrence of idiocy remains a distinct possibility. By idiocy, I offer this example."

Eagerly, I clicked on your "this example" link, certain to find one of my old, forgotten posts from hither or yon. What I found was an example of some curious, inexplicable action by a regional center. If, for future reference, you need examples of idiocy of greater depth and clumsiness----though, admittedly, less effectual . . . but wait! Does its greater ineffectiveness not confirm its greater idiocy? Let’s save this thought for a posting of its own----anyway, if you seek idiocy of a higher order, I have an archive of opinions. I offer this to you, as one who is determined to expand not only the definition, but the goods and services of the “helping professional.”

Now, on to your question . . . and, perhaps, an addition to my archives.

SDS will and will not be the same old thing. (How’s that for taking a stand? A true idiot. . . a great idiot . . . always takes a very strong stand on any issue. After my boasting above, that I am now failing as an idiot is truly pathetic. But wait! Is not such boasting the calling card of the idiot?) The value of SDS, like every new model or service option before or after, will depend on who is doing it and how it’s done.

Supported Living, or rather, its apostles, naively promised the moon. But, just because it rarely delivered all that we promised, or just because it was (and is) frequently done poorly, does not alter the fact that the lives and opportunities of many, many people greatly changed and, for many, dramatically improved. Of course, bad supported living can be the “same old” naked emperor . . .. essentially the same as a bad group home, or even worse---there being no one to share your misery.

If you take Mr. Magoo out his Model A and put him in a Ferrari, the results will be the same. SLS offered a substantially new and different option for people and, for some, spared the help of Provider Magoo, it worked far better than anything previously offered or devised.

Self Directed Services also offers new opportunities. In fact, if offers radical, new possibilities. Allowing individuals to purchase what is actually needed or wanted, in the amount that is actually needed and wanted, and from a world far beyond the sparse, over-regulated service options existing only by the sanction of the State is, indeed, a radically different. The possibilities may not be limitless, but they can become far less limiting.

Obviously, with a Mr. Magoo as your service broker, or the bad geographical luck of a low-functioning regional center, many folks may well find SDS to be the “same old, same old.” We can complain about the 10% reduction, the required cost of a service broker, the restrictions on choice regarding congregate stuff, and every other arguable imperfection. Any or all of these things will certainly limit the access to SDS for a large number of people. However, for many others, SDS allows the possibility of options and resources they, and we, have yet to imagine. (How’s that for taking a stand!)

Jeff, I promised myself that I would not engage in this argument any more (it’s well-represented in my archive) but to dismiss someone as wrong for liking their dumb day program or group home and wishing to remain there, seems like a kind of cultural fascism. No, I am not calling you a fascist, I know that you’re not . . . just that your ideas on this seem to me a tad narrow . . . maybe a little restrictive towards the diverse opinions and interests of a diverse group of people. A group whose interests and opinions have been dismissed—---if rarely even recognized or considered----more than any other throughout human history. And no, choosing your group home over supported living is not the same as hitting your kid, smoking crack or killing your wife. And yes, I know there are a ton of people in group homes and day programs only because someone else stuck them there and who may peek in once a year to have them sign something absurdly referred to as a "plan". For those lucky souls who happen to like where they got stuck I wish we had something they liked more to offer---the wild possibilities of SDS, perhaps? Until we do, to each his own

--Andy

Doug said...

Andrew, that was a great summary. Does your archive exist where we can read it or in the turbulent waters of your mind?

Do you see an opportunity through SDS at low-functioning Regional Centers for insurgent clients and families to fight the system?

Regarding cultural fascism, does it make any difference that the State would not be telling people how to use their private resources but public ones?

stanley said...

Apologies for DDS web page SDS stuff known all too well by contributor to this blog...butbut comments are posted to other groups who may not be as knowledge.

AND Andy, it OK to call Jeff a fascist...also believe you, Jeff or Doug could make SDS work as intended...but not sure how it fits with your programs.

A caveat: SDS, SLS and most any program would work had/if DDS/RC and stakeholders obeyed the law...the Lanterman Act...stakeholders shot themselves in the foot by gaming the system...and those w/ special needs became the victims of the game...that said;

DDS web page say: SDS Principles; Freedom. Authority. Support. Responsibility. Confirmation.

COMMENT: Principles (ditto mission statements) must be more than words...otherwise SDS becomes another bureaucratic nightmare...basic Lanterman intent (the law); KISS principles, must be followed/enforced: determine needs, find programs to fill needs, adequately fund programs...gaming the system as now done is not acceptable...SDS could “reset lanterman”.

Enrollment Criteria
*Accept and manage within the individual budget amount that has been established on his/her behalf.

(budget is just taking one bite of the elepkant at a time... see DDS web page for complete criteria)


COMMENT: stakeholders (RCs, providers, parents, etal) have criminally gamed the individuals budget. This can NOT be done if SDS (or any program) is to succeed...true cost including inflation (whatever) must be the amount established.

For decades many, if not all, providers have submitted program costs based on what they felt RCs would accept...eg, rationalized 1:2 support when they knew full well 1:1 was required.

RCs then submitted these meaningless figs to DDS who submitted them to the Gov...and lo and behold they became the budget that RCs and providers had to live with…and rail against.

Which BTW lead the current DDS director to say programs were fully funded...a first impression of her comment (some months ago) was she was sucking up to the Gov...butbut;

A recent Marty-telemtg indicated she really believed programs were fully funded. In response to question, did she really believe...she basically said yes...and as proof stated RC budgets were submitted to the Gov.

Another caveat: adequate funding is not the end all...accountability for positive outcomes is...

Stanley seigler

Doug said...

Stan, I agree that reported costs and reported outcomes are a fiction and phantom. The best thing that SDS can bring to the system is marketplace in which supports purchased receive prices based on the valuer they add to the lives of those served rather than unreliable cost-statements and rhetorical outcomes.

Ms. Delgadillo can be forgiven, I think. DDS really has no mechanism to really inventory the actions that take place within the system. You're right, though, that the difference between how the system works in its description and how it functions in the community can be staggering. There's little to no accountability for failing to comply with regulations which is few outside DDS bother to read them a first time.

Stephanie said...

Money makes the world go round! Let's have a Caberet, my friends! One thing I cannot get past is that our community service funding is 3.8 BILLION dollars for 220,000 people. And that does not include Medi-Cal, IHSS, California chldren services, healthy families, etc. Why is 3.8 billion dollars not enough?

Doug said...

No wine for me, Stephanie, I'm state-funded. Is there cheese? Either way, I toast you with Martinelli's Salud, Prost, Skal!

You know, from this distance you can't see all the crucial stuff that $3.8B is paying for and maybe it isn't enough but I have the precise same reaction you do.

stanley said...

[Doug say] Ms. Delgadillo can be forgiven, I think. DDS really has no mechanism to really inventory the actions that take place within the system [...] There's little to no accountability for failing to comply with regulations which is few outside DDS bother to read them a first time.

Perhaps straying from SDS discussion...then maybe not...there is a need to recognize why current system fails so many...so that history (SDS) will not repeat.


believe Ms D is a dedicated, compassionate, caring, public servant who works 24/7s to protect and improve life for those w/ special needs...butbut who is resp for current unacceptable status quo...who is accountable for results, positive outcomes. who is to be forgiven.

Have stakeholders been too forgiving...over played go along to get along in odrer to get a place at the table...crumbs from the table seem to be the results of this approach.

If one is resp shouldnt one really have or install the mechanisms to evaluate the actions/results of the system...seems like SOP for any organization/business.

there are serious disconnects in discussions of the cuts and entitlements...eg;

Ms D at a recent MartyO-telemtg said the entitlements (IPP needs) were protected...eg, she said the RC would be responsible for cuts to IHSS...cover hrs if reqd by IPP...then went on to discuss the cuts...the disconnect: the proposed cuts indeed do effect/cut the entitlements...

was previous director forgiven too...

a celebration was held for Cliff Allenby, Director of Department of Developmental Services (DDS) to honor and appreciate the contributions he has made at DDS. http://groups.yahoo.com/group/DDRIGHTS/message/2095

Again feel sure Mr A is a dedicated, compassion public servant who works 24/7s to protect and improve life for those w/ special needs...butbut who is resp for current unacceptable status quo...who is accountable. who is to be forgiven...

what are the contributions and good works...what are the positive outcomes for citizens w/ disabilities...what was the status of DDS programs in 1998 as reported by SF Chron and HCFA...how did they improved on Director Allenby*s watch...have Lanterman ideals, goals, mandates been strengthened or weakened...has the quality of care improved...has pay of dedicated direct care staff risen above poverty levels...have unqualified direct care staff and providers been eliminated...are providers hiring staff who are qualified, ie, have more than just a clean DMV record...do those without strong advocates get the same level of care as those w/ strong advocates...in too many cases are IPPs still just paperwork to justify funding...etc, etc, etc, etc, etc,...

Perhaps the Broken Homes articles provide an evaluation of the good works...improvements from 1998 to 2006.

What are the standards by which good works and contributions are measured...negative, status quo, results forgiven...by what standards are leaders held accountable for positive results...perhaps unfair, but *good job brownie,* comes to mind.

Of course we all are resp, Pogo...but where does the buck stop...

moving on,

[Stephanie say] Why is 3.8 billion dollars not enough...weel, perhaps because, as SCDD 2007/11 Plan say...

Overwhelming complexity is a defining characteristic of California*s government services...In 2005, Governor Schwarzenegger*s own California Performance Review Commission reported that *California*s state government is antiquated and ineffective. It simply does not mirror the innovative and visionary character of our state. Instead of serving the people, it is focused on process and procedure. It is bureaucracy at its worst...costly, inefficient and in many cases unaccountable...and often times [the complexity] is actually compounded, within the developmental disabilities service system. It is multidisciplinary, multi-departmental, and multi-governmental (federal, state, region, county, city) in both form and function.

andand

until these issues are addressed and corrected...cuts to DD services are a lubricous, dumb, budget fix...have little if any short term cost containment benefit and increase long term cost.

Response not necessary...just points to ponder.

stanley seigler

stephanie said...

Stanley: It is easy to hold the DDS director accountable, whether Allenby or Delgadillo, for all the ills of our service system. That is like holding firefighters responsible for the fire. Voters in this state do not want to see their taxes raised to pay for goods and services, at this point in time at least. At the same time, legislation goes through that increases the draw on the state budget. The state budget doesn't have enough money to fund all of the promises explicit and implicit in statute. If the budget cannot be increased, because the will of the people is not there, then how can we avoid cuts to the budget? And if regional centers have finite budgets, and if providers merely have to comply with regulations, then WHO is going to hold WHO accountable?

BTW, I also listened to the townhall meeting with the DDS people. I thought the director was saying that the overall regional center budget was funded--she was talking about the new thing reducing the estimate by 100 million (or some such) when she said the budget was fully funded--not provider rates. At least, that is what I heard.

stanley said...

As said my comments stray from SDS pro/con points...soo I will post what I heard at teleconf and my opine re WHO is going to hold WHO accountable on DDRights@yahoo.com (a list I use to file my rants, no one reads)...if still interested pls go there...its open, public domain.

the whowho is most difficult...but avoiding accountability is not the answer...In the old Navy the capt was court-martialed if ship ran aground, even he was not on the ships bridge

Also will post here if doug wishes...feels appropiate.

BTW re: cuts to DD services are a lubricous, dumb, budget fix...lubricous, s/b ludicrous...tho guess lubricous could apply...DD cuts are a slick, tricky fix.

stanley seigler

Doug said...

Stan, your question: "Have stakeholders been too forgiving...over played go along to get along in order to get a place at the table...crumbs from the table seem to be the results of this approach." My answer: Uh, yeah. I would add to that that families and people with disabilities have been way way too willing to help providers advocate for rates in lieu of every other thing that might make the system work better,
for them.

Stephanie, that was about what I heard. Stan's point is a good one: Can you say the system is fully funded if the assumptions regarding what can be purchased for how much are false?

Stan, it's nice to have dialogue happening here. As long as we're nice to each other and people aren't personally attacked I'm happy for this site to be a forum for rambling rants other than my own,

stanley said...

[doug say] Stan, it's nice to have dialogue happening here. As long as we're nice to each other and people aren't personally attacked I'm happy for this site to be a forum for rambling rants other than my own
xxxxxxxxxxx

thanks...but to keep on SDS track have posted WHO/WHO accountibility comments on DDRights...

you might want to start a topic re the status quo...how we got here and how we can get out.

As mentioned and you commented: perhaps SDS is the opportunity/vehicle to get out...reset Lanterman.

would be careful selling SDS as more cost effective...well,

it is, but only if realistic cost are compared...ie, as current cost are fiction based on decades of system gaming...then the cost to provide positive SDS outcomes could/should exceed current cost.

stanley seigler

Doug said...

Stan, I'm working on that. Take the new post as a baby-step in that direction.

All of you, thank you very much for participating. This was a lot of fun and very rewarding for me, personally. If it's rewarding for you all, I'll continue to host debates here.

Julie said...

This is such a great discussion!! I'm enjoying lurking, reading, and learning!

Doug said...

Julie, lurk if you prefer but you're good for daylight. Thanks, though.