Sunday, August 08, 2010

About the Examiner

So, I thought I would begin the new dealybob at with an explanation of what I would write as a reference for any future readers who would happen by. That first post was rejected, probably appropriately, for being too much in the first person. But, just to share, here is what it would have said.



This will be my first article as an Examiner (and so, the oldest one in my eventual archive.) It's a good place to predict what this column will cover. Consider this half a promise and half a bet, if there are takers for either.

This column will cover events, trends and policies related to the provision of human and social services. Professional caregiving is often publicly funded and usually highly-regulated so public policy will be discussed extensively, but market forces and demographics will also be considered. Sporadically, we in the social services think about actual people, so expect occasional profiles of people with disabilities, policy-makers, caregivers, charlatans and reprobates.

About me: I work in the social services industry as the chief executive of a small for-profit company that assists adults with developmental disabilities to live independently, as a subcontractor to state contractors. We will soon offer companion services to the elderly and physically disabled.

There is a phrase in the paragraph just above to make anyone skeptical, so here are the biases I'll admit to up front-

  1. There are two principle purposes for having a social and human services system, to defend the threatened and to extend community participation beyond the barriers that nature and circumstance impose.
  2. Services provided through government tend to be both inefficient and underfunded for their missions. The former defect makes a bigger difference than the latter and is more fixable. Inefficient service delivery creates costs not only to the taxpayer but also to the people who depend on the support provided, through malarkey.
  3. Purely private services may (or may not) be more efficient, reliable and of higher quality but are also extremely rare. Very few of us will ever receive professional care not influenced by public policy.
  4. Ideology drives idiots crazy, madmen to folly and reasonable people to fake deafness. This column will be very interested in the granular details of what works and doesn't work in both regulation and the marketplace. Democrats, Republicans, vampires of both union and capitalist varieties, dithering managers and doddering staff all may receive attention here, some of which may be complimentary.
  5. I am a reformer, may heaven have pity and my neighbors patience.

Sounds fun, right? I welcome your comments.

Wednesday, July 21, 2010

Brand new bag

Howdy and a quick announcement. I am now writing generally about social services, human services and professional caregiving for It's something slightly closer to a job than this blog has been. The new site will take most of the effort I've been putting into this site (roughly 1400%) and be less focussed on developmental disabilities. I'll keep this site so Andy and Stanley have somewhere to rant and I can get deep in the policy weeds from time. The link to my new page is in the title of this post.

You're all welcome to join the conversation there.

Tuesday, July 06, 2010

Talking cents

The dollars needed to preserve the system will not be forthcoming, I'm afraid. Not for a long time, anyway. I believe our choices will be to let it all continue to crumble or start seeing nickels and dimes worth of actual service as more desirable than advocacy denominated in billion dollar bills.

In support of a resolution I've proposed to the San Gabriel/Pomona Regional Center Vendor Advisory Committee, I've recently had the opportunity to retell this story: In 2002 or so, I started receiving a lot of phone calls from Service Coordinators asking me questions that took me by surprise. But they had a pattern: Many asked about the clients' height and weight (useful mostly if you are going on rides at Disneyland or boarding a helicopter;) some asked about the clients' ambulation (useful for special olympics planning;) others asked if the client had been out of service for any extended periods, out of state or hospitalized or in prison (useful for identifying fraud, assuming the same vendor would bill fraudulently and then answer the question diligently.)

The questions were odd and there was no particular place for me to find the answers, so after receiving the calls I would generally get up, search through the client's file and, if that didn't turn up the answer, call the supervisor responsible for the case who would, next time she wasn't with a client search through notes for the answers. Then I would call the SC back with or without the right answer. I don't know how much time SCs were spending on the questions, but Arriba staff were spending several hours per week.

At some point, I found an unimpertinent way of asking "why are you asking?" and the answer came "for the waiver documentation" nine times out of ten. After that I talked to the very smart person in charge of said documentation and we worked out a template, to be included in every progress report, that would answer all of these questions. Staff already, when updating the reports looked in all the places that data would be for the answers to other questions so once we changed our template, the administrative workload here went down sharply and at least some time was saved for the SCs who eventually would learn that the answer was sitting on their own computer. At the very least, the calls per client-question fell from two to one.

Spread that change from Arriba's 100 or so clients to a regional center's some-thousand-and-some, and it might be that half a year of one person's work could be saved. That's not a ton, but it could be enough to turn an administrative position into a service position or a savings.

So, here's a question for commenters who seem to need questions: What are some other small changes that might make the cost of service left while leaving the service intact?

Wednesday, April 07, 2010

The pettiest post on this site

This is a very small point, but the conversation around caseload ratios for service coordinators has become too funny to leave be. What I keep hearing is that for HCBS waiver clients, the caseload ratio remains limited to 62:1 but that the cap has been lifted entirely for non-waiver clients. It makes sense that people would say this because neither CMS nor DDS nor anyone else want California to twit the federal government in a way that requires a response.

But, the assertion keeps getting made without irony or humor or apparent self-awareness so let's just us, we few who discuss here, set the record straight. If the non-waiver caseload is uncapped, then the waiver caseload is also uncapped. The reason I think so: I don't know of a regional center that has waiver and non-waiver caseloads. As far as I know, all service coordinators have mixed caseloads.

This means that that to say "we have a 75:1 caseload ratio" means the same distribution as to say "we have a 62:1 caseload ratio for HCBS clients and a 101:1 ratio for non-waiver clients (assuming 2/3 of clients are on the waiver and I did my math right.) Really, this is a very unimportant point, but I do hope you will join me in smirking whenever you hear someone claim that the caseloads are fixed for waiver clients.

Thursday, April 01, 2010

Other closures

Much has been made of the pending closure of Lanterman Developmental Center, and it would be to our detriment to ignore the impact of the planned closure of Lanterman Regional Center. According to DDS Director, Teri Delgadillo, Lanterman is being closed and merged with Harbor and Westside regional centers to save money. As Ms. Delgadillo says in her statement, "The administration considers these three regional centers, which have already harmonized their service coordination process to the degree that client expectations have been regionalized. Furthermore, by pooling staff, the combined regional center will have the capacity to say 'no' in more than 80 languages."

"We certainly defer," Director Delgadillo continued, "to the combined 80-person board of the merged center in terms of naming the new facility and appointing management. But DDS personnel are recommending 'Richard Riordan Regional Center,' because we enjoy the sense of whimsy that alliteration brings."

Walt Disney Regional Center, which will be created from the merger of South Central and Orange Country RCs will have the capacity to say "please" and "thank you" in more than 30 languages and on legal pleadings.

Friday, March 19, 2010

Because a new post is sorely needed

I apologize to the few but loyal readers that not much has come to mind to write about here. There's big news about Lanterman Developmental Center, of course, a topic on which I don't feel qualified to opine about.

But, in the post below, Godwin's Law seems to have reproven itself and the phrase "dead white male philosophers" has also appeared and I feel ready to propose my own Doug's First Law of Internet Discourse: To wit, no subject is so arcane that common platitudes won't dominate the discussion once the topic has been exhausted.

So, lacking anything else to mind, I'll open the thread to you all with three questions:
First, if anyone out there has interacted with the Delatorre audit, I'd be interested in hearing about the tone and rigor of the inquiry. Can anyone tell how well-informed the study has been or whether it appears vindictive or exploratory?

Second, if self-determination/directed-services is no longer an available option for streamlining and improving the system, what would you all suggest as a conceptual frame for intentional systemic reform?

Third, an anonymous guest suggested something I absolutely agree with (and have agreed with in previous posts,) that more funding won't fix a broken system. Anonymous suggests Stanley's answer to the question, but I am curious for two sentence answers: Do you all think the system is primarily underfunded or primarily broken?

Some etiquette: Let's start by answering one of the three questions (as opposed to two, all or none) per comment, begin by identifying which question you are answering and, if at all possible, consider the poor blogger who feels compelled to read all the comments and try to begin with two- or three-sentence replies.

I'll try to come up with a new post before anyone begins comparing department directors to war criminals.

Friday, January 29, 2010

Who will reward the far-seeing?

OK, so this post was either not prescient or very prescient. I doubt we're done with cutting.

So, here's a topic for discussion. Immanuel Kant distinguished between phenomena, things that are observed, and noumena, things as they are in themselves. One thing I believe strongly about our system (and most others) is that the phenomena we describe when we talk about support to people with developmental disabilities, are almost entirely process. That makes sense, considering that support is initially a verb. But process is hard to defend and, really, if all we do is do, and nobody gets anything of value in itself, then it may be right that we have trouble defending. My question, regarding what our system produces, is what do you all think the noumenon is? What is the thing in itself that people with disabilities receive from all the work that goes on.

Just to handicap the discussion, "dignity," "sovereignty," "choice" or "safety" sound too abstract to me. Is there something people get from being supported that they would know they lacked if the system went away? What are those things?

So how is everybody?