Thursday, February 17, 2011


Alongside "draconian," "savage," "irresponsible," "responsible" and "common sense," "darwinian" is an adjective that deserve to modify the cuts in process. Still, there seems to be little discussion of how the system will evolve in the presence of significantly less funding and new regulations. To the extent that there's a vision for change, it seems to be towards accountability, a welcome new feature, if the new accountability systems proposed didn't seem as spectacularly inefficient as the worst images of the system and if there were some little bit of the new oversight that addressed outcomes.

But as to the composition of the system, I have a very hard time believing that will not change over the next year. What has frustrated me the most watching the changes so far has been the lack of intentionality to it all. In essence, real cuts have come with implementing statute which in at least half the cases was implausible. This has left it to regional centers to cut services not mentioned in the trailer bills. So, from the be the change you seek department, here is my projection for the system we are now creating.

Congregate care will be much more prominent on the menu of options, and large providers will dominate: Larger non-profits, with some notable exceptions such as Jay Nolan Community Services, are principally site-based, secondarily group-based, and often have individualized services attached as tiny portions of the whole. They are also more likely to be non-profit and to fund-raise successfully. These services have been unsuccessfully targeted for cuts. But are the best placed to weather them and have generally avoided implementation of most, leading to cuts not targeted in individualized care.

There will almost certainly be fewer providers in the future. Parent-providers may continue and large agencies should survive but the smaller agencies that comprise most of the individualized system will be less sustainable. These agencies may merge with one another to survive, or close. To the extent that large non-profits are willing and able to provide ILS, SLS, micro-enterprise support or that smaller agencies can merge, person-centered services may continue to be available. But it is worth noting that under the hedgehog principle that firms specialize for a reason, it seems worth noting that at large agencies that provide both congregate and individualized support, ILS and SLS et cetera are usually very small pieces of overall programming.

Note: For the purpose of this post I am not assuming that this is a bad thing for people with disabilities, but I also do not assume this will make care more efficient. While congregated services are cheaper per person and per hour, clients receiving individualized support often require much less of it. I think it would be impossible to say based on data we have whether the site-based system is more or less efficient than its alternative. For example, micro-enterprise and job-coaching are much more common than workshops or enclaves with clients of ILS and SLS services which eliminates a lot of bureaucracy.

Moreover, changes rarely go well without planning and, thus far, DDS has been scrupulous in spreading damage to the system fairly evenly. As a consequence, whatever system change will come is likely to favor not cost-savings nor efficiency, nor quality but the fiscal positions of the providers. Fortunately for everyone, blogging is a low-overhead activity.

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