Sunday, March 27, 2011

ILS/SLS Workgroups

So, this here workgroup thingabob is open enough to have too many participants but not quite open. Since some of us are representing all of us, CDCAN is holding weekly conference calls for what happens in the meetings to come out. Along those lines, I'll post my input to the group here.

Email sent 3/25:
Due to the inspired (yet stern) leadership of Tammy Bachrach, ELARC VAC chair, we spent the bulk of our meeting yesterday divided into tables based on the workgroups. The ILS/SLS group recognized that the legislature has changed their focus from service standards to "best practices," so we allowed ourselves the liberty of focus on cost-saving practices around ILS and SLS. Following are suggestions from the group.

For ILS: It was suggested that we might get more realistic service plans if, when a referral is made for a new ILS client, that in addition to the agencies referred to serve the client, a different ILS agency be referred the task of writing the initial assessment. The suggestion recognizes that when an agency writes its own initial assessment, even the honest and wise among us have a natural bias towards overestimating the need (although probably not by a lot, demagogues.) The assessing agency would have to agree not to work with the assessed client for at least a year.

There are some down-sides to this to be concerned with. One is just that regional centers might prefer agencies that write emaciated service plans. It would be important that the assessing agencies also be serving ILS clients and that the assessor rotate. Also, in areas where there is only one or two ILS providers this arrangement will not be possible. An objection from the group was that the assessment serves an important function of developing a mutual understanding between a new vendor and a new client.

All of that said, I think the idea has merit and should be discussed.

For SLS: There were two suggestions. Unlike the ILS suggestion, these had unanimous support in our discussion group.

1. It was felt that benefit appeals specialist (particularly, but not exclusively regarding IHSS) may be more efficient than some agencies at insuring that IHSS hours are covered by IHSS rather than the regional center or an agency. The proposal is that regional centers cultivate these advocates and vendors that choose this assistance would surrender a portion of their administrative funding proportional to their expected benefit management cost.

2. If somebody could, for heaven's sake, do something about worker's compensation costs for SLS providers, those providers would be thrilled to surrender a like amount of their hourly rate.

Email sent 3/27:

Hi, all. Me again. FIrst, to commend Scott. I think that was a nice job. The only exception I'd take is that some level of skill-development service ought to be available to clients living with family do not intend to change their home setting immediately. Whether that service is provided under the myth of Adaptive Skills Training rather than the myth of Independent Living Skills, makes no difference I can see.

Something that has been on my mind which is related to the topic at least: (The following is written in a prophetic voice, by which I mean I hope to be heard but don't really expect to be listened to, a la Jonah in Ninevah)

A lean system has to be a smart system and our system is never less smart than when it is focused on some sort of reform having to do with vendor codes and categories. Regional Center staff, forced by the nature of the regional center's role to make policy with a minimum of information and a maximum of effect, tend towards involuntary glibness and in my experience lose what concentration and permeability they otherwise retain when the topic of vendor codes is on the table.

Likewise, vendor executives, already prone to priestly grandeur and martyrdom (cf, this email,) are never more divisive, sanctimonious and grasping as when we contest our vendor codes (excepting, of course, when unions sponsor bills.)

To direct care staff and clients, vendor codes represent less than nothing. I don't believe anyone who will be in the room Monday would be able, watching individualized support delivered, to identify the vendor code under which delivery takes place. Either services are led by the client and his or her needs and abilities under the influence of a circle of support or not. If so, the service itself is probably efficient, whether or not the referral process or agency supervision, for example, are. If not, it's wasteful of taxpayer money and negligent of the value clients have the right to expect. I believe that any discussion of reform that focuses on category or code is likewise wasteful of scarce funding and negligent of important support.

So my concern with the work of our group is that it represents a deepening of our reliance on irrelevancies and distractions in defining the value we deliver and setting its price; and steps further away from efficiency and smartness in our system. The legislature has opened an opportunity to be brighter by changing the administration's proposal of "purchase of service standards" to a proposal of "best practices." Granted, that was a bad use of nomenclature but an improvement in focus. I do hope we can take advantage of this. As I said, I don't mean to change the agenda, but I would point out that most of the work we've accomplished so far has been the delivery of data and instructions from DDS and the return of criticism. I don't think much achievement will have been undone if we change our focus.

There is work to be done in how and why clients are assigned for agencies and services, work to be done on how vendors deliver that service. Granted that our services must always be individualized, it isn't necessarily the case that all regional centers and vendors need all of their processes to be idiosyncratic for that purpose. There must be opportunities for service delivery to become leaner which would lead us in a better and smarter direction than a discussion of standard hours or normal eligibility. Since by any name we are really talking about budget cuts, I would hope those cuts could be as much as possible to process rather than to support.

In sincere friendship and admiration (but with a pinch of sarcasm by which old friends recognize me,)

Doug

May God bless and keep you, make his face shine upon you and be gracious unto you. Amen.

17 comments:

Karen said...

Your post has more acronyms than I can endure. I hope all goes well for you in Sacramento.

stanley seigler said...

[doug say] ILS/SLS Workgroups (WG): So, this here workgroup thingabob ... I*ll post my input to the group here.

THANKS doug!

if WG cant make it true best practices...then at least call a spade a spade and call them "program cut practices"...perhaps this is a good time to get true best practices regs...

as others have mentioned DDS/legs WG thingabob is a diversion...but guess we have to play the game...so;

how about some current statistics...total caseload served and amount budgeted before and after cut...assume figs found at: http://www.dds.ca.gov/Budget/Docs/2010_2011MayDDSHighlights.pdf
for 2010-11 are the base and cuts will be made to these figs.

using these figs the per capita, ballpark, cost for community services is around $16,000 (244,000 clients) and for developmental centers (DCs) around $300,000 (2000 clients).

just thinking...say move 2000 DC folks to the community and save $100000 each...$200M total...use the budget crisis as a reason to do the right thing.

probably wont save anything, but a good talking point and no one will follow up to determine real cost...eg, no one will follow up to determine real cost of IHSS cuts

is there a breakout of ILS/SLS caseload and amount budgeted before and after cut.

stanley seigler

ps. [doug say] May God bless and keep you, make his face shine upon you and be gracious unto you. Amen.

and give you peace, and give you peace. amen amen

stanley seigler said...

some workgroup info (with my comments) from ARC 3/28 MMM, in case some havent seen:

[ARC say] The Department of Developmental Services [DDS] workgroup on Supported [SLS] and Independent Living Services [ILS] will have their final meeting in Sacramento...all proposals must adhere to the Lanterman Act values and maintain the entitlement to services. However ... trailer bill language is that the proposals can change who is eligible for which services, how much service and supports a person can have, who can provide the service and their rates...The Arc is concerned that these goals are incompatible and we will continue to oppose all proposals that violate the Lanterman Act and the IPP. Check out these resources to help judge for yourself: IPP Filter Arc v DDS KTLP IPP Bill of Rights

COMMENT

Why do the workgroups bring to mind images of the Trojan horse.

least we forget: [2009 ARC president say] And the legislators allowed themselves to be misled [by DDS]. Our groups* professional advocates in Sacramento clearly and repeatedly, as recently as this morning, let the legislators* staff members know that these cuts were the Schwarzenegger administration*s [DDS] proposals, not ours, and that we have concrete alternatives. Hundreds of people testified at three separate hearings with some of these 10 legislators present. Thousands called, emailed and faxed letters to all 10 of them http://groups.yahoo.com/group/DDRIGHTS/message/4996

[one may want to review this entire ARC Alert]

[ref say] Increased wages for direct service professionals may be cost effective over time: Authors suggest that since the costs of staff turnover were largely borne by state funding, rather than the providers, it could be cost effective for states to subsidize wages to reduce turnover costs. http://dps.sagepub.com/content/21/4/195.abstract

heard the same story/opine/fact in 2003 when control freaks shot down workforce bill AB649, with false and misleading statements:

By increasing pay, benefits, and training, AB 649 will encourage workers to stay on the job longer, allowing them to have closer and more productive relationships with people and provider agencies. They will remain loyal to people with disabilities and provider agencies in the same way California legislative employees are loyal to the state legislators who hire them, even though the are employed by the State Controller, and IHSS workers are loyal to the consumers they serve, not to the public authorities that issue their paychecks. http://groups.yahoo.com/group/DDRIGHTS/message/6805

perhaps a workforce plan similar to 2003 AB649 could be a suggestion to reduce cost...

stanley seigler

Doug said...

Yeah, Karen, I wouldn't recommend this blog for people not in this business. Particularly when I'm pasting in emails.

Stanley, you're welcome. As to the Trojan Horse, I'm not sure. This isn't a ruse. I mean, DDS doesn't say "come on by, y'all, we got cake and ice cream" and then take your wallet. This is about cuts we help to plan or cuts we don't help to plan.

stanley seigler said...

[doug say] As to the Trojan Horse, I'm not sure...this isn't a ruse...This is about cuts we help to plan or cuts we don't help to plan.

the horse probably not a good metaphor...my concern related to steve miller comment at the 3/22 hearing...(his comments around 51:00 on tape 1/3 of the hearing)

what he has heard in the workgroups bears no resemblance to best practices...its cost cutting and will significantly change lanterman...not an exact quote but the intent is there...ie,

as mentioned if WG cant make it true best practices...then at least call a spade a spade and call them "stupid program cut practices"...

stop using euphemisms to salve our and DDS' conscience...stop BS-ing our children/friends with disabilities...and beware DDS mislead the legs in 2009.

stanley seigler

Anonymous said...

who is stanley steigler and why does he write so much while saying the same thing over and over and over and over?

stanley said...

[Anonymous say]... who is stanley steigler and why does he write so much while saying the same thing over and over and over and over?

stanley seigler is stanley seigler...more to the point who is anoonymous...and why is she-he anonoymous...care to answer, annonoymoous?

i say the same thing "over and over and over and over" cause advocates, DDS, RCs, providers dont get it...the results: special needs children/folks die waiting the lanterman dream to become the reality vice an illusion.

if i annoy you, annoymoous...suggestion: DONT read it the first time and certainly NOT: "over and over and over and over" again...unless you enjoy punishing yourself...

stanley seigler

Karen said...

Yeah, Doug. You're probably right. My mistake. I didn't realize California's Developmental Disability System needed reform.

stanley seigler said...

ps.

[Anonymous say]...who is stanley steigler...

seems a little ironic that one signing anonymous...would ask who a named individual is...

have to assume it was a left handed adhom...ie, anon is asking (anonymously) "who does he think he is."

i am just a parent...

stanley seigler

stanley seigler said...

pps

just who is this anonymous...the mask man maybe.

stanley seigler

Doug said...

Anonymous, Stanley's a good friend of mine and if he repeats himself, it's probably because he knows his mind.

Karen, yeah, this is pretty much written for people interested in the topic.

Stan, don't sweat it, brother.

stanley seigler said...

[doug say] it's probably because he knows his mind.

it's probably due to Alzheimer...

[doug say] don't sweat it...

too old to sweat or take anything personal...just trying to get anon to contribute...maybe provide some new material/ideas...

agree w/ anon there has been very little new from me or anyone else.

thanks for the friendship...

stanley seigler

paul said...

I always miss all the fun!!
“….why does he write so much while saying the same thing over and over and over and over?
Top ten reasons…
10. If you say it enough it makes it true.
9. If you say it enough it makes it true.
8. If you say it enough it makes it true.
7. If you say it enough it makes it true.
6. If you say it enough it makes it true.
5. If you say it enough it makes it true.
4. If you say it enough it makes it true.
3. If you say it enough it makes it true.
2. If you say it enough it makes it true.
1. Because Andy needs repetition.

stanley seigler said...

[paul say]... Top ten reasons…If you say it enough it makes it true.

no it doesnt...but most of it is true in any event:)...

would love to hear anon's opinions on issues...any issue...maybe the one shehe has read over and over and over again.

saying one thing over and over and over and over, FYI: "stanley steigler is not an issue..."neither is why he say the same thing over and over.

stanley seigler

paul said...

Because it is seemly the only subject we are capable of discussing:

http://www.usdebtclock.org/state-debt-clocks/state-of-california-debt-clock.html

Doug said...

Paul, I'll try to change the subject before too long, but that's a nice feature. Thanks.

paul said...

Doug,

It was a comment of general applicability. If there are any exceptions to this general rule, there is an exception here

Of course - I do not get out much.