There sure is and it's awful big. We're going to talk about it here.
One of the many things identified by the ongoing NY Times series on support to people with developmental disabilities is the dual system of the provision of these supports - namely the state of New York as one and the private, nonprofit or voluntary sector as the other.
Before we go too far though let's talk about this terminology. Two discussions are important - nonprofit and voluntary. Many times the general public and sometimes people in positions of great power think that nonprofit means a poor, underfunded, always on the brink kind of organization. There is a general perception that nonprofits should not run a surplus or make a "profit". Sometimes people are surprised to find out that nonprofit status is really about "members" of the corporation, in many cases the Board of Directors, not making a profit. Instead all of the profits are to be reinvested back into the nonprofit entity. Some of that reinvestment is the development of "reserves" that help the nonprofit navigate in difficult times or that allow programs that run deficits to continue operations. These are important choices that have to be made by well informed Board members with the support of qualified and honest managers.
State Operated vs. Voluntary Operated
So why do we hear this terminology - State Operated and Voluntary Operated? Well this is the dual system of supports established many years ago in New York State. For many years New York State was the provider of services and supports for people with developmental disabilities. These services and supports were put in place over many years and were a mandated responsibility of government. Thus institutional care as a model - basically the need to house and take care of large numbers of people. But there was another model even before what's referred to as deinstitutionalization. That was the community support and rehabilitation model developed and practiced by many nonprofit organizations in the '30's, '40's and 50's and into the '60's. As deinstitutionalization began to occur, the state needed major assistance and turned to what was dubbed the voluntary sector - voluntary because these organizations were not mandated to provide these services and supports. They chose to provide them. I contend that there is a great difference between doing something because you have to and doing something because you choose to. I believe that basic difference is why there is a cultural divide between state operated and voluntary operated systems of support. It doesn't mean one group of people is better then the other but it does mean there are real differences and you can't pretend to be one vs the other.
Now the hard part that few want to talk about. When the real push for deinstitutionalization occurred, the state had an existing workforce of thousands of unionized employees. At the same time the state was looking to the private sector of voluntary, nonprofits to assist and most of these were non union entities. No surprise, a dual system of funding and reimbursement emerged. The agency responsible (under the law) for providing the supports, the Office for People With Developmental Disabilities, was now responsible for funding, developing and auditing/regulating the programs it ran and contracted for. They have tried valiantly over the years to figure out ways to do it - regional offices, set up a separate division, hire outside auditors and on and on. The reality is that it hasn't worked for a couple of reasons.
First and foremost, the system is just too damn big and diverse. Supports for 125,000 plus people provided by 13 or so regional offices operating their own programs and contracts for similar supports with 700 plus nonprofits. In addition there continues to be approval of more, smaller, less sophisticated nonprofits even today. A system like that is just too big and hard to manage.
Secondly, you can't have two workforces with different rates of pay and operating under minimally, two sets of rules. Just won't work and the proof is in the eating of the pudding.
So what are the possible solutions? For one, the state should be trying to resolve the workforce issue. From my perspective this isn't an anti or pro labor issue. It's a reality that needs to be dealt with, probably over time. The state should look at redeploying its workforce through attrition to other state agencies. That would be a start. I think there should be a commitment made by the state to get out of all but the most necessary of services and supports of people with developmental disabilities. The state should concentrate on figuring out how to manage all of the data it already collects as well as developing meaningful performance data that recognizes geographical, size and programmatic differences by support providers. There may be a temptation to turn the overseer, licensing function over to another state agency or entity. That would in my judgement be a mistake. The current Office for People With Developmental Disabilities does have an understanding of the constituency and the providers that has tremendous value. It just needs to be focused and supported properly.
There's the elephant. The big nut to crack as it were - State operated vs voluntary operated, a state workforce and a voluntary workforce, oversight vs operation. These are the discussions that have to begin taking place before any real and meaningful change can occur.
Wednesday, December 28, 2011
Another Story From The NY Times
The NY Times has printed another story on supports and services provided to people with developmental disabilities. The most recent story is interesting to me for a couple of reasons. First, I think it is trying to get at and identify what the systemic issues may be relative to poor performance by providers and the state's response to those issues. It seems to me that one of the problems is that the reporters either don't understand how the quality assurance and survey system does work within the Office for People With Developmental Disabilities or the people providing them with information don't know how it works and therefore are providing them with not so good information. Frankly it could be either one of these situations or a combination. It sounds like the non profit agency they are reporting on in this article had serious problems that needed to be dealt with differently but it's hard to say why things went the way they are reported to have gone. From previous discussions we also know that inferences are the wrong way to draw conclusions. The second reason the story is interesting is that there is at least some recognition in this article that the vast majority of non profits provide good services. The article has the following comment in it: "To be sure, many of the non profit organizations in New York provide exemplary care, using the state's generous reimbursement rates to devise and operate excellent programs."
Between this article and the last, there has been push back to the Times on its reporting by a number of people and entities, including comments on this blog. A group of provider organizations did send correspondence to the Times questioning the paper's method of drawing conclusions about an entire field. It wasn't the best response because it didn't get at the heart of the poor reporting issues, but at least it was something. Here is that correspondence:
The recent New York Times article, “Aiding Disabled, Nonprofits Rake
in State Money,” is misleading and unfair to the vast majority of
non-profit service providers who work to ensure that they offer
quality supports, services and programs for people with developmental
disabilities.
While the article focuses on one agency, the headline and the story by
reporter Russ Buettner use the terms nonprofits and nonprofit
providers when referring to alleged abuses of the system by a very
few, thus leaving the impression that this is a widespread problem.
The nonprofit provider agencies we represent have adopted a code of
ethics and practices to ensure that funds are used to provide the best
possible supports for people with disabilities and their families. We
have worked in collaboration with government agencies and provide
annual fiscal reports of our operations to the appropriate State
agencies. There are also annual program surveys to ensure that we meet
all regulations and guidelines as required by local, state and federal
agencies. We strongly reject any accusation that providers are simply
interested in “lining their pockets” by billing as much as possible.
As a group, our organizations place staff as our most valued resource,
with more than 75 percent of our operating budgets devoted to the
salaries and benefits of the thousands of people who work daily to
provide opportunities for people with disabilities to have full and
active lives in their communities. Community habilitation is an
example of a program currently in place that allows people to live
with support in the community or to remain in their family’s home for
as long as possible at a fraction of the cost of alternatives.
The vast majority of provider agencies do not maintain large surpluses
or pay excessive salaries to their executives. If a provider is able
to generate a surplus in one program, it is typically used to offset
losses incurred by the many underfunded programs our agencies provide.
The salaries of the executives are readily available to the government
agencies, and agencies are required to follow IRS guidelines (Internal
revenue Code 53.4958). Most agencies also adhere to the guidelines put
forward by the Commission on Quality Care’s “Report on Executive
Compensation”. Additionally, we are working with OPWDD to establish
executive compensation guidelines. These steps are a result of our
organizations’ strong and involved Boards of Directors who ensure the
fiscal integrity of the agencies in order to provide the highest
quality programs and supports possible.
If the practices of one or even a few organizations appear
inappropriate, then the facts should be investigated. We like other
New Yorkers, support immediate corrective actions when agencies are
found to be abusing the system. OPWDD contracts with over 600
provider agencies. The vast majority of them operate in a highly
ethical manner. They daily help to support over 100,000 New Yorkers
with developmental disabilities. OPWDD receives extensive detailed
cost reports itemizing both income and expenses every year from the
providers. If they have any information that indicates that providers
have unethical billing practices they should investigate immediately
and not wait for the New York Times to call. However, a headline
condemning a community of providers based on the experience of one
provider is irresponsible at best. There needs to be a balance in
reporting so that the readers are not left to believe all providers
operate in a questionable manor.
For decades, our organizations have provided needed services. We have
worked with OPWDD and other agencies to ensure we provide quality
programs for people with disabilities. We are committed to this
process and will continue to support the providers and the State’s
efforts to improve the system.
Alliance of Long Island Agencies
Seth Stein, Esq., Executive Director
Cerebral Palsy Associations of New York State
Susan Constantino, President & CEO
Interagency Council of Developmental Disabilities Agencies, Inc.
Peter Pierri , Executive Director
New York Association of Emerging & Multicultural Providers, Inc
Yvette Watts, Executive Director
NYSARC, Inc.
Marc Brandt, Executive Director
Perhaps the Governor's office and the Office for People With Developmental Disabilities are also learning a hard lesson about being a part of condemning the non profit sector, even if by silence and acceptance of what I and others perceive as broad brush attacks. It should also be noted that the state's generous reimbursement rates have received substantial reductions over the past 12 months.
But back to the article at hand. There are numerous cases that I'm familiar with where the Office for People With Developmental Disabilities made sure that serious corrective action was taken by non profit boards when systems failed. There are numerous cases where non profits themselves have taken actions when systems or people have failed. There are executives and managers who have been terminated and removed from their positions. There is tremendous oversight and regulation that people are responding to everyday. There are fiscal and program audits by the Office for People With Developmental Disabilities. There are corporate compliance programs and training of staff and Board members - and, the Office for People with Developmental Disabilities has all of this information. So what is the problem?
Clearly the system is too big and here's the biggest nut to crack - you probably can't be an overseer, licenser and a provider at the same time. That's the big one and that's what probably needs to be talked about. More to come........
Between this article and the last, there has been push back to the Times on its reporting by a number of people and entities, including comments on this blog. A group of provider organizations did send correspondence to the Times questioning the paper's method of drawing conclusions about an entire field. It wasn't the best response because it didn't get at the heart of the poor reporting issues, but at least it was something. Here is that correspondence:
The recent New York Times article, “Aiding Disabled, Nonprofits Rake
in State Money,” is misleading and unfair to the vast majority of
non-profit service providers who work to ensure that they offer
quality supports, services and programs for people with developmental
disabilities.
While the article focuses on one agency, the headline and the story by
reporter Russ Buettner use the terms nonprofits and nonprofit
providers when referring to alleged abuses of the system by a very
few, thus leaving the impression that this is a widespread problem.
The nonprofit provider agencies we represent have adopted a code of
ethics and practices to ensure that funds are used to provide the best
possible supports for people with disabilities and their families. We
have worked in collaboration with government agencies and provide
annual fiscal reports of our operations to the appropriate State
agencies. There are also annual program surveys to ensure that we meet
all regulations and guidelines as required by local, state and federal
agencies. We strongly reject any accusation that providers are simply
interested in “lining their pockets” by billing as much as possible.
As a group, our organizations place staff as our most valued resource,
with more than 75 percent of our operating budgets devoted to the
salaries and benefits of the thousands of people who work daily to
provide opportunities for people with disabilities to have full and
active lives in their communities. Community habilitation is an
example of a program currently in place that allows people to live
with support in the community or to remain in their family’s home for
as long as possible at a fraction of the cost of alternatives.
The vast majority of provider agencies do not maintain large surpluses
or pay excessive salaries to their executives. If a provider is able
to generate a surplus in one program, it is typically used to offset
losses incurred by the many underfunded programs our agencies provide.
The salaries of the executives are readily available to the government
agencies, and agencies are required to follow IRS guidelines (Internal
revenue Code 53.4958). Most agencies also adhere to the guidelines put
forward by the Commission on Quality Care’s “Report on Executive
Compensation”. Additionally, we are working with OPWDD to establish
executive compensation guidelines. These steps are a result of our
organizations’ strong and involved Boards of Directors who ensure the
fiscal integrity of the agencies in order to provide the highest
quality programs and supports possible.
If the practices of one or even a few organizations appear
inappropriate, then the facts should be investigated. We like other
New Yorkers, support immediate corrective actions when agencies are
found to be abusing the system. OPWDD contracts with over 600
provider agencies. The vast majority of them operate in a highly
ethical manner. They daily help to support over 100,000 New Yorkers
with developmental disabilities. OPWDD receives extensive detailed
cost reports itemizing both income and expenses every year from the
providers. If they have any information that indicates that providers
have unethical billing practices they should investigate immediately
and not wait for the New York Times to call. However, a headline
condemning a community of providers based on the experience of one
provider is irresponsible at best. There needs to be a balance in
reporting so that the readers are not left to believe all providers
operate in a questionable manor.
For decades, our organizations have provided needed services. We have
worked with OPWDD and other agencies to ensure we provide quality
programs for people with disabilities. We are committed to this
process and will continue to support the providers and the State’s
efforts to improve the system.
Alliance of Long Island Agencies
Seth Stein, Esq., Executive Director
Cerebral Palsy Associations of New York State
Susan Constantino, President & CEO
Interagency Council of Developmental Disabilities Agencies, Inc.
Peter Pierri , Executive Director
New York Association of Emerging & Multicultural Providers, Inc
Yvette Watts, Executive Director
NYSARC, Inc.
Marc Brandt, Executive Director
Perhaps the Governor's office and the Office for People With Developmental Disabilities are also learning a hard lesson about being a part of condemning the non profit sector, even if by silence and acceptance of what I and others perceive as broad brush attacks. It should also be noted that the state's generous reimbursement rates have received substantial reductions over the past 12 months.
But back to the article at hand. There are numerous cases that I'm familiar with where the Office for People With Developmental Disabilities made sure that serious corrective action was taken by non profit boards when systems failed. There are numerous cases where non profits themselves have taken actions when systems or people have failed. There are executives and managers who have been terminated and removed from their positions. There is tremendous oversight and regulation that people are responding to everyday. There are fiscal and program audits by the Office for People With Developmental Disabilities. There are corporate compliance programs and training of staff and Board members - and, the Office for People with Developmental Disabilities has all of this information. So what is the problem?
Clearly the system is too big and here's the biggest nut to crack - you probably can't be an overseer, licenser and a provider at the same time. That's the big one and that's what probably needs to be talked about. More to come........
Friday, December 23, 2011
Lives Worth Living - Celebrating Martin Luther King, Jr. Day
I'm honored to have been asked to introduce and lead a discussion on the film 'Lives Worth Living' on January 16, 2012 as part of a Martin Luther King, Jr. Celebration in Watkins Glen, NY. The event is being sponsored by The Glen Theatre and The Arc of Schuyler. The film chronicles the disability rights movement and draws parallels between it and the civil rights movement led by Dr. King. Recently the film was aired on PBS as part of the 'Independent Lens' series.
Here is a link to the flyer for the event: Lives Worth Living Flyer
As I said, I'm honored to have been asked to participate. The Glen Theatre and The Arc are to be commended for bringing this free event to the general public and for commemorating the memory of Dr. King through education about the disability rights movement, mobilization and non-violent civil disobedience.
Here is a link to the flyer for the event: Lives Worth Living Flyer
As I said, I'm honored to have been asked to participate. The Glen Theatre and The Arc are to be commended for bringing this free event to the general public and for commemorating the memory of Dr. King through education about the disability rights movement, mobilization and non-violent civil disobedience.
Thursday, December 22, 2011
The Sad Story of Aaron Shehu
I didn't know Aaron Shehu personally but I've known people like him. People struggling with their own perception and understanding of themselves. Aaron was a young man (17) with a developmental disability and a hard life. Over the years Aaron got himself into trouble mainly due to behavioral issues at school and in his home. In 2010 he was referred to a non public school for troubled youth. At some point, the school knew they were probably in over their head and Aaron was removed. He tried to return to the school and in the process allegedly stole a few vehicles. He was apprehended by a NYS Trooper and ended up in a small Town Court and remanded to the county jail. He remained in that setting for 6 months while the wheels of justice slowly, very slowly turned. On the morning of Nov. 27, 2010 after taunting by other inmates, Aaron Shehu tied a sheet around his neck and hung himself from his cell door.
All of this is reported in an article in the Chronicle Express in Penn Yan, NY that you can read here. The article is about an investigation and finding by the NYS Commission of Corrections that the county jail acted properly in the case of Aaron Shehu. Maybe, maybe not. Aaron's parents are suing the Sheriff, jail administrators, a local hospital, a Doctor and others. In the meantime, Aaron is dead and it doesn't seem many spoke up for him in those last 6 months of his life. A system of support for Aaron, support for his family and even support for the jail personnel failed miserably it seems.
This is what happens when community supports are either non existent or people don't know how to access them. This is what happens when good intentioned people reduce services. This is what happens when people are devalued by our legal system. There are serious questions in my mind about the role of state agencies (Office for People with Developmental Disabilities, State Education Department, Department of Health to name a few) as well as county and community agencies in this story. I hope lots of people think this one through. Read the article and ponder how many things went wrong and how many Aarons you may know.
All of this is reported in an article in the Chronicle Express in Penn Yan, NY that you can read here. The article is about an investigation and finding by the NYS Commission of Corrections that the county jail acted properly in the case of Aaron Shehu. Maybe, maybe not. Aaron's parents are suing the Sheriff, jail administrators, a local hospital, a Doctor and others. In the meantime, Aaron is dead and it doesn't seem many spoke up for him in those last 6 months of his life. A system of support for Aaron, support for his family and even support for the jail personnel failed miserably it seems.
This is what happens when community supports are either non existent or people don't know how to access them. This is what happens when good intentioned people reduce services. This is what happens when people are devalued by our legal system. There are serious questions in my mind about the role of state agencies (Office for People with Developmental Disabilities, State Education Department, Department of Health to name a few) as well as county and community agencies in this story. I hope lots of people think this one through. Read the article and ponder how many things went wrong and how many Aarons you may know.
Tuesday, December 20, 2011
More Thoughts on Recent News Stories
The reaction to my post last week after the NY Times' article on supports for people with developmental disabilities has been interesting. For the most part comments, notes and conversations have been positive. Some people have been thankful that someone is speaking up about the issues raised in the article. Not everything has been positive however. I've had some people tell me that I should stop writing about any of these issues, that all I'm doing is drawing attention to the issue and this will cause the articles and coverage to continue. What comes through in these conversations is fear. Fear of the press, fear of elected officials fear of state agencies and fear of people in power generally. It's sad. So I don't think I'll be quiet.
I made some errors in the past week myself while researching the article and found out it is easy to do. That's why verification and good fact finding is so necessary and important. We all need to be careful.
My biggest gripe with the article continues to be assumptions, inferences and comparing Community Habilitation to home care and Direct Support Professionals to home care aides. Apples and oranges as they say and good research will bear that out. These are different services. The article also tries to compare Direct Support Professionals to home care aides and other 'caregivers'. This is really inaccurate. Direct Support Professionals are not caregivers or at least they shouldn't be and that is not what the state is paying for. They are trainers, teachers, counselors, behavior support staff and much more. The last thing people with developmental disabilities want is to be taken care of in the community. The people I know want their independence and want assistance and support to make that happen.
A friend of mine who's the parent of children with developmental disabilities said the following to me: "I take offense at the dismissive tones the reporter uses to describe community habilitation, as if this is an unworthy service that exists solely for its profit potential. It is undeniably true that many New Yorkers are living with their families or in independent settings only because of supports like this. It is difficult, specialized work, and the article's implication that anyone can do it (why not just pay a relative to teach people to brush their teeth?) is an insult. Again, unsaid but left for inference, is that these poor, disabled people would just be better off if the state took them off to a nice, clean facility and cut out the middleman seeking to profit from their problems."
On the difficult issue of executive compensation, here's another quote from my friend: "If my bank president or business leader makes an error in judgement, the enterprise loses money, customers, market share, etc. If the executive director of an agency that provides supports to my daughters makes an error in judgement, programs that keep my daughters safe, involved in their communities and advancing towards ever greater independence could go away. The stakes are high. The pressures are almost unimaginable. Nonprofit executives face all the responsibilities of the leaders of any enterprise, plus the knowledge that the course of lives of individuals and families absolutely dependent on their judgement is at stake. It takes special people to take on that challenge. I can't think of a single one of the human service agency executives I have known who was in it for the money."
I made some errors in the past week myself while researching the article and found out it is easy to do. That's why verification and good fact finding is so necessary and important. We all need to be careful.
My biggest gripe with the article continues to be assumptions, inferences and comparing Community Habilitation to home care and Direct Support Professionals to home care aides. Apples and oranges as they say and good research will bear that out. These are different services. The article also tries to compare Direct Support Professionals to home care aides and other 'caregivers'. This is really inaccurate. Direct Support Professionals are not caregivers or at least they shouldn't be and that is not what the state is paying for. They are trainers, teachers, counselors, behavior support staff and much more. The last thing people with developmental disabilities want is to be taken care of in the community. The people I know want their independence and want assistance and support to make that happen.
A friend of mine who's the parent of children with developmental disabilities said the following to me: "I take offense at the dismissive tones the reporter uses to describe community habilitation, as if this is an unworthy service that exists solely for its profit potential. It is undeniably true that many New Yorkers are living with their families or in independent settings only because of supports like this. It is difficult, specialized work, and the article's implication that anyone can do it (why not just pay a relative to teach people to brush their teeth?) is an insult. Again, unsaid but left for inference, is that these poor, disabled people would just be better off if the state took them off to a nice, clean facility and cut out the middleman seeking to profit from their problems."
On the difficult issue of executive compensation, here's another quote from my friend: "If my bank president or business leader makes an error in judgement, the enterprise loses money, customers, market share, etc. If the executive director of an agency that provides supports to my daughters makes an error in judgement, programs that keep my daughters safe, involved in their communities and advancing towards ever greater independence could go away. The stakes are high. The pressures are almost unimaginable. Nonprofit executives face all the responsibilities of the leaders of any enterprise, plus the knowledge that the course of lives of individuals and families absolutely dependent on their judgement is at stake. It takes special people to take on that challenge. I can't think of a single one of the human service agency executives I have known who was in it for the money."
Thursday, December 15, 2011
The Rest of The Story - NY Times Reporting
The New York Times has published another story in a series it is doing on supports and services to people with developmental disabilities in New York State. The series is trying to get at the expenditures of federal and state Medicaid dollars for these supports and services and is also exposing abuse and neglect in this system of support. Those who know me understand that I have a great deal of respect for the first amendment and specifically for the important role that journalists and journalism play in the pursuit of truth and action against injustice. I also respect the 'Gray Lady' as one of the oldest and most respected newspapers and news sources in the world. Great reporters have uncovered and reported on so many important stories over the years. I also hate to hear critics of the media going on and on about the media's hidden agenda and unbalanced reporting. Having said all of this, I really am disappointed in the Times' reporting on the issue mentioned above. The issues of fiscal waste and abuse of any group of people are critically important and deserve the best reporting and editorial review.
Again, I've worked for many years in this field and admit my biases. I've seen the good and the bad in terms of fiscal policy, government oversight, and yes, abuse and neglect. The gist of the latest story is that non-profit agencies supporting people with developmental disabilities are receiving much more money then they need in a particular program, that they are rolling in money and that executive directors and administrators of these agencies are making hundreds of thousands of dollars off of the system while paying the people who do the actual hands on work poverty wages. Sounds awful and also feeds on the environment of corrupt CEO's, bankers and Wall St. fat cats that is sweeping the country. And the problem is, there is some truth to what's being said in the article. But that's it - some truth, because there is always an outlier or two who can make a great headline.
We've heard about 'the ladder of inference' before and this article is a great example of some truths being the basis for creating beliefs and then people thinking about acting on those beliefs. Two agencies are discussed in the article and the situations in both are abhorrent as presented. What the article does however is to then move to statements about large numbers of agencies, large numbers of non-profits doing the same thing with absolutely no factual basis presented. In one case, an executive director is reported as making a $400,000 annual salary while paying direct support professionals somewhere between $9-15 per hour, generating a surplus, etc. Then there's a quote by the current Commissioner of the state agency responsible for funding and overseeing these programs where she references these non-profits 'lining their pockets'. So we get to the some truth aspect.
It's easy to get tax data and confirm the salary of this one executive director. Based on the article, reported size of the agency, etc. it seems excessive and wrong. By the way, there are other executive directors who make large six figure salaries. They should be judged on specific criteria such as budget size, geographical location, years of service, expertise and various financial ratios. There is plenty of data to help get that info and come to some legitimate conclusions and the Times should be able to be a leader in that discussion.
There's more to the rest of the story that good investigative reporting would uncover. New York State has methods for determining fees and reimbursement rates. Providers have pointed out for years the problems with these methods including reimbursement levels for direct support employees. New York State also has systems in place to review, audit and act on and punish providers who are out of line both fiscally and relative to the treatment or mistreatment of individuals. This system obviously has flaws and government should be held accountable. Here's more - while some programs run surpluses, others run defecits. Non-profits have no choice but to use surplus revenues to operate deficit programs or to end them. More rest of the story - some people operate programs better then others, some grow for the sake of growth while others grow to provide choice to families and the people they support. More rest of the story - there is data that indicates how feverishly many executive managers have advocated for increasing wages for direct support staff over many years.
The other agency referenced in the article supposedly was making money hand over fist that caused sleepless nights for the former Board President. The rest of the story - again a little research shows that the agency was decertified and basically put out of business earlier this year due to, in part, the executive director stealing a couple of hundred thousand dollars. The Board President should have had sleepless nights relative to the seeming lack of oversight by the Board of Directors. Poor financial reporting was clearly identified it seems. Again, one example of what seems to have been a poorly operated organization. This does not represent an entire field or the hundreds of well informed and dedicated volunteers who serve on non-profit Boards. It's shameful to make that leap.
The latest article ends with a reference to how the Commissioner is moving from a fee for service method of funding to a managed care model. Interesting that the reporters in this series haven't identified the potential problems with this model. A little research shows lots of administrative support and overhead abuse potential in this model.
So here's what the Times' series has pointed out - Institutional care is bad, smaller community support is bad, non-profits are bad, government is bad, too much money is spent/spend less, abuse is rampant, etc, etc., etc. Big on problem identification but very weak on alternatives or solutions.
What is the lesson from all of this? There are bad apples. There are also good ones. Throw out the bad and nurture the good. Oh and let the NY Post do the sensational reporting.
Again, I've worked for many years in this field and admit my biases. I've seen the good and the bad in terms of fiscal policy, government oversight, and yes, abuse and neglect. The gist of the latest story is that non-profit agencies supporting people with developmental disabilities are receiving much more money then they need in a particular program, that they are rolling in money and that executive directors and administrators of these agencies are making hundreds of thousands of dollars off of the system while paying the people who do the actual hands on work poverty wages. Sounds awful and also feeds on the environment of corrupt CEO's, bankers and Wall St. fat cats that is sweeping the country. And the problem is, there is some truth to what's being said in the article. But that's it - some truth, because there is always an outlier or two who can make a great headline.
We've heard about 'the ladder of inference' before and this article is a great example of some truths being the basis for creating beliefs and then people thinking about acting on those beliefs. Two agencies are discussed in the article and the situations in both are abhorrent as presented. What the article does however is to then move to statements about large numbers of agencies, large numbers of non-profits doing the same thing with absolutely no factual basis presented. In one case, an executive director is reported as making a $400,000 annual salary while paying direct support professionals somewhere between $9-15 per hour, generating a surplus, etc. Then there's a quote by the current Commissioner of the state agency responsible for funding and overseeing these programs where she references these non-profits 'lining their pockets'. So we get to the some truth aspect.
It's easy to get tax data and confirm the salary of this one executive director. Based on the article, reported size of the agency, etc. it seems excessive and wrong. By the way, there are other executive directors who make large six figure salaries. They should be judged on specific criteria such as budget size, geographical location, years of service, expertise and various financial ratios. There is plenty of data to help get that info and come to some legitimate conclusions and the Times should be able to be a leader in that discussion.
There's more to the rest of the story that good investigative reporting would uncover. New York State has methods for determining fees and reimbursement rates. Providers have pointed out for years the problems with these methods including reimbursement levels for direct support employees. New York State also has systems in place to review, audit and act on and punish providers who are out of line both fiscally and relative to the treatment or mistreatment of individuals. This system obviously has flaws and government should be held accountable. Here's more - while some programs run surpluses, others run defecits. Non-profits have no choice but to use surplus revenues to operate deficit programs or to end them. More rest of the story - some people operate programs better then others, some grow for the sake of growth while others grow to provide choice to families and the people they support. More rest of the story - there is data that indicates how feverishly many executive managers have advocated for increasing wages for direct support staff over many years.
The other agency referenced in the article supposedly was making money hand over fist that caused sleepless nights for the former Board President. The rest of the story - again a little research shows that the agency was decertified and basically put out of business earlier this year due to, in part, the executive director stealing a couple of hundred thousand dollars. The Board President should have had sleepless nights relative to the seeming lack of oversight by the Board of Directors. Poor financial reporting was clearly identified it seems. Again, one example of what seems to have been a poorly operated organization. This does not represent an entire field or the hundreds of well informed and dedicated volunteers who serve on non-profit Boards. It's shameful to make that leap.
The latest article ends with a reference to how the Commissioner is moving from a fee for service method of funding to a managed care model. Interesting that the reporters in this series haven't identified the potential problems with this model. A little research shows lots of administrative support and overhead abuse potential in this model.
So here's what the Times' series has pointed out - Institutional care is bad, smaller community support is bad, non-profits are bad, government is bad, too much money is spent/spend less, abuse is rampant, etc, etc., etc. Big on problem identification but very weak on alternatives or solutions.
What is the lesson from all of this? There are bad apples. There are also good ones. Throw out the bad and nurture the good. Oh and let the NY Post do the sensational reporting.
Monday, December 12, 2011
The Importance of Words and Language
Acronyms Be Gone!
I really believe words are important. Words are part of how we communicate with each other and we all know how difficult communication is sometimes. So words along with gestures and other tools help us all communicate with each other better. So why is it then that so many people insist on using acronyms instead of words? We all see it.....almost to the point where it becomes a game or a contest. Who can make a word acronym out of the newest concept that someone is promoting? The excuse is always that it will help people remember this very important new thing or idea. In most cases that's just BS and it should be confronted that way. Here's the issue - Words are Important. They communicate ideas. Sometimes they communicate good ideas and sometimes bad ideas but communicate they do.
So why else do people insist on using acronyms? Some of it's laziness - it's easier to say or write DOT instead of Department of Transportation. Some of it's power. The old haves and have nots issue. You have the information (know what acronyms stand for) and therefore you have the power and authority. We've all sat in meetings where someone is using acronyms that we don't understand. Most of the time we sit there in silence and pretend we know what is being said. Finally someone says something about the alphabet soup and for a moment we're relieved that we're not the only one who doesn't understand half of what's being talked about. More people have to speak up about the use of letters versus words in my opinion.
Recently, the Office for People with Developmental Disabilities (OPWDD to those in the know) in New York State with the help of stakeholders, came up with a new acronym to describe an organization model that's being looked at - here it is - DISCO. Now isn't that cute. It's letters that make a word that everyone can remember - at least everyone from the 70's. And people can laugh about it, joke about it, make dance references and on and on. So now everyone in that field of work is referring to DISCOs and discussing if their agency will become a DISCO.
So what is this thing or what does the acronym stand for? It's a Developmental Disability Individual Support and Care Coordination Organization. Now just so we're straight, those words are important. They identify a specific group of people, they identify the importance of individualized support, care and coordination and they describe that this is an organizational model. It is hard to say all of those words, but they are important, not the letters or the acronym.
Here's another one that really gets me - DSPs. That stands for a Direct Support Professional but who would know when you use letters only. Direct Support Professionals do awesome work supporting people with disabilities, the elderly and others in community settings. Again, the words say much more then the letters. There are many more of these examples but you get the idea. Use words. They mean something.
Words That Hurt or Devalue People
There are plenty of these but I'm going to point out some that are again related to my own experiences working with and supporting people with disabilities. I really hate to hear people talking about caring for people. It implies that people are totally dependent. Sometimes people are dependent on others to help, assist or support them but most people I've met want to be able to do things for themselves even if it's hard. I also hate to hear people talking about "the people we serve". It sounds almost religious or like some sort of charitable quilt work. My choice for those words is always to talk about "the people we support". I know some will say it's just some attempt at political correctness but I think it's more important than that. I think it's about dignity and respect.
How about this - people who work with people who need support many times struggle with what to call these people. Its run the gamut from clients to participants to consumers and then some. Nobody's comfortable with any of it so we've come up with things like "the folks" and "the guys". None of it's very good and in many cases it's demeaning and devaluing. The easiest thing is to refer to people as people either by name or as the people I/we support.
Yep language and words - they're really important - not just for conveying messages but for changing attitudes and presenting images in people's minds. Use them and think about them.
I really believe words are important. Words are part of how we communicate with each other and we all know how difficult communication is sometimes. So words along with gestures and other tools help us all communicate with each other better. So why is it then that so many people insist on using acronyms instead of words? We all see it.....almost to the point where it becomes a game or a contest. Who can make a word acronym out of the newest concept that someone is promoting? The excuse is always that it will help people remember this very important new thing or idea. In most cases that's just BS and it should be confronted that way. Here's the issue - Words are Important. They communicate ideas. Sometimes they communicate good ideas and sometimes bad ideas but communicate they do.
So why else do people insist on using acronyms? Some of it's laziness - it's easier to say or write DOT instead of Department of Transportation. Some of it's power. The old haves and have nots issue. You have the information (know what acronyms stand for) and therefore you have the power and authority. We've all sat in meetings where someone is using acronyms that we don't understand. Most of the time we sit there in silence and pretend we know what is being said. Finally someone says something about the alphabet soup and for a moment we're relieved that we're not the only one who doesn't understand half of what's being talked about. More people have to speak up about the use of letters versus words in my opinion.
Recently, the Office for People with Developmental Disabilities (OPWDD to those in the know) in New York State with the help of stakeholders, came up with a new acronym to describe an organization model that's being looked at - here it is - DISCO. Now isn't that cute. It's letters that make a word that everyone can remember - at least everyone from the 70's. And people can laugh about it, joke about it, make dance references and on and on. So now everyone in that field of work is referring to DISCOs and discussing if their agency will become a DISCO.
So what is this thing or what does the acronym stand for? It's a Developmental Disability Individual Support and Care Coordination Organization. Now just so we're straight, those words are important. They identify a specific group of people, they identify the importance of individualized support, care and coordination and they describe that this is an organizational model. It is hard to say all of those words, but they are important, not the letters or the acronym.
Here's another one that really gets me - DSPs. That stands for a Direct Support Professional but who would know when you use letters only. Direct Support Professionals do awesome work supporting people with disabilities, the elderly and others in community settings. Again, the words say much more then the letters. There are many more of these examples but you get the idea. Use words. They mean something.
Words That Hurt or Devalue People
There are plenty of these but I'm going to point out some that are again related to my own experiences working with and supporting people with disabilities. I really hate to hear people talking about caring for people. It implies that people are totally dependent. Sometimes people are dependent on others to help, assist or support them but most people I've met want to be able to do things for themselves even if it's hard. I also hate to hear people talking about "the people we serve". It sounds almost religious or like some sort of charitable quilt work. My choice for those words is always to talk about "the people we support". I know some will say it's just some attempt at political correctness but I think it's more important than that. I think it's about dignity and respect.
How about this - people who work with people who need support many times struggle with what to call these people. Its run the gamut from clients to participants to consumers and then some. Nobody's comfortable with any of it so we've come up with things like "the folks" and "the guys". None of it's very good and in many cases it's demeaning and devaluing. The easiest thing is to refer to people as people either by name or as the people I/we support.
Yep language and words - they're really important - not just for conveying messages but for changing attitudes and presenting images in people's minds. Use them and think about them.
Sunday, December 11, 2011
Utah Phillips Tribute - Caffe Lena Saratoga Springs, NY
"In a modern day, mass-marketing economy, a revolutionary song is any song that you choose to sing yourself - welcome to the revolution"
-Utah Phillips-
Tuesday, December 6, 2011
Fracking - A Hot Topic!
Hydraulic Fracturing (a process of drilling for natural gas) is a huge issue across the country, in NY State and in the Finger Lakes Region. The process utilizes large amounts of chemically treated water that is then extracted as contaminated waste water, etc., etc. - so you see the potential problems that present themselves.
Last night I attended a Town Hall meeting in Penn Yan, NY hosted by State Senator Tom O'Mara and Assemblyman Phil Palmesano. Both men represent the geographical area surrounding the Village of Penn Yan which includes Yates County, the Finger Lakes and the Southern Tier of NY. Obviously, people in the Finger Lakes region that is known for its beautiful and bountiful lakes, wineries, tourism and agriculture, are concerned about gas drilling and the hydro fracking process.
I know both Sen. O'Mara and Assemblyman Palmesano. They're both what I would call good men - honest, concerned and trying to represent the interests of the areas they represent. As always, there are competing interests when it comes to issues around resource development, the environment, jobs, lifestyles and economic development. Sen. O'Mara has proposed and Palmesano supports a 4000' buffer zone from hydro fracking around the Finger Lakes. Many in the audience argued that gas companies can drill 4000' horizontally and therefore they propose that the buffer be 4000' from the watershed. That kind of sets the stage for last nights meeting.
Well the representatives from Albany got an earful and then some from a crowd of 75 to 100 people. As with many meetings of this nature there was a lot of emotion, shouting out of opinions, facts and feelings. The meeting wasn't organized or led very well. O'Mara tried to make sure everyone had a chance to weigh in but some people dominated the discussion. Both men made it clear that they aren't experts in the area of engineering or chemical processing and so, they're waiting for the NYS Department of Environmental Conservation (DEC) to gather comments from the public, the industry and outside experts and to issue regulations on the process. The audience wasn't satisfied with that response. They wanted more. I don't know if it was the way the question was asked or if it was the way it was attempted to be answered but no one seemed satisfied at the end of the session.
The question really boils down to this: Let's assume the DEC report is in and it doesn't have appropriate protections built in to protect the watershed and the environment of the Finger Lakes - what will you, as a legislator, do to ensure those protections? That's it basically. People understand the regulatory review process aspect of all of this. What they want to know is at the end of the regulatory review process, what are you as legislators willing and prepared to do to protect the environment around the Finger Lakes? It was hard to get to that point last night and I don't know why.
I'm not an expert either, but I do know that this watershed is critically important to hundreds of thousands of people in this and other regions of the state and I do know that gas companies have not been forthright about their operations in the past. I know that the trade off between an energy solution and a natural resource like water is very serious business.
The opponents of hydro fracking have done a good job of making their opinions known. They are having an impact on elected officials. But the bottom line is that what DEC and Gov. Andrew Cuomo do after the comment period will be critical and frankly, O'Mara's and Palmesano's steps at that point will be easier to measure.
Last night I attended a Town Hall meeting in Penn Yan, NY hosted by State Senator Tom O'Mara and Assemblyman Phil Palmesano. Both men represent the geographical area surrounding the Village of Penn Yan which includes Yates County, the Finger Lakes and the Southern Tier of NY. Obviously, people in the Finger Lakes region that is known for its beautiful and bountiful lakes, wineries, tourism and agriculture, are concerned about gas drilling and the hydro fracking process.
I know both Sen. O'Mara and Assemblyman Palmesano. They're both what I would call good men - honest, concerned and trying to represent the interests of the areas they represent. As always, there are competing interests when it comes to issues around resource development, the environment, jobs, lifestyles and economic development. Sen. O'Mara has proposed and Palmesano supports a 4000' buffer zone from hydro fracking around the Finger Lakes. Many in the audience argued that gas companies can drill 4000' horizontally and therefore they propose that the buffer be 4000' from the watershed. That kind of sets the stage for last nights meeting.
Well the representatives from Albany got an earful and then some from a crowd of 75 to 100 people. As with many meetings of this nature there was a lot of emotion, shouting out of opinions, facts and feelings. The meeting wasn't organized or led very well. O'Mara tried to make sure everyone had a chance to weigh in but some people dominated the discussion. Both men made it clear that they aren't experts in the area of engineering or chemical processing and so, they're waiting for the NYS Department of Environmental Conservation (DEC) to gather comments from the public, the industry and outside experts and to issue regulations on the process. The audience wasn't satisfied with that response. They wanted more. I don't know if it was the way the question was asked or if it was the way it was attempted to be answered but no one seemed satisfied at the end of the session.
The question really boils down to this: Let's assume the DEC report is in and it doesn't have appropriate protections built in to protect the watershed and the environment of the Finger Lakes - what will you, as a legislator, do to ensure those protections? That's it basically. People understand the regulatory review process aspect of all of this. What they want to know is at the end of the regulatory review process, what are you as legislators willing and prepared to do to protect the environment around the Finger Lakes? It was hard to get to that point last night and I don't know why.
I'm not an expert either, but I do know that this watershed is critically important to hundreds of thousands of people in this and other regions of the state and I do know that gas companies have not been forthright about their operations in the past. I know that the trade off between an energy solution and a natural resource like water is very serious business.
The opponents of hydro fracking have done a good job of making their opinions known. They are having an impact on elected officials. But the bottom line is that what DEC and Gov. Andrew Cuomo do after the comment period will be critical and frankly, O'Mara's and Palmesano's steps at that point will be easier to measure.
Thursday, December 1, 2011
Job Loses At Non-Profits
We all know how difficult the economy is right now. New York State as every other state is struggling. There's something that strikes me however in terms of news and information about job losses in the not for profit sector. Just about everywhere you go you hear about the importance of economic development. All kinds of jobs need to be developed, created, or saved both in the private and public sector. It's big news when a Governor holds the line with public employee unions and jobs are potentially lost and/or ultimately saved. Big news when private companies or local municipalities announce 5 or 500 layoffs.
Well here's where it gets interesting. As I've stated before, I worked for many years in the non-profit or social sector as an administrator of an organization supporting people with developmental disabilities. There are 400+ programs like this across New York State. The reason there are so many is because NYS provides support to over 120,000 people with developmental disabilities in community settings across a wide geographic area. The organization I worked for was part of a larger statewide organization that has representation in just about every county across the state. Obviously the size of the organizations differ based on geographical areas served, budgets and supports, so the number of employees varies as well. The number of employees at each organization range from small (200) to large (over 1000) as well.
These are really important jobs, performed by very talented and dedicated people who chose to provide these supports to people with all ranges of needs. Budget cuts have impacted these organizations in a pretty sustained way over the past 12 to 15 months. At the same time, state government and the media have raised issues about the quality of supports and care that people receive. Obviously, it's always important to raise issues about quality of care but the real problem is, you can't have it both ways as NYS government seems to want it - cut costs but increase regulation and oversight to get at important quality issues. These two things just don't add up.
So how does all of this tie in with economic development and job growth or job loses? As I said, this sector has sustained substantial budget cuts over the past 12 to 15 months, being told like everyone else to do more with less. As a result, there have been major reorganizations of supports and services and in many cases pretty serious layoffs of employees or reductions in hours or a combination of both. But who knows about this? Who is hearing about it? More specifically, who is even keeping track of the data of the layoffs in this sector of the workforce? It would seem important that this information be tracked from a point in time to show elected officials, legislative leaders, funding sources, contractors and other parties that this sector and the people it supports, a vulnerable population, is being impacted significantly. Without that type of action it seems as though people are just waiting to get kicked in the rear end and at the same time saying, "here, do it again". Data like this is important for a couple of reasons. It helps people in the organizations themselves get a feel for what others have done and perhaps duplicate as necessary. It helps underscore the potential damage to a fragile system and support advocacy efforts. Just as an example, if there are 400 agencies providing supports and each laid off 10 people, that's 4000 jobs. Again, this is only an example without clear data but I think it shows the potential impact of having this type of information.
Well here's where it gets interesting. As I've stated before, I worked for many years in the non-profit or social sector as an administrator of an organization supporting people with developmental disabilities. There are 400+ programs like this across New York State. The reason there are so many is because NYS provides support to over 120,000 people with developmental disabilities in community settings across a wide geographic area. The organization I worked for was part of a larger statewide organization that has representation in just about every county across the state. Obviously the size of the organizations differ based on geographical areas served, budgets and supports, so the number of employees varies as well. The number of employees at each organization range from small (200) to large (over 1000) as well.
These are really important jobs, performed by very talented and dedicated people who chose to provide these supports to people with all ranges of needs. Budget cuts have impacted these organizations in a pretty sustained way over the past 12 to 15 months. At the same time, state government and the media have raised issues about the quality of supports and care that people receive. Obviously, it's always important to raise issues about quality of care but the real problem is, you can't have it both ways as NYS government seems to want it - cut costs but increase regulation and oversight to get at important quality issues. These two things just don't add up.
So how does all of this tie in with economic development and job growth or job loses? As I said, this sector has sustained substantial budget cuts over the past 12 to 15 months, being told like everyone else to do more with less. As a result, there have been major reorganizations of supports and services and in many cases pretty serious layoffs of employees or reductions in hours or a combination of both. But who knows about this? Who is hearing about it? More specifically, who is even keeping track of the data of the layoffs in this sector of the workforce? It would seem important that this information be tracked from a point in time to show elected officials, legislative leaders, funding sources, contractors and other parties that this sector and the people it supports, a vulnerable population, is being impacted significantly. Without that type of action it seems as though people are just waiting to get kicked in the rear end and at the same time saying, "here, do it again". Data like this is important for a couple of reasons. It helps people in the organizations themselves get a feel for what others have done and perhaps duplicate as necessary. It helps underscore the potential damage to a fragile system and support advocacy efforts. Just as an example, if there are 400 agencies providing supports and each laid off 10 people, that's 4000 jobs. Again, this is only an example without clear data but I think it shows the potential impact of having this type of information.
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