Posted by on Wednesday - July 23rd, 2008

Re-Design of the Service System in New Mexico

The Arc of New Mexico believes that there is a crisis in the developmental disabilities service system.  This refers to the Home & Community Based Services waiver programs. This system is steadily becoming less and less effective in meeting the needs of the citizens in New Mexico who have developmental disabilities.  This is in spite of the best efforts of many dedicated staff and professionals who face tremendous system obstacles to providing valuable and quality support on a daily basis.  The Arc also believes that the future of this system, as it is designed today, is unsustainable.  The Arc is calling at this time for nothing less than a re-design of this service system.  New ideas, new models, new concepts about how best to respond to the needs of citizens with developmental disabilities must be discovered and must replace the problematic features of our current system.  Individuals with developmental disabilities, their families and allies, advocates, government personnel and providers must share the responsibility for the re-design of the service system.

Why is the service system in crisis?

The indicators that have led The Arc to this conclusion are many and include the following:

• The average cost per capita has increased from $64,000 in 2002 to approximately $70,000 in 2007.  This makes New Mexico the 4th in the nation in spending for a Developmental Disabilities waiver program.
• The increase in the state’s share of FMAP has increased as the economy of the state has improved.  This means that the state pays a few cents more of each dollar that is used to pay for services.  The federal government is paying fewer cents per dollar for services.
• The legislature’s appropriations for additional dollars for serving people have been static over the past several years.
• The combination of the first three bullets means that more of the legislature’s appropriations are being used to replace FMAP share and to cover increased cost, and less on serving more people.  For this reason, The Arc predicts that a person getting on the waiting list today will wait 16 years; this is up from 5-7 years.
• To deal effectively with the seriousness of these issues requires consistent and dedicated leadership.  The lack of consistent leadership in the Department of Health and at the Developmental Disabilities Support Division disrupts attempts to adequately address the problems.  During the Richardson administration, there have been three Secretaries of DOH and four Division Directors at DDSD.  The frequent change in leadership interrupts any change initiatives and ensures that the status quo continues.

What if we just got more dollars appropriated?  Wouldn’t that solve the problem?

Funding will never be adequate to serve all individuals in the current system.  This is because current service design is rigidly structured and relies upon the most expensive service models.  For example:

<ul><li>• The use of the most expensive residential model, the 24 hour staffed model, is increasing in the Developmental Disabilities waiver program.</li>
• The cost of direct support professionals, most notably in the 24-hour staffed residential model, will become increasingly more problematic in the future as the workforce crisis necessitates increasing wages for direct support professionals.
• There is an over reliance on “professionalization” of all aspects of life in the Developmental Disabilities waiver program, which increases costs.
• The lack of flexibility in service choices and designs in the Developmental Disabilities waiver program makes it difficult to arrange services that are less costly
• The over reliance on bureaucratic requirements to assure quality in the DD waiver program is costly.
• Service models in the Developmental Disabilities waiver program are overly comprehensive and as a result are barriers to accessing natural support and community support; some say the Developmental Disabilities waiver is designed to “buy a life”
• Self-directed, flexible models that are likely to cost less are underutilized, such as Mi Via and the Self-Directed Family Support model.</ul>

What are some hopeful trends and models for re-design?

Trends in the field of services and supports for people with developmental disabilities that are less costly are based on the concepts of:

• Freedom and choice for individuals and families to design an array of services and support to meet their needs, not the service system’s needs
• Self-direction and control of service dollars which has been demonstrated to cost less
• A shift in the purpose of service models away from being overly comprehensive – the “buy a life” model – to supporting individuals in the lives that they choice
• Seeking other resources for support, such as community resources and other public programs, such as housing and transportation
• Improved public education that is more inclusive and places higher expectations on academic achievement for all person with disabilities and that will result in higher levers of independence and employment
• Empowering person centered planning processes that help find creative ways to meet individuals needs outside of the service system in the interest of keeping people connected to their communities, included in community life and free from service system environments to the extent possible
• Creative support strategies to help individuals generate income so they can do more for themselves
• Greater flexibility in arranging supports on an individual basis that allow for alternatives strategies to the 24 hour staff model, such as house sharing and technology for safety
• Intentional strategies designed to build relationships in the community around individuals, which enhances opportunities for natural support and serves as an alternative to assuring quality
• Quality assurance models that rely upon self-responsibility for assuring quality and peer-to-peer programs

In consideration of the re-design of the service system, The Arc of New Mexico believes that:

• The current service system is unsustainable in the future
• It is untenable that some people have no support while others have services; this is a situation that we cannot tolerate
• It is possible to create a system to support all people to live the lives they choose
• It is possible for each individual and family to creatively craft an arrangement of support that responsibly uses the service system in partnership with other community, personal and public resources
• There is a wealth of knowledge and experience among the staff and professionals who serve people today that can help to generate sound ideas for system change in the future
• Individuals with disabilities and families, in service or on the waiting list, have the responsibility, individually and collectively, to re-design the system for support of all
• The Arc has the responsibility to provide the leadership to involve individuals with disabilities, families, the state, elected officials, community leaders, providers and other stakeholders in collaborating together to re-design the service system in New Mexico

The Arc of New Mexico adopts these principles to guide the re-design of the service system:

• The provision of services should not interfere with self-determination, inclusion in the community, developing supportive relationships, and accessing a variety of resources outside of the state service system
• Staff and professionals have long supported these principles will be valued partners in the effort to re-design the system
• Individuals and families will have access to an empowering person centered planning process that supports the dreams and values of the individual and family and creatively discovers ways to support the individual that incorporates personal, community and public resources in collaboration with the state service system
• Services will be self-directed
• Quality assurance will be a shared responsibility between the state and individuals/families
• Commitment to health and safety, as defined by the individual/family
• Ongoing collaboration among all stakeholders (the state is a stakeholder) to design, reflect upon performance, clarify learning and continual change of the state service system
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Posted by
Wednesday - July 23rd, 2008

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