ABSOLUTE CATHARSIS

Sometime back I read the book Tribes by Seth Godin and decided to subscribe to his daily email blog. On February 22 of this year I received the following post in my inbox:

At the edges it falls apart.

Extremism is rarely the thing we need.

Absolutes let us off the hook because they demand not to be negotiated.

But absolutes usually bump into special cases that are truly hard to ignore.

The good middles, the difficult compromises that matter, that’s where we can build things that have long lasting impact.

We need a compass and a place to go.

But the road to that place is rarely straight and never absolute.

For the last number of years I have tried to negotiate with those having a different perspective of the service system than mine and their timeline for reform without any meaningful compromise. So I am going to use this editorial to relieve some emotional tension (catharsis) about the following reform initiatives that are being proposed free from any restriction or condition (absolute).

Olmstead Plan

In my view Minnesota’s court-approved Olmstead Plan is a reasonable document that affirms individual choice and moves the system towards more inclusive settings. The following two passages from the court order support my view:

  1. “The Olmstead decision is not about forcing integration upon individuals who choose otherwise or who would not be appropriately served in community settings”, and
  2. “…(the) goal of placing individuals with disabilities in the most integrated setting must be balanced against what is appropriate and desirable for the individual.”

Where the edges begin to fall apart for me is goal two on page 21 of the 10/9/15 version of the “Olmstead Plan Workplan – Employment” that states: “By June 30, 2020, of the 50,157 people receiving services from certain Medicaid funded programs, there will be an increase of 5,015 or 10% in competitive integrated employment”. That the goal is 5,015, or 10% is an absolute that is not conditioned by the individual choices of 50,157 people with disabilities who have yet to be asked the question if they are interested in competitive integrated employment.

Employment First Policy

The 9/29/14 version of the Minnesota Employment First Policy states that: “Employment First means raising the expectation that all working age Minnesotans with disabilities can work, want to work, and can achieve competitive integrated employment; and each person will be offered the opportunity to work and earn a competitive wage before being offered supports and services.” Using the word “all” is an absolute that even some supporters of this policy admit is not true and yet there is no willingness to consider compromise language such as: “Employment First means raising the expectation that working age Minnesotans with disabilities can work, want to work, and will be offered the opportunity to earn a competitive wage before being offered supports and services”. I cannot fathom, or endorse, a policy that even the most militant of supporters has to know is not true and is also contrary to individual choice.

HCBS Transition Plan

Reading all the guidance on this rule I came away with the understanding that the Centers for Medicare and Medicaid Services (CMS) is requiring the Minnesota Department of Human Services (DHS) to ensure that recipient’s funded by the HCBS waiver do not receive institutional services and are not intentionally isolated from the broader community. Further, nothing in the CMS rules prohibits facility-based settings and the rule established a definition of HCBS settings “based on the individual experience and outcomes, rather than one based solely on a setting’s location, geography, or physical characteristics.” Yet, DHS actions to date appear to be focused only on a setting’s location, geography, or physical characteristics free from any conditions regarding individual experiences and outcomes.

Summary

I have to acknowledge that for an exceptionally small minority group the Kool-Aid Krew has been very impactful in swaying people’s opinion to their views. In this case that is not admirable because by refusing to find “good middles” many stakeholders are unwilling to collaboratively build programs that can have a positive and long lasting impact. So, I’ve decided I am done trying to reason with the militants and will briefly pause while considering my next strategy.

Thanks for reading, I feel better already.

 

In memory of Jerry Mueller, former Executive Director of MnDACA, (June 27, 1944 – March 26, 2016) 

A gracious host and colleague that appreciated that I said what needed to be said
to those that needed to hear it.

4th Annual Big Wood Brewery Golf Tournament

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Oak Glen Golf Course and Event Center

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