Personal S Support t Budgets ts as a a Means f for Promoti ting S Self-Direc ection: n: Balancing Ideology with Fiscal Discipline within a LifeCourse Framework Applie pplied Self lf D Dir irectio ion Self D Dir irectio ion Conference May 9, 2017 John Agosta Jagosta@hsri.org Alena Vazquez Avazquez@hsri.org Human Services Research Institute 7690 SW Mohawk Street Tualatin, OR 97062 +1 503-924-3783 www.hsri.org
What is a Supports Budget ? A supports budget is a targeted amount of money, Benefits or allocation that is made known to individual Increased personal control over service recipients before service planning to acquire resources, encouraging “demand driven” approaches. the services they need and prefer. Opportunity to alter service array The amount is determined by assessing the extent and rates to match demands. of an individual’s support needs, while accounting Increased fairness among all for where they live (e.g., community residence, service recipients. family), and their age (e.g., youth or adult). Increased allocative efficiency. An exceptions review process is also used to Increased predictability of overall system allocations and spending. assure that extraordinary needs are appropriately addressed. 2 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
THE SUPPORTS BUDGETS PROCESS While the specific circumstances of each jurisdiction’s system transformation are unique, the overarching goal of a supports budgeting process is to create a system that is efficient, fair, and person-centered. Assessment & Personal Policy Service Planning Service Delivery Why? Service Supply Support Budget Intentions - Support needs - Service mixes by support - Self-direction - Choice What do you need to solve? - Person-centered - Support levels level, residence type - Community - Quality What is the lift? - Integrated planning - Service array and age group integration - Services that are adequate - Community-based - Rate structures - Support budget - Expanded resources and ample - Efficiency - Fairness ACTIONS OUTCOMES INTENTIONS Financing Strategy & Communication 3 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
What We Believe “Where imagery leads, policy follows and behavior results.” Ellen Goodman 4 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Human Services Research Institute - Establishing Individualized Supports Budgets We believe that… All people and their families have the right to live, love, work, play and pursue their life aspirations in their community. www.theriotrocks.org 5 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Human Services Research Institute - Establishing Individualized Supports Budgets Complementing principles A person-centered, community-oriented approach to deliver services for people with disabilities. The approach emphasizes: That people with IDD be in charge of their lives as much as possible. • That people with IDD have opportunities to use resources in ways that • enhance their lives and help them participate in their communities. The contribution that people with IDD and their families may make. • A shared responsibility for the wise use of public dollars. • That the system be managed in a way that is efficient and fair to • everyone . 6 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Transforming Services and Supports Everyone exists Integrated Services and Traditional within the context Supports within context Disability Services of family and of person, family and community community 7 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Trajectory Towards a Good Life Friends, family, enough money, job I like, home, faith, vacations, health, choice, freedom Vision of What I Don’t Want 8 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Focusing ONLY on Eligibility Supports Friends, family, enough money, job I like, home, faith, vacations, health, choice, freedom Poverty, loneliness, Eligibility segregation, Supports restrictions, lack of choice, boredom, institutions 9 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Relying ONLY on Family & Friends Friends, family, enough money, job I like, home, faith, vacations, health, choice, freedom Poverty, loneliness, Relationships segregation, restrictions, lack of choice, boredom, institutions 10 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Three Types of Supports Discovery & Goods & Connecting & Navigation Services Networking (Information, (Day to day, (Talk, peer direction, Medical, support, exchange Training) Specialized) networks, community) 11 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
LifeCourse Integrated Supports STAR resources, skills, abilities characteristics family, friends, i-pad/smart phone neighbors, co- apps, remote workers, church monitoring, cognitive members, community accessibility, members adaptive equipment school, businesses, church IDD services, Special Ed, faith based, parks & rec, Medicaid, Voc Rehab, public transportation Food Stamps, Section 8 R 12 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Demand for community integration & self direction High spending levels for program enrollees, but years-long waiting lists Potential Policy Budget cuts and/or pressure for containing costs Concerns Too much emphasis on facility based and “services only” approaches to offering support Weak relationships between individuals’ needs and the type and amount of services they receive A lack of tools to support service planning and service use consistent with the community integration and self-direction Unmaintained systems in which nearly everyone is in the highest category of need Payment approaches that do not differentiate between individuals’ needs so that there is a ‘one size fits all’ approach Rates that do not adequately support community-based services 13 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Potential Policy Intentions Fiscal Ideology Seek additional funds while illustrating enhanced allocative management Discipline strategies Give people greater control over their allocation Expand and/or adjust the service array Adjust the rate schedule and payment rules These goals may be Reallocate resources to promote efficiency and fairness approached in different Focus resources more sharply to achieve preferred outcomes tied to principles ways, but underlying issues Establish personal allocations based on assessed need will not disappear without action. Apply budgets within a person-centered planning process Promote use of resources to complement public services The “supports budget framework” offers one means for responding. 14 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
THE SUPPORTS BUDGETS PROCESS While the specific circumstances of each jurisdiction’s system transformation are unique, the overarching goal of a supports budgeting process is to create a system that is efficient, fair, and person-centered. Assessment & Policy Personal Service Planning Service Delivery Why? Service Supply Intentions Support Budget - Support needs - Service mixes by support - Self-direction - Choice What do you need to solve? - Person-centered - Support levels level, residence type - Community - Quality What is the lift? - Integrated planning - Service array and age group integration - Services that are adequate - Community-based - Rate structures - Support budget - Expanded resources and ample - Efficiency - Fairness ACTIONS OUTCOMES INTENTIONS Financing Strategy & Communication 15 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
Assessment may be used to: Assessment Determine eligibility for long-term services and supports Assessing support need • Support Levels • Expenditures by Support Level Determine an individual’s needs for support • services Determine a personal support allocation in advance of service planning Set tiered rate schedules relates to support levels Inform an individual service plan to address needs. 16 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
A Few W w Words a about A t Assessing g Support Need eeds Focus on Assessing “Support Need” can be quantified as a variable, low to high with a distribution Support Needs… resembling a normal distribution results. Medical and behavioral challenges are not easily measured. These conditions are present across the distribution. These factors must be accounted for as well. Exceptions process are needed to ensure that exceptional needs are adequately addressed 17 HUMAN SERVICES RESEARCH INSTITUTE – PERSONAL SUPPORTS BUDGETS
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