Resources

Quality and Accountability for 7 Cents a Day

James Gardner, Ph.D., President and CEO, The Council on Quality and Leadership

The Council is completing a preliminary analysis of its ten year Personal Outcome Measures database that includes over 4,500 interviews with people receiving services and supports from over 550 organizations throughout the United States.

The results are in.

People receiving services and supports through accredited organizations are achieving very high numbers of outcomes in the areas of Health and Wellness, Freedom from Abuse and Neglect, and Safety. Consider that at a time when:

The national media are questioning the quality of services in both institutional and community settings;
The National Quality Review Federal Look Behind teams are finding significant deficiencies in “client protections“ and “active treatment” in ICFs/MR; and
The Government Accounting Office is questioning the quality oversight of the Home and Community Based Waiver.

Our data indicate that The Council’s accreditation program successfully addresses the concerns for basic assurances in health, wellness, safety, and freedom from abuse and neglect.

We wish that our data also indicated that accredited organizations facilitated far greater outcomes in areas of community affiliation and self-determination and choice. But, these accredited organizations have initiated the goals and processes that promote community participation, choice, and self-determination. And they are facilitating these quality of life goals for people with all levels and types of disability without sacrificing outcomes associated with Health and Wellness and Safety. Organizations, networks of organizations, and large regional and state systems in North America, Western Europe, and Australia are now using the Personal Outcome Measures to promote social capital for people with intellectual disabilities and people with mental illness.

In fact, our data indicate that the organizational processes (supports and services) associated with the outcomes of community, choice, and self-determination are based on the same personal outcome principles and practices that account for the outcomes of Health and Wellness, Freedom from Abuse and Neglect, and Safety. Being connected to natural supports, having close and intimate relationships, and having continuity in supports are all closely associated with the outcomes of health and safety. This leads us to the following quality axioms:

1. Connections, Relationships, and Participation: Critical ingredients in the promotion of health and wellness, safety, and freedom from abuse and neglect. Health and wellness, freedom from abuse, and safety are best promoted by keeping people connected to family, friends, neighbors, and community. Standards and inspections may build upon and supplement these protections, but, as a society, we have never been able to provide basic assurances for any group of citizens isolated from family, friends, and other sources of social capital.

2. Protections and Belonging: No need for a trade-off. In organizations participating in The Council’s accreditation program with the Personal Outcome Measures, there is no trade-off of health and wellness, freedom from abuse, or safety in the pursuit of greater outcomes in the areas of community affiliation, choice, or self-determination. The data show no negative relationship between the outcomes related to quality of life and social capital and those of basic assurances. People can make choices associated with where to live and work, and what to do during the day without compromising health and safety. Promoting choice and connections to the community and relationships, in fact, help to promote and sustain these basic protections. And, The Council’s accreditation program successfully holds organizations accountable for doing both.

3. Just 7 cents a day: The cost of quality of life and basic assurances. When we calculated the cost of our accreditation over multiple years on a per person basis and then calculated the cost on a per person per day basis, we learned that the cost of Council accreditation is approximately 7 cents per day for each person.

Isn’t it time for organizations to ask self-advocates, families, boards of directors and community representatives, “Aren’t quality of life and basic assurances worth 7 cents a day for the people we support?”