Shopping For Service A Client Choice System Creates Competition Among Agencies That Aid North Idaho’s Developmentally Disabled
Every Tuesday at 8 a.m., a developmental specialist travels to a blue-and-white trailer home on the west side of Sandpoint to help Robert Edwards plan meals for the week.
They sit down on Wednesdays to draw up a budget for the money Edwards earns at his janitorial job. Thursday afternoon, the pair goes grocery shopping. This year, the 32-year-old Edwards, who is developmentally disabled, went shopping for something he never bargained for - the organization that would be responsible for helping him keep his life in order.
On July 1, legally mandated “client choice” went into effect for an industry that has always been driven by exclusive contracts with the Idaho Department of Health and Welfare.
The change resulted in a revamped vocabulary and a new approach to social services.
Service providers are now vendors. Clients are customers.
And, with five agencies vying for a limited population base, cooperation has been replaced by free-market competition.
Sandpoint became the staging area for client choice last October when Panhandle Special Needs Inc. declared Chapter 11 bankruptcy.
For almost 20 years, the agency had been the community’s only provider of life skills and job training for the developmentally disabled. In the attempt to create in-house employment opportunities for clients, the agency formed three businesses and rolled up unpaid withholding tax debts of more than $159,400, causing it to close.
“The collapse of Panhandle Special Needs forced us to try things in Sandpoint that the whole state adopted later,” said Tim Voz, Region 1 manager for Health and Welfare’s developmentally disabled program. “The system was anticipating client choice, but the timing was an accident.”
Coeur d’Alene’s TESH Inc. stepped in to fill the services gap for about 35 clients but opted against drafting an exclusive contract with Health and Welfare.
That allowed other organizations to compete for customers in Panhandle Special Needs’ absence.
Goodwill Industries expanded its presence in the region. Nova, a nonprofit agency based in Spokane, added a community-supported employment program. An $8.5 million for-profit corporation called S.L. Start opened a Sandpoint office.
With newly acquired accreditation in hand, Panhandle Special Needs submitted a reorganization plan to Bankruptcy Court this fall and now wants back in the game.
“It’s almost like having a gas station on every corner,” said Ken Korczyk, executive director for TESH. “Somebody’s going to fall out. There’s not enough clients up here for all the agencies.”
TESH, Goodwill Industries, Nova and S.L. Start all provide the same services out of offices in Coeur d’Alene.
“But there are more clients in Kootenai County,” Korczyk said.
Roger Stanton, community employment services manager for Goodwill in Bonner and Boundary counties, believes the spirit of free enterprise will benefit customers. Like Korczyk, however, he looks for an eventual shakeout of service organizations.
“When you open up a marketplace - whether it’s hardware or service to the developmentally disabled - you see quality go up and costs go down,” Stanton said. “Three to five years down the road, though, there won’t be as many people trying to provide those services. The rural population can’t support them.”
Connie Kimble doesn’t seem overly concerned about falling by the wayside. As Sandpoint branch manager for S.L. Start, she works for the sole profit-minded player in a field of nonprofits.
“That brings a new spin to things,” Kimble said. “If your service is not any good, you’re not going to survive.”
The function of state employees has also changed under the privatized system.
“We’ve become more of a managed care organization; a gatekeeper for the industry,” Voz said. “The days of exclusive contracts with one agency are gone and I don’t see us going back.”
The complexities of client choice can be lost on the severely disabled, industry experts agree, making the support network of family, friends and longtime caregivers critical to the decision-making process.
Similarly, some clients are not suited for a movement that makes community job placement a priority.
“Philosophically, the focus has changed to community-based employment and integration,” said Panhandle Special Needs general manager Jean Post.
Before the attempt to form its own businesses forced the agency to close last year, Panhandle Special Needs had a history of successful workshop contracts. Those accounts eventually dried up and such in-house services fell out of vogue. But customer demand may bring the industry full-circle, Post said.
“What we did within these walls has been referred to as archaic,” she said. “But there continues to be a need for employment opportunities that are not just community based. Not everybody can be integrated.”
For those who can integrate, the results can be as satisfying for the community as they are for clients.
In 10 years as janitor for the Bonner Mall, Robert Edwards has come to double as door man for the shopping center, greeting customers as he wipes down the glass entrances.
“I like cleaning those doors and windows,” Edwards said. “It makes me feel good to do a good job.
“And people compliment me on it,” he continued. “They say, ‘This is the cleanest window in North Idaho.”’
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