In recent years there has been a tremendous increase in the number of people with disabilities supported in community settings in the United States and other locations around the world. An assumption of this growth is that private organizations, both for-profit and nonprofit, will provide most of the services and supports. As expansion continues, provider organizations are faced with the question of whether they should grow in size. In this article we present perspectives on expansion with case studies of two organizations from the state of Oregon in the Pacific Northwest of the United States: Independent Environments, which supports approximately 20 people with an annual budget of approximately $1,000,000, and Partnerships in Community Living, which supports approximately 115 people with an annual budget of approximately $10,000,000. These organizations have pursued different policies regarding growth, with different patterns of success and difficulty. Examples of other organizations are used as well, so not all examples pertain directly to these two organizations.
Many organizations seek to grow and aggressively pursue opportunities for expansion. Expansion may include supporting increasing numbers of persons within extant service modalities, expanding to provide new types of services, or branching out to serve new populations. There are numerous reasons for growth, including diversification of funding sources, increasing revenue, or fulfilling organizational missions. Diversification of funding sources is particularly attractive in times of governmental reorganization. Reliance on one source of income leaves an organization vulnerable to changes in funding priorities or governmental reorganization. Diversification of services refers to developing residential supports, employment services, or alternatives to employment services when one has not done so previously. Expanding to serve new populations might include providing services for persons with chronic mental illness instead of focusing solely on persons with developmental disabilities. An organization that excels at residential supports might add low-income housing for persons without identified disabilities. Increasing revenue through expansion is often a powerful incentive for organizations. Although it is a primary goal for a for-profit organization, increasing revenue is often just as important to nonprofit organizations. Increasing revenue opens many options for organizations, such as increasing pay, adding staff members, and pursuing an economy of scale. Benefits packages for staff members often can be improved by simply adding more staff members. In many places, rates for service increase with successive waves of service expansion.
High quality organizations may be asked to add services, with the logic of doing well for a small number and doing even better for a larger number. Growth might come from wanting to do a better job for people they support by providing more services. This was the case for one organization, Partnerships in Community Living, which provided only residential supports until recently. This organization had considered for a long time whether they could provide employment supports as well. They had experienced significant growth in residential supports as part of the closure of the large public institution in Oregon. Following the rapid growth in residential support, the organization decided to tackle adding employment services, initially wanting only to provide individualized employment supports for people already in the program, but eventually expanding to serve people not receiving residential supports from them. As a final note on this topic, change will come to an organization whether the organization wants to change or not. Pursuing a policy of growth invites a well-planned approach to growth and change. Many say that organizations must grow or die.
Why Not Grow?
Although there are powerful reasons to grow, there are also many powerful reasons to avoid growth, namely, costs of growing, some of which are hidden and some apparent. The first concern is that growth will hurt the quality of services. Both organizations serving as examples for this article had periods of time in which their excellent quality was a direct result of the direct involvement of their administrative staff in all aspects of services. Independent Environments is still small enough that the central administrative staff is knowledgeable about activities in all sites. Communication is far simpler when there are fewer people with whom to communicate, and one can be sure that staff members in multiple settings are “on the same page.” Partnerships in Community Living, on the other hand, is large, so it became necessary to create information systems to keep administrative staff informed about daily supports and activities. This organization also found it important to spend significant amounts of time in mentoring and training. The co-director of Partnerships in Community Living made it a point to keep involved in direct support, but many executive directors find it impossible to continue direct involvement with clients. It is these very daily operations that motivate most people in this field to keep going year after year. Administrative duties often do not hold the same charm and enjoyment, so growth may result in job dissatisfaction for an executive director who enjoys direct work with people who have disabilities.
Another cost is that growth may create an economy of scale, but it may also generate situations where administrative staff people, who are typically already overworked, become more overworked. Any significant growth must fund an expansion of infrastructure, but that may take away the economy of scale that the organization was pursuing in the first place.
Growth may destabilize an organization during growth periods or on an ongoing basis. An organization may have been doing well because of strong administrative oversight. When a new program is opened, for example, the administration may pay attention to start-up concerns. While that is going on, the oversight at other sites is reduced, and they begin to destabilize. Finally, growth may change the character of an organization or require the organization to maintain or re-create character, especially when expansion involves new customer bases that necessitate changes in philosophy of service or practices, such as serving adjudicated youth. However, these factors are not impossible to address and are considerations for an organization deciding to grow.
Aggressive Growth Perspectives
Partnerships in Community Living pursued an aggressive plan of growth, increasing in big chunks that typically coincided with successive waves of downsizing in Oregon's large state institution. Growth was not well-planned initially, with little preparation occurring during expansion and inaccurate cost projections. The co-directors were involved in nearly every activity regarding growth. Along with the Board of Directors, the co-directors found it rewarding to grow and do well. “How can you say no if people have a need?” Around the point at which Partnerships in Community Living served 40 to 50 people, the situation changed. The co-directors could no longer do everything, and the organization needed to grow further to fund necessary expansion in infrastructure. The co-directors still tried to be around on site to “keep things on track” and avoid becoming a bureaucracy.
During the following phase of expansion, Partnerships in Community Living grew to support about 70 to 80 people and had 150 to 175 staff members with a focus on increasing programmatic capacity. That took care of some of the program needs, but the administrative capacity was not sufficient. There were some financial control problems, but, on the positive side, the co-directors still knew everybody's families, and the organization still had a grass-roots feel.
In the final wave of expansion, administrators of Partnerships in Community Living focused on improving the structure of the organization. It is important to note that in Oregon each successive wave of expansion was better funded than the last, an incentive to keep growing. Partnerships in Community Living hired a competent accountant, and the co-directors earned master's degrees in rehabilitation administration. Growth had to be efficiently planned due to the size and complexity of the organization. For each new person being supported, a careful assessment was made of necessary support needs, including behavior support capacity and health care. Partnerships in Community Living had a staff person who focused on development full time, built a quality assurance team, and developed a training institute. Growth brings opportunities to develop skills of existing staff members and offer promotion if there is a good job match. Administrators of Partnerships in Community Living found that as the organization grew, they became more able to provide person-centered services due to the expansion in resources. Partnerships in Community Living's experience, though, is that even with careful planning, there are always growing pains. Administrators found a significant need to re-create and maintain the sense of history and culture within the organization. In 2001, about half of the direct care staff members had many years of experience, and the other half had been there under a year. However, this organization has seen many benefits from their choice to aggressively pursue growth, and personnel are pleased with their decision, finding that benefits outweighed the costs.
Slow Growth Perspectives
Independent Environments pursued a much slower, more measured pattern of growth, with expansion occurring one program or one person at a time. Administrators have tried to make “smallness” work, focusing very hard on providing a sense of community within programs and trying to keep programs within one part of their community (the Eugene, Oregon, metropolitan area). Although not currently the case, Independent Environments tried to have all programs within a 5-minute driving radius. Independent Environments is a residential program only, though some alternative-to-employment supports are offered. The slow growth has assured that administrative staff members are very visible within programs, and the slow growth in management has created opportunities for direct-care staff members to move into management positions in a mentored approach. Independent Environments administrators try not to expand unless the growth can build upon existing resources. They have tried to grow with supports for individuals one person at a time rather than opening new group homes. There is a focus on utilizing natural supports rather than creating new supports. Many positive aspects are seen to this pattern by staff and the Board of Directors. There is a sense of culture and significant longevity in employment among staff members, much like that seen with Partnerships in Community Living. Existing expertise is used, and there is an effort to grow at a pace assuring that continuity is not lost.
The administrators of Independent Environments believe that a smaller organization faces fewer challenges in meeting its mission of high quality services for persons with disabilities. There is more time to focus intently on needs of people, both those receiving supports and staff members, with the potential for a great depth of knowledge. The executive director of Independent Environments had stated that Independent Environments is not cost-efficient, does not offer multitudes of services, but does focus deeply on the people they support, their families, their challenges in life, and their dreams. This does not mean that deeper relationships and this level of focus are impossible in a larger organization, only that there are greater barriers due to the sheer numbers of people involved. The director of Independent Environments noted that the more people there are, the more relationships there are to build, and the harder it becomes, almost diluting results. Personnel at Independent Environments made the decision to grow slowly rather than rapidly, as it may have been too difficult to maintain that focus. However, they now see disadvantages in their slow growth. Funding is low, and the starting wage for staff members does not compare well with wages of other providers in the area. As noted previously, new development in the state of Oregon is better funded than previous development, and many organizations grew to help support their current group of people being supported, who did not have large service payment rates. This policy in Oregon and common in other states as well created an incentive to grow, and organizations such as Independent Environments that did not aggressively pursue growth have lower average service rates. Administrators of Independent Environments plan to pursue future growth, particularly in new areas of support, such as in-home service through brokerages, but will concentrate on growing in the geographical area in which they are currently located. They see that their choice of slow growth has brought many benefits, because they believe that small is beautiful, but it has presented challenges as well. In the balance of things, for Independent Environments, it was worth it because slow growth has allowed fine tuning of their goals.
We encourage each organization to pursue their own unique culture in growth. Growth has to start from the staff members' and the Board of Directors' vision of where the organization wants to be. Growth should not be careless; it should be deliberate and planned, with infrastructure needs carefully considered. Both Independent Environments and Partnerships in Community Living, although pursuing very different approaches, were strategic in their growth and their consideration of what infrastructure needed to be in place (e.g., factors such as transportation, expertise, staffing, community, logistics [such as accounting software and office space], and teamwork). We recommend that as many staff people as possible be involved in decisions and strategies around growth. Partnerships in Community Living added infrastructure, whereas Independent Environments did not need to add much infrastructure due to its policy of not pursuing new growth until previous projects were fully integrated into the organization. Both organizations are glad that they pursued their own individual paths. Although much that has been discussed in this article is consistent with growth in generic business, the philosophy and practices differ, which sets human service apart.
Note: The second and third authors contributed equally and are listed in alphabetical order.
Authors:Daniel J. Baker, PhD, Professional Development Specialist, Oregon Rehabilitation Association, 1655 25th St. SE, Salem OR 97302 ( DBAKER@oregonrehabilitation.org). Joanne Fuhrman, MBA, Partnerships on Community Living, PO Box 129, Monmouth, OR 97361. Fred Renter, MS, Independent Environments, 946 Coburg Rd., Eugene, OR 97401