A few of us lonely voices have long been warning (e.g., Wolfensberger, 1994, 1997) that the culture of modernism, as embraced by the United States and more or less all other Western societies, is not sustainable, and that collapses both are bound to occur and could be very sudden. Experts on systems theory are well aware that complex systems in particular can collapse much more quickly and drastically than simple ones and are also more difficult to restore. The recent economic crisis is the result of one such unsustainability, and happened with such startling suddenness that even the world's leading economic experts were taken by surprise.
There are several points about the current financial crisis of relevance to our discussion.
1. The current crisis has been brought about by a combination of the country living beyond its means and a systematic transfer of wealth by immoral (even if legal) means from the lower and middle classes to the uppermost—and widely unproductive, parasitic—class. There is no work that warrants someone getting paid $464 million a year, as many hedge fund managers were in 2008 (Armangue, 2009). No one creates any real new wealth like that, even in a lifetime.
Strangely enough, even the economic experts of the world, and the world-class mathematicians (“quants”) who built the mathematical models for the financial market, not only failed to foresee the coming disaster but even contributed to it happening, yet they cannot fully explain it. They have not yet understood the dynamics of postprimary and postsecondary production economies like ours that produce less and less and surrender much manufacture and agriculture to other countries, from whom they then buy commodities and products by going into debt. This is said to “save money” when, in fact, it ruins a country over the long run. Ironically, the leading “quant” who was a major actor in bringing about the 2008 collapse, Daniel Xi Li, was well on his way to a Nobel Prize when his theories blew up (Philips, 2009).
2. Societal developments always find expressions in the domain of human services, and a big expression at present—and the one we are concerned with here—is a reduction, as well as feared further reduction, of public funding of human services and advocacy. Even such bodies that are privately funded are experiencing hardships because of reduction of their investment income, capital, paying clients, and/or private donations, the latter despite fairly desperate appeals. When all of society suffers hardships, service and advocacy bodies, and families of vulnerable people, should not imagine that the hardships will pass them by.
3. Economic hardships are known to have particularly severe impacts on already vulnerable people.
4. There are many authorities in economics, politics, and the media who tell us that the current crisis will be short lived, that recovery will soon (or “is bound to”) take place, and that economic growth will continue where it left off in 2007. However, there are also some doubters, myself included, who suspect that we will never see the prosperity of 2007 again, or for very long. Also, we need to face the fact that as the lonely voices keep pointing out, an even bigger collapse of Western cultural ways is inevitable, sooner or later. Yet, a large proportion of the population does not want to hear these things. They want to be given “good news” and what they call “hope” —in other words, they want to be lied to.
5. Even if the financial markets recover somewhat, sooner or later, things must get much worse. There are at least eight reasons why it is doubtful that economic recovery will occur, or will last long if it does.
a. Probably a permanent warfare with Islamic radicals, much as Europe and even just traditional Islam were at war for 1,100 years, from roughly 700 to 1800. This will absorb vast amounts of money.
b. Environmental degradation that will exact high costs.
c. Climate changes that will not only play havoc but will also be exceedingly expensive. For example, entire nations will be under water soon. On the New England shore, water levels have been predicted to become particularly heightened, by as much as 3.5 feet. People have simply not contemplated the costs of such events.
d. A decline in some energy sources, and an increase in the cost of extracting energy. It is unlikely that we will ever see cheap energy again.
e. An increasingly sick, elderly, and dependent population. In regard to aging alone, for an economy to thrive, it needs a much larger percentage of children who are capable of becoming productive adults, but developed societies no longer generate enough children to support an aging population, in part because these societies are not generating sufficient traditional families. The trends are rather stunning: about 1955, the percentage of the population below age 4 exceeded that of those above age 65 but then began to decline steadily while the percentage of elders grew steadily. The two curves crossed in 1965, and now elders make up almost 20% of the population and young children less than 5%. By 2050, the elderly are predicted to be almost 30% more of the population than young children (see Goldman, 2009). No amount of bail-out money can overcome this demographic reality!
f. An increasingly decadent, nonfunctional, and bureaucratized society, with ever fewer functional systems and people in it.
g. An increasing sentiment to make medically dependent people dead. In Oregon, it has become standard procedure for the state's health insurance plan to tell patients who had no insurance, or whose expensive treatment costs were being denied, that the plan would fund their very inexpensive suicide assistance (e.g., Marker, 2009).
h. Hardly anyone willing to make tough and unpleasant relevant decisions until it is too late, if even then, as exemplified by the current responses to the environmental and financial crises.
6. What is fairly well understood—though also ignored—is that there are not too many ways in which a country can live beyond its means, as we have been doing.
a. One is to print money, but this only works for a very short time until inflation catches up with it.
b. Another is to strip nature of its resources until it kicks back with a fury, as it is now doing.
c. One can borrow money from other countries and future generations. So far, we have done (b) and (c).
The American government is currently borrowing 50% of its expenditures (Brooks, 2009). Almost all our current bail-out packages are being financed by going deeper into debt to other countries. We have also been selling the infrastructure and the means of production to foreign countries, which we have been doing in a hidden way for the sake of short-term income up front and which is another way of going into debt to foreign holders. Also, Social Security in the United States is a big Ponzi scheme to which the country now owes $2.5 trillion that the next generation has to pay. There are also hundreds of billions of dollars of unfunded liabilities by states and local governments, including health benefits and pension funds, and these too are a debt to the future. These liabilities are being kept hidden from the public. The federal Pension Benefit Guarantee Corporation may soon need a bail-out itself.
One manifestation of people and nations not willing to live within their means is what the experts and leaders offer as the answer to the decline in domestic production, excessive consumption, low savings, and foreign borrowing, namely “more of the same”: resumption of consumption, no more than small savings, and dramatic increases in foreign borrowing. The U.S. budget deficit is anticipated to quadruple in a single year.
British Prime Minister Gordon Brown told us that 20 billion more people in the world need to quit being producers and become consumers (Flaherty, 2009). The cover of Newsweek (March 23, 2009) even trumpeted, “Uncle Sam wants you to start spending,” and headlines demanded, “Stop the Frugality” (p. 5), “Stop Saving Now!” (p. 27). Time reported, “Savings are up, unfortunately” (2009).
One of the responses of our Congress was to lard the February 2009 bail-out bill with wasteful spending, special interest deals, and 15,000 member items (read “pork”), which averages out to roughly 30 items per member of the two chambers of Congress (Grunwald, 2009). All this in violation of the economist Herb Stein's law that says that if something can't go on forever, it won't.
7. So far, I have not seen any sign that the different interests in society and human services are willing to acknowledge that major sacrifices will have to be made on everybody's part, though there has been plenty of willingness to sacrifice other people's interests.
Cutting back on spending and consumption would be a way of living within one's means, but virtually no one wants to do that. The “masses” have little appreciation of what has been going on. They want lower prices and higher wages, and if these are an impossibility given a country's situation, they may riot, and/or overthrow their governments, as has happened in a number of countries during the current, as well as previous, crises. Because of such riots, a scared Greek government quickly reversed public spending cuts, probably by going into debt or inflation. The governments of several other countries have fallen without riots after being blamed for the advent of economic reality. The debts of several countries have been demoted to junk status, and others are teetering on the brink (e.g., Hall & Day, 2009; Margolis, 2009).
Similarly, hardly any parties that rely on government funds have shown any willingness to voluntarily effect savings or shoulder their part of the societal burden. As I said, everybody wants everyone else to cut back but not themselves.
At least 46 U.S. states face a total of $350 billion in budget deficits over a 30-month period (Basler, 2009), and some are facing outright bankruptcy, like California.
But if you follow the news, you will have seen innumerable oppositions to specific budget cuts. For example, major organizations, including the American Association of Retired People, are even opposing state budget caps altogether, even in bankrupt California. They want something cut, but not anything that benefits older people, even affluent ones. Even though the czars of the financial world live or work in New York State, it has the country's highest taxes, and yet a huge budget shortfall, hence a huge deficit and debts. Its governor, David Paterson, said in spring 2009 that the state had the “worst fiscal crisis in its history,” and asked members of the legislature for suggestions on where to cut, and not one single legislator proposed any. Different human service interest groups held rallies around the state, though in my opinion more to protect their jobs than the people they serve. Public worker unions and other groups spent millions of dollars to convince the public of how poor they are. One thing the governor said was that the well-paid state employees union must agree to reduced compensation or face a cut of 9,000 positions. Replied the public employees' union president, “We will not agree to any changes…that reduce compensation” (Brynien, 2009). A union counterproposal was to rely on federal bail-out money instead (Tedisco, 2009). When the governor suggested some very sensible and relatively painless new taxes, such as a tax on sugared soda drinks and on luxuries such as beauty treatments, massages, gym memberships, and entertainments, he was shot down on all of them, and his previous popularity waned to almost nothing. The governor then called an emergency meeting of the state senate, which agreed to no cuts at all. The meeting was emotional and chaotic, and legislators almost came to fisticuffs. A newspaper editorialized that the governor was the only adult in the room (Riede, 2008). Eventually, New York state passed its biggest budget ever, 10.3% above that of the previous year, also increasing the deficit by 11%, but it was interpreted as “cutting spending” by $6.5 billion.
In one instance when it was proposed in New York to cut a state subsidy to the arts, a howl went up. Some people would rather sacrifice a few dozen group homes than their enjoyment of a live symphony performance, or the display of unintelligible or morally offensive paintings or sculptures.
What is happening in New York state is just one example of innumerable instances all over the country of people sticking their heads into the sand.
8. One day, the reckoning will arrive. Lenders will demand their money back, and the only way to pay off our unimaginably large debts will be by impoverishing the country. In essence, our progeny will pay for our profligacy. Confronted by comparable situations, several countries in the past have defaulted on their international obligations.
9. The response in human service and paid advocacy circles has been loss of nerve and panic. In turn, this has set in motion first a desperate competition of the service and its related advocacy sector against all other expenditures, and, second, a vicious and irrational competition among service and advocacy bodies for the remaining funds. An example is the area of cancer research, where the lung, bladder, brain, and other organ-centered cancer organizations are at each other's throats, trying to take money away from each other, as a result of which funding becomes arbitrary and irrational. In order to make shameless lobbying for money for oneself or one's own cause look better, some people have begun to call it “advocacy,” and training to do lobbying may be called “advocacy training” (Forsyth, 2009). The parties that protest proposed or actual cuts for their own services hardly ever make counter-proposals as to where savings might be achieved, though the implication is very clear that it should be some other program that should be cut. As of 2008, there were 16,000 registered lobbyists in Washington, DC, alone, up 50% over 1998, plus 295,000 other unregistered high-level influence peddlers (Samuelson, 2008).
The fights over the shrinking dollar have also contributed to intergenerational adversarialness. Younger adults want more unemployment benefits and more tax rebates; older people would rather have pension protection (Economic Stimulus Priorities, 2008).
All of this has become animalistic and disgraceful, and is of the nature of cries, “Don't take our money, take that of the other service or advocacy sectors or bodies, and let the devil take the hind-most.” I have seen no sign that the different service and related advocacy parties are willing to acknowledge that major sacrifices will have to be made on almost everybody's part, though there has been plenty of willingness to sacrifice other people's interests.
We need to wake up to the fact that in human services as in other sectors, we have gotten very spoiled, and taken a lot of things for granted that a distressed economy or society will now or soon no longer be willing to fund, or even able to afford.
Declines and collapses of and in Western culture and lifestyles are and will not be surprises to us lonely voices.
At the 1976 convention of our association in Chicago, I gave a plenary presentation (entitled “A Look at the Future Directions of Human Services in Light of Historical Developments”) in which I warned of the signs of decadence and collapse of our society, and the impending deathmaking of societally devalued people. After that, I became a pariah in the field, even to people who had previously celebrated me for my work on the principle of normalization and citizen advocacy. My message was totally rejected, and I was practically declared insane.
In 1992, I spoke again at another plenary meeting of our association here in New Orleans. By then, many of my 1976 predictions had come true, but also by that time, a great many members who, in 1976, had denied that these would come about had embraced the very elements of decadence and deathmaking that I had predicted. In 1992, I spoke on the signs of the times, underlined the increasing decadence and the deathmaking of vulnerable and devalued people, and made further dire predictions, many of which once again have come true.
The 1992 plenary was published in our Association's journal, Mental Retardation, in February 1994. The abstract of the article probably set a record of brevity for the journal: “The world is going to hell in a wheelbarrow, and this is not going to do retarded people any good” (Wolfensberger, 1994, p. 19). You can also read there that I said the following, “In an intermediate state of collapse are the financial institutions, such as banks, credit systems and insurance” (of course, by 2008, “intermediate” collapse had slipped into “total” collapse). I also said, “I believe that now entering a state of collapse are…private pension funds.” (I actually had started to draw attention to the increasing theft of people's pension funds in the October 1989 issue of the human services newsletter TIPS that our Training Institute published, and in many issues thereafter.) And I added, “Even people with graduate degrees can no longer deal with taxes, banks, credit cards, insurance,” because of how complex these had become.
One of the other things I said in 1992 was that people should stop trusting government because it habitually lies (p. 32). I also said that the people of the culture of modernism—including academia, scholarship, the research culture, the professions, and professional and scientific organizations—were being insanicerated, meaning made crazy and insane, and that unpleasant truths are not and cannot be dealt with (p. 75). Ask yourself: are you, or do you want to be, insanicerated? Do you want to embrace what I called “normative insanity”? If not, what are you going to do about it?
I said also that “truth and reality are like the mighty Mississippi River a few steps away from this hotel. It is there whether one sees or knows it or not, and especially relevant to people of our day, whether one likes it or not…one cannot wish it away…” (p. 25). This was aimed at the new constructivist mentality that makes up realities to suit one. When one makes up “false realities,” the “real realities” will eventually assert themselves with a bite.
Further, I said that at times of societal distress, mentally retarded, impaired or dependent people will fare poorly, and I called for anticipatory planning for the difficulties ahead.
To my surprise, the 1992 presentation was well applauded, probably for the wrong reason, because it was promptly also forgotten. There was probably more consternation over the fact that I did not use politically correct language than that the world was going to hell in a wheelbarrow, and no anticipatory planning ensued. However, one reader in France called it a “pre-mortem” on our society.
Although we are still a very wealthy country in which even the poor live in comparative luxury, one thing that may be beginning to sink in is that vulnerable people will suffer first and worst when things get rough.
Not all service sectors and expenditure patterns are equally threatened by the current fiscal crunch. Six that have considerable protection at least over the short run are the following.
1. The states are not likely to cut back programs that are totally subsidized by the federal government, or that are so federally subsidized (e.g., under Medicaid) that the states in essence are “making money” from them.
2. Programs that were generated in response to lawsuits and court decrees have a certain amount of protection.
3. So do service or benefit sectors that have very strong constituencies and lobbies, such as the hospital and nursing home ones, and the American Association of Retired People. Families who take care of a family member may belong to no relevant organization, or only a local one, and therefore have no clout in the competition for funds.
4. Sectors that benefited from the capricious nature of the bail-outs. Some have gotten windfalls; others were left to the devil to take. However, this funding source will not last very long, maybe 2 years.
By the way, we keep being told that there was one big bail-out, when in truth, we have had four. The first was near the end of the Bush administration, the second one soon after the Obama administration came in, the third was hidden in the mammoth deficit federal budget, and the fourth was an almost totally unheralded infusion of $1.2 trillion by the U.S. Federal Reserve into the economy. This exemplifies what I mean by the government lying to us.
5. Services that thrive on the anxiety of people who still have money. Thus, fear is driving people into the arms of psychological counselors. There was a recent summit meeting of the American Psychological Association on how the present crisis will “enable psychological practice to thrive” (Martin, 2009). The chief executive (Norman B. Anderson) of the American Psychological Association shamelessly said that one of the recent bail-out packages offered psychologists “tremendous opportunities” (Anderson, 2009).
6. State and local service providers will try to protect their workforce even if they have to sacrifice their clients. In other words, the economic crunch will fall more severely on actual or potential service clients than on service agency people. Is that good news or bad news?
However, tomorrow, even the currently still protected service sectors may no longer be favored, and the people in the still protected services (especially those receiving bail-out monies) are apt to be lulled into a likely false sense of security.
When resources are tight and competition for them fierce, we in human services and advocacy need to think rationally, strategically, and ahead of time about (a) what to propose to our funders, and (b) what we can do that is in our power to get the most service value for the dollar. We need to develop a cost/yield mentality, and ask ourselves questions such as the following.
If we were given a certain limited amount of money, how would we allocate it so as to get the most service value for it?
What are the most basic kinds of services?
If we had to sacrifice something, what would it be? What sacrifice would do the least harm? What service would trump the others? If having homes for so many people goes up against getting dance therapy for them, which are we going to fight for?
What will we fight for to the bitter end?
On our part, we also need to develop a mentality of parsimony. Can we think of clever ways of holding costs down while still meeting the most pressing needs?
Services and advocacies also need to evolve a relatively united front, with shared strategies, or the government will play one party against another, and beat both down.
If we fail to do these two things, cuts will be made capriciously by ignorant, partisan, irrational, and unstrategic parties, and any number of patterns of cuts can leave vulnerable people far worse off than if the same amount of cuts had been made rationally. Often, the cutting decisions are made by management people in government who do not really know the service sector. How did people like that get into the most powerful decision-making positions? Sometimes, they came with schools of management degrees, and sometimes, they rose in the administrative hierarchy without ever having had much clinical experience, or even training.
It is, of course, possible that no matter what we try to do, we will have no voice in the decisions being made. But we should have some rational proposals to make to the degree that we are given a voice.
I will now make a series of broad strategy proposals that aim at a favorable cost/yield ratio.
1. We should be willing to cut services that are of low, if any, validity or productivity. This includes the many human service crazes that keep washing over the human service scene in great waves that come and go. One day it is est, then “patterning,” then touch from a distance, then Reiki, then dolphin therapy, then waving one's hands before people's eyes, and so on. At any one time, a significant proportion of human service consists of the transaction of invalid crazes. Much of this craziness arises out of magical and superstitious thinking that is not recognized as such, and even masquerades as science. Shamanism would be much more straightforward. What goes by the wayside are valid pedagogies that sometimes have been known to work for hundreds, or even thousands, of years. This explains why children are no longer learning to talk, read, write, cipher, or even walk right.
Unproductive service activities include a great many of those that are done for what I call nonprogrammatic rationales. Programmatic issues are those that are raised by the needs or identity of a person or class—in other words, what gets done to or for the party in the way of services and helping that is based entirely on what the real needs of that party are, and would benefit that party rather than another party. Thus, we can speak of programmatic service issues not only in formal service contexts, but also in informal and unpaid ones.
Nonprogrammatic issues are those that affect the way a service is rendered but that are not derived from considerations of the people's identity or needs. They include things such as what the law, regulations, or courts forbid, allow, or mandate; what the funding enables or disallows; how certain historical realities express themselves in the service; what political processes enable, distort, or prevent a programmatic measure; and whether there are people available who can and will do the right thing.
It is very rare that a service gets shaped exclusively on the basis of what is needed by, and is best for, a service recipient. Typically, a large number of nonprogrammatic issues shape a service, and especially formal ones. Nonprogrammatic measures can facilitate the address of recipients' needs, as when funding is attached with requirements for accountability to show that the funding actually benefited recipients. However, typically, the nonprogrammatic issues constitute obstacles to providing what is needed and to maximizing the quality and efficiency of the service, and programs tend to be distorted and subverted in all sorts of ways by the nonprogrammatic issues. For instance, a law or funding mechanism may disallow a provision that would benefit people. Available staff may not be competent to do what would address a person's need. And so on.
Extremely problematic is that the minds of people, especially those of human service workers, have been shaped so that they commonly treat nonprogrammatic concerns as if they were programmatic ones. For instance, many human service workers believe—or at least act as if it were the case—that if the law requires something, then it must be good for recipients, and whatever the law prohibits must be bad for them. People also tend to drift into thinking that legal, administrative, and fiscal categorizations of services and of recipients reflect actual recipients' needs and/or possibly meaningful clinical syndromes and diagnoses.
A vernacular way to think of the nonprogrammatic considerations is that they all are examples of the big “buts…” that we hear so often: “But the law won't let us,” “but our funder requires,” “but our staff don't,” and so on. So whenever one of those “buts” comes up in one's mind, one should ask oneself whether it is a “but” that is an objection because of some nonprogrammatic constraint.
Nonprogrammatic activities have become increasingly required for bureaucratic reasons, for self-defense of administrative structures, for warding off lawsuits, and so forth. This includes a lot of record-keeping, spending time on computers and in meetings.
One type of work that could be cut out because it is done for largely nonprogrammatic reasons (and at any rate is not very productive) is most of individual program planning, and even case management. While these can be very helpful, in my opinion, they have become so pro forma and bureaucratized that in terms of recipient benefits, they pay back only a small fraction of their enormous costs. Some people do “IPP work” full-time, and computers are programmed to spit out identical “individual plans” by the millions. There is also the problem that what a plan aspires to often goes far beyond the basics, is costly, and there is either no money to fund it, or only inequitably so. Better to retain that which the manager was supposed to manage, and the planner to plan. Otherwise, we will have plans, but nothing with which to fulfill them, like plans to nowhere, and managers of nothing. This is not an exaggerated statement, because there are, in fact, people who are unemployed, hungry, homeless, and friendless, but who do have one or more case managers, and a great deal of individual program planning.
Of course, there is no obstacle to people doing personal planning on an unpaid, voluntary basis, as some people have been doing all along.
Another example: school people—often in conjunction with parents—spend countless hours in justifying some educational provision for a child with a handicap (e.g., Lindsley, 2009). In essence, they are being paid to fill out forms and write justifications for being paid, a wonderful way to employ people unproductively and stimulate the economy. Reduction of bureaucratism would also make the lives of service recipients and their families so much easier.
Here is another example. There are small state-run residences and day centers for troubled youths scattered throughout New York State. Nine of these have been virtually empty though they still had full paid staff complements. One such 24-bed residence had 25 employees but no residents. A bed, even though unoccupied, costs between $50,000 and $100,000 a year (Goldberg, 2008). The state wanted to close these underutilized, low-security centers and use the money to serve youths some other way, but both unions and legislators opposed the closures (Common-Sense Cuts, 21 Nov. 2008).
Altogether, low-validity and nonprogrammatic activities get funded even as many people are left without the essentials.
A lot of costly bureaucratism is imposed from above, especially by the federal funding categories. One substrategy is to lobby for legislative relief, and another is to practice resistance and outright noncompliance as long as possible.
2. When pretty much the same service is delivered by a more expensive operator and a less expensive one, the more expensive one should be reduced or eliminated.
An example is services that in some states are being provided by both public and private agencies, but at a much higher cost by the public ones. We see this in New York state, where a huge community service system is operated by the state very bureaucratically and at great expense, side-by-side with much less expensive, private nonprofit agencies, even when these are funded by the state. The state might be able to save hundreds of millions of dollars by spinning off its services to nonprofit private providers, retaining only a quality-control function over those private services that it funds.
Also, privately run services can be reconfigured much less expensively than government ones, illustrated by the above story of the state-run homes for troubled youths.
3. We should be prepared to cut funding for services that are, or come close to being, luxuries, in going above the basic bread-and-butter issues.
In Syracuse, a so-called autistic boy goes to school with a so-called service dog, even though the boy is not blind, deaf, or halt. The dog supposedly “calms” him, and helps him concentrate. Since he has such a dog, he also has a paid “dog handler” who comes to school with him. The dog alone cost $12,000 to train, partially paid for via Medicaid. A law got written that children have a right to have service dogs with them, though two of the child's potential teachers are allergic and cannot be in the same room with the dog (Doran, 2009a). This was happening even as the governor was accused of wanting to cut school funds. Paying for both a dog and a handler, on top of all the other special arrangements for this child's presence in a generic school class, is the kind of luxury that someday will be unaffordable, and we need to be capable of recognizing the difference between this kind of arrangement, and those that pay for giving any kind of education for impaired children who at one time were excluded from schools altogether.
Some luxury enterprises border on the ridiculous, such as helping a paraplegic to climb Mt. Everest, go skydiving, and similar things, which often ensue from personal futures plans (about “dreams” and “visions”) and are egged on by advocates and service workers. Even if such luxuries are privately paid for, that kind of money should be spent on the basics for people.
More on luxuries later.
4. We should cut down any salaries or compensations that are extravagant—and yes, there are such, even in human services, mostly in administrative positions or health care.
There is one human service institute director in our field who earns close to $500,000 a year, mostly for bringing in big grants. While we do not have much influence over health insurance, Blue Cross/Blue Shield in the central New York state area paid 62 employees more than $200,000 a year each, and its CEO got $2.73 million (Mulder, 2009). Many chief executives of private colleges are earning in the millions, and even many professorial salaries are excessive.
If an administrator who earns a luxury-level salary will quit the field if the salary were to be cut to a reasonable level, then the people served might actually be better off. But it is unlikely that such a person would quit if there were no such high salaries to be gotten elsewhere. They might be grateful to get only $80,000 a year.
Income luxury is also found in the retirement plans of some states. In some, one can retire in one's 50s at a high percentage of one's salary. This is, in essence, an incentive to retire very early and then take on a different job in human services at about the same pay as one's old job, and live excessively from the combination of one's pension, new salary, and eventually perhaps even a second pension on top of Social Security income.
Exorbitant incomes in any field are particularly scandalous if the service recipients are overwhelmingly poor, as is the case in our field, welfare, and a few other fields and services.
5. We should be willing to accept cuts of services that are inequitably allocated, with some people having vast sums spent on them while others with similar needs get little or nothing.
For instance, some people get subsidized to the tune of about $200,000 a year to live in their own house, with full-time attendants around-the-clock, while ordinary people have no one who pays for their houses, and while some of their handicapped peers may live crowded, two to a very small room, in nursing homes. Often, it is handicapped people with a lot of powerful advocate figures behind them who get the palaces while their abandoned peers get the hovels. It is in instances such as these that the categories of luxury and inequitability overlap. The example I gave is certainly inequitable, but is also a luxury in that few single adults get subsidized to own a whole house. They are often lucky to get subsidized to live in a seedy single-room-occupancy hotel. Yet renting or owning a home has for years been forwarded as the ideal solution for people with intellectual impairments, without any debate of the many problems in addition to inequitability that are associated with this measure.
There is one scenario where inequitable resource allocation can save money overall. It occurs when institutions are getting phased out. As the number of residents declines, their per-capita cost increases greatly, which is why states and Canadian provinces have sometimes committed themselves to shelling out astronomic sums in order to get the last few residents out of institutions. However, this sits poorly with families who had taken care of an impaired person at home, and who were told that they had to do “more with less” while people who were about equally impaired got huge subsidies for community placements.
There are many inequities in open society, such as social parasites being paid hundreds of millions of dollars a year. Reducing them could free up money for needy people. However, here I am speaking mostly about inequities within human services to mostly vulnerable people.
6. There are services of which there are more, as well as less, desirable alternatives. When funders prepare to cut a preferred service version so as to leave no service at all, but the less preferred one can be offered at lower cost, it is smarter to plead for a retention or reinstitution of the less preferred version than to have no version at all. For example, in education, any number of options are preferable to no education at all. In a high school in central New York state near Syracuse, a boy with partial vision was assigned two personal aides to assist him to be able to be “included” in a regular class (Doran, 2009b). Could the child be maintained with fewer than two personal aides? Does every child with one personal aide need one, or could aides be shared among several needy children? Are there never any suboptimal but still viable alternatives? Soon, personal aides might outnumber the students in a class. Smaller classes may be more desirable than larger ones, but large ones are better than none at all.
Another example is that there are integrated and segregated versions of the same service, but again, the segregated one is better than none at all. Thus, when expensive educational integrations are being cut, it is still better to have segregated classes than no education at all. If expensive, so-called supported employment options are being cut, and especially if they were largely make-believe ones at that, then which is better for adults with a handicap: to be in a sheltered workshop, or to have no day activities at all?
When individual residential placements are being cut, one can fall back on group residences. After all, at one time, group homes were like palaces to people in institutions. If we do not watch it, society may take away both individual living arrangements and grouped ones, and give us back the large, snake pit institutions. Pressures—and even tendencies—to do so have actually never gone away, and in cost-cutting measures in some states, some group homes have already begun to be defunded (e.g., Ansberry, 2008), and institutionalism has been revived.
Relatedly, we need to keep in mind that even segregated services can be normalized, normalizing, and social-role–valorizing in many ways. Consider the fact that segregated group homes these days are usually vastly more homelike than college dormitories.
Strategy 6 can overlap with Strategy 5, in that the less preferred alternative may be both less luxurious and more equitable. For instance, there is something grotesque about schools not being able to supply soap and toilet paper, while impaired pupils show up with entourages of multiple attendants, service animals, and animal handlers.
Strategies 1, 2, 3, 5, and 6 are particularly relevant in light of the fact that so-called “choice” may become a victim of the crunch, meaning that impaired people who have been enabled to opt for the most expensive of several service or living arrangements will be fortunate if they get any viable one at all. In other words, that part of the so-called self-determination ideology that called for giving service recipients the option to select more expensive over less expensive alternatives at taxpayers' expense is unrealistic. In fact, it was never rational to claim that taxpayers had no right to set conditions to the use of their tax monies.
However, there is one way out for some people, especially in residential settings, and that is to have family and friends supplement public funding with private money and upgrade the service. For instance, in some residential settings for dependent people, a single room costs less than double the cost of a shared room. Several benefactors chipping in a few hundred dollars each per month might be enough to upgrade a person from a crowded shared room to a more spacious, and more private, single one.
7. We need to give high priority to the recruitment of what I call “extra-structural” and volunteered services, which overlap somewhat. Extra-structural supports are all those that are not part of a formal organized or paid service, and they can be individual or communal in nature. Examples are what family members, individual friends, citizen advocates, or so-called circles of friends do for a person. Some volunteered helping is of a borderline nature in that it is mediated by a formal body and paid workers. Examples are volunteering for a service agency. Citizen advocacy falls in-between, because the recruiters and facilitators of the advocates and advocacy are paid, but the individual citizen advocates are unpaid free agents, each allied to a single needy person. Best Buddies and Special Olympics also fall in between.
Volunteering for some services can make a critical difference. In Syracuse, one of the hospices for the dying might not be able to function were it not for its many volunteer helpers. And citizen advocates have performed heroic deeds, including prying intellectually disabled people out of the service system altogether, and saving many lives (e.g., see Hildebrand, 2001). Unfortunately, the power of citizen advocacy is not widely recognized, and therefore, citizen advocacy has fallen on hard times. One benefit of recruiting volunteers is that even after their initial volunteer engagement ends, they are often recruitable again later.
Despite these realities, paid staff supporting volunteers are often the first to be cut. This then makes people angry who want to volunteer but are not well handled. It may alienate them forever from volunteering (Kadlec, 2009).
As I have done for decades, I call once again for the building or recruiting of such unpaid supports for handicapped people, as being the only thing that in many instances will be protective of at least some impaired persons when the structures abandon them and/or when societal order collapses, as it did in New Orleans in 2005.
8. Service bodies should hold onto at least a modest staff development and training budget. These budgets are commonly among the first to be cut, but if such cuts become long term, one ends up with even more incompetent staff than one would otherwise, and recovery is often not easily achieved, because the incompetent employees get entrenched, and future employees will not have good models and teachers. With at least some ongoing staff education and development that is valid and useful, a service can be prevented from becoming very much worse, and it may even be able to rise like a phoenix from the ashes if financial resources ever come back.
9. What we should fight to the bitter end to hold onto—or even to increase funding for—are services that prevent the certain escalation of expenditure of other sectors or services. A prime example is those home help services without which a person would end up in a nursing home, and where the home help service costs a fraction of the nursing home. Amazingly, like clockwork, home help services have been the target of reduction every time a money crunch has loomed, and I suspect that the nursing home lobby is behind that.
Funding home help services for elderly and handicapped people should trump nursing home funding anytime if it keeps people out of nursing homes. And, yet, a number of states have cut, or have been trying to cut, home services. For instance, New York state cut them by $68 million. Alabama ended homemaker services for more than 1000 elderly people (Basler, 2009). But then, New York state added $3.3 billion, or more than 7%, to its Medicaid program, which among other things pays for nursing homes, including for the people who now must go into nursing homes after losing their home supports. Respite services for families with an impaired adult at home can also prevent vastly more expensive residential placement. Invalid transport services are also common targets of cost cutting. Yet at least some of these keep their users out of hospitals and nursing homes, thereby saving vast sums.
An example of an irrational cost-cutting proposal in my area (central New York state) was the county announcing that a $20 round-trip Homebound Transportation Program would be defunded. This would have raised round-trip prices by other invalid transportation services to as much as $100 and driven many people into nursing homes where the costs are so much higher as to defeat the entire cost-cutting idea.
However, we should be willing to cut those transportation service subsidies that tend toward the luxurious or inequitable, such as transportation of people who have homes to live in to go to recreational events, while other people are homeless or reside in nursing homes for lack of essential transportation. It also makes no sense to subsidize transportation for individuals or families that have good incomes while such transport for the poor is curtailed (Mariani, 2009). Where money is tight, inexpensive subsidized transport should be reserved for the impecunious to make very important trips, such as to health services.
Another example of services to preserve are programs that help released convicts to reintegrate into the community and to stay out of trouble. Such programs typically cost a tiny fraction of imprisonment costs, save vast sums by reducing recidivism, but are also commonly among the first to be eliminated. For instance, in my home county (Onondaga), a mere $84,000 was being spent to support 2,300 defendants (O'Hara, 2009). Even keeping a single one out of prison would pay for the whole program. Cutting these kinds of programs is a typical example of being penny-wise and pound-foolish. A similar foolishness has been state efforts to curtail Medicare Plan D payments for drugs to poor elderly people, which would dramatically increase vastly more expensive hospitalizations. Overall, curtailing expenses at one level or department of government in a way that increases the expenses of another one is either psychopathic or insane.
In many states (such as New York), and maybe all of them, the ruling powers have the crazy idea that they can reduce their deficits by shoving some of their expenditures upward onto the federal government, as if federal money were not also the people's money, and were somehow inexhaustible, not to mention that such a shift is a violation of the principle of subsidiarity and will always cost more money in the end.
Certain preventive services would fall into Category 9, but this is too complicated an issue to deal with here. Also under this category, and related to No. 7, fall what one might call service multipliers. By this I mean public expenditure on a person that brings in other services that are not subsidized by tax monies but mostly by substantial unpaid supports by volunteer citizens. This would include giving small subsidies to families who will put in a lot of their own time and money to support a dependent family member, thus providing much unpaid service and keeping the person out of expensive service arrangements.
Another example of a service multiplier is citizen advocacy offices, because these have proven to recruit ordinary citizens who will voluntarily support dependent people extra-structurally, including some with enormous needs. As noted before, citizen advocates have performed miracles on behalf of their protégés, and even saved many lives. Because citizen advocates are unpaid volunteers, the only cost involved is funding a citizen advocacy office that employs some people to recruit and support a large number of advocates. Unfortunately, few people have understood the power of citizen advocacy, which is why it has fallen on such hard times, even though citizen advocacy offices typically function on a shoestring.
10. The competency development of impaired people should be taken much more seriously. At present, there are enormous variations in competency emphases in different services and settings, including in family life.
The more that people have bodily, social, and economic competencies, the less dependent will they be and the less paid services will they need. So all these competencies need to be cultivated from earliest age. Social and economic competencies specifically have been neglected lately, partly because of an emphasis on self-determination divorced from competencies and on “inclusion” above competency acquisition. Social competencies include such things as courtesy, obedience, cooperativeness, and social graces, and economic competencies include the ability and willingness to work and to submit to the instructions of superiors. It is pitiful to see so many grown-up people with handicaps lacking the competencies that they were quite capable of acquiring but now no longer can because countervailing bad habits have become so deeply entrenched.
At this conference and elsewhere, there has been much said about self-determination and so-called inclusion, but rarely is a link made between these and competency. This is the result of people having gotten insanicerated.
To foster competency in service recipients, one needs competent staff, but so many services have drifted into hiring ever less competent workers. In fact, they have been scraping the bottom of the employability barrel, hiring the people who are the last step away from unemployability and who sometimes do not even speak the language of those served. These people sometimes are good caretakers, especially where body care is needed, but are very poorly equipped to be role models, teachers, trainers, and developmentalists and to foster positive appearance, normal behaviors, good manners, and clear and civil speech. They often are poorly suited as residential staff, not only because of their poor social competencies but also their poor housekeeping. Many have never kept house themselves and acquired good stewardship. They do not know how to fix little things, how to buy house supplies, or even how to buy groceries and cook. They may then buy expensive meals to be brought in and run out of food money before the end of the month.
This hiring policy is a reflection of the mindsets of service employers that competency development in clients is unimportant or that the service recipients have no unactualized growth potential. Also, many services have no financial incentive to cultivate competencies.
An extremely difficult dilemma to resolve is the conflict between funding programs for children versus adults. Children have vastly more potential for competency acquisition, but they also usually have family support, whereas many adults are abandoned, or in the care of parents who are rapidly losing their caring capacity.
11. Unrelenting attention must be paid to public attitudes, because if these attitudes turn bad, this will override all safeguards, including laws, and endanger service funding even more. Attitude change work goes far beyond the tiresome, obsessive, and tyrannical current language policing. There is hardly any evidence that the so-called “people first” rules change anybody's mind content, while a great deal is known as to which attitude change strategies are effective, or even highly effective. These can be learned and used, and they do not necessarily cost money, only consciousness and thoughtfulness. For instance, increasing interpersonal identification between handicapped people and others in society, and creating positive images and especially valued roles for handicapped people, go a long way to fostering and maintaining positive attitudes.
12. People are being very successfully brainwashed into looking to deathmaking as the answer to any number of life's problems. It starts with abortion, going to infanticide, then suicide, suicide assistance, and involuntary “euthanasia,” including with cruel and unusual means, such as sucking out the brains of babies during birth, and gruesomely starving and dehydrating people to death. For instance, already over 90% of unborn babies predicted to have Down's syndrome are being aborted. People are willing to abort even because of the most minor or speculative problems, such as that their baby might develop “Alzheimer's” late in life. If the very lives of impaired and dependent people are not sacred, and not deemed worth living, how can we expect people to pay out vast sums in support of such persons once they are born and grow up? They are then people who by mistake were not killed in the womb or shortly afterwards, and who could even now save us much inconvenience and big money if we made them dead. Never too late, as in the case I cited earlier from Oregon.
There is a tremendous amount of deceptive propaganda in support of deathmaking. For instance, economic rationales are invoked for “letting (debilitated) people die,” and not using “high technology” to “keep them alive,” and then it turns out that the people who argue in these terms mean to starve and dehydrate people to death who are on relatively low-tech life supports, such as nasal tubes (e.g., Lukits, 2009). Higher tech life supports are increasingly being described as “torture” (Lukits, 2009), which is very convincing to a lot of people. Who would want to be a torturer?
The fact is that support for any form of deathmaking desensitizes people to other forms, and soon, debilitated people will have a duty to die, as is already de facto the case in several European countries. The logical and moral position to take is a reverence for life, and what I call a unity of life position that values the life of each and every human, and opposes all intentional dead-wishing and deadmakings. As I had already said in my 1976 speech to this association, the killing thought must be vigorously opposed.
With a reverence for life, one would also try very hard to protect those services that support the survivability of vulnerable persons. That includes access to most kinds of health services, at least those that do not function as the deathmakers for society.
Several of these 12 points I have also set forth in greater detail in my 2003 monograph, The Future of Children With Significant Impairments: What Parents Fear and Want, and What They and Others May Be Able to Do About It (Wolfensberger, 2003, pp. 43–53).
There must be additional ways of saving money in human services, plus there are of course many ways of saving vastly more money outside of human services, but speaking to the latter goes beyond the scope of this paper. Also, when competing against expenditures outside of human services, we need to choose our battles wisely. For instance, it is more plausible for us to go to war against public subsidies to jazz fests (a real vignette: Bialczak, 2009) than to suggest (as some people have done) that the Pentagon should hold bake sales for its fancy weaponry.
There are several principles that lie behind some or all of the proposed strategies.
Solidarity, interconnectedness, and communitarianism, in contrast to the radical individualism that is currently winning the values war. When there are so many hardships, there is something immoral and anticommunitarian to either wanting to profit from the hardships of others, or being unwilling to carry an equitable burden so that all the hardships do not fall disproportionately on just some people, often in an almost random fashion, or even mostly on the weakest.
Justice, as expressed in the equitability issues.
The principle of subsidiarity, that says that problems should be solved at the lowest possible level of social organization. The American service scene has done the opposite since about 1960: shifting local control and funding up to state levels, and state ones to the federal level. Many of the current societal and human service dysfunctionalities are fruits of this violation of a sound principle.
Realism. My 12 strategy proposals are not beyond reach, even though they would take a lot of battling for. Cost-containment ideas must have plausibility in order to gain ground. Petitions, demonstrations, and so forth, may save a particular service, but do not contribute to cost containment.
These strategy proposals should not be segmented, but should be considered in relation to each other, and in a nuanced fashion. For instance, take individual person funding versus agency funding. Some instances of person funding can save very large sums, either because they are in the category of “multipliers” or because they prevent more costly services, but other cases of person-funding are in the categories of luxuries and/or inequitabilities.
Here is an example of an arrangement of great promise that falls partially into the multiplier category, and partially into the category of least bad alternative. For many decades, the unemployment rates for handicapped people have been around 60%–70%, despite all the vocational, rehabilitation, and supported employment efforts and a roughly doubling of expenditures in recent years; yet, no one seems to be able to think outside the employment box. For about 20 years, I have been vainly proposing the crafting of unpaid valued adult work roles for impaired people, because working in valued and contributive adult roles, even if unpaid, is vastly superior to sitting about idle, perhaps in front of the TV, losing fitness but gaining weight, or hanging out with bad company. It is also better to be engaged in valued, unpaid adult work that occupies much of a typical adult workday than to be in paid work (e.g., via a supported work arrangement) that only occupies a few hours a week.
There have been at least four major obstacles to unpaid work by impaired adults.
North Americans now equate work with jobs. This was not always so. At one time everybody worked, but few got paid for it. All they got was their “keep.”
Ideologues have whipped up dependent people and their allies to spurn unpaid work, and interpret it in all sorts of negative ways, including being mere “voluntarism” or being demeaning. This has got to stop. Unpaid work can be just as contributive, and often even more so, than paid work. A handicapped person who helps to clean up two neighborhood businesses on an unpaid basis is more contributive to society than the executive of the Lehman Brothers financial firm who received half a billion dollars compensation a year (Roberts, 2008).
The paid service empire has no incentive to craft valued unpaid adult work roles for dependent people.
Few people in our field are sufficiently oriented toward social role valorization (major recent readings on the topic are Race, 1999; Wolfensberger, 1995, 1998; Wolfensberger & Thomas, 2007). And in light of yesterday's discussion, I want to say that there is something very problematic about “buying paid work.” We must put an end to the currently widespread bad-mouthing of unpaid work, and teach children from earliest age that working is good even if it is unpaid, and that everyone who is capable of it has an obligation to others and to society to make a productive contribution via work, whether paid or not.
What is being presented here is admittedly strong medicine, but if we do not get and keep our minds together on measures such as these, then a fiscally stressed society will not have the patience to argue with us. Society will act peremptorily, and we will get less than what we could have bargained for.
A good example of this is happening right now. There are proposals to make all sorts of Medicaid cuts, but without a public debate or consultation with affected parties. Nobody has said, “We are going to have to cut so many billions of dollars from Medicaid, so tell us which cuts would hurt the least.” Had we been asked this, we would have had no answer.
Also, one thing to watch for is government playing one group of advocates against another, dividing them, and then conquering both. Advocates actually contribute to their own downfall by advocating stubbornly only for themselves and letting the devil take the hindmost. Who has ever heard of two or more different advocacy groups getting together to plan an accommodation, and to make mutual concessions so that no one becomes an isolated hindmost? Though it may be difficult to get organizations to collaborate, persons functioning outside the role of a representative of an organization should find it easier to do so.
The anticipatory planning that I have been calling for is similar to what some consultancy firms are now doing in the business world: help companies that are still profitable draw up doomsday plans (McGinn, 2009). But where are any of us seeing any anticipatory planning being done in human services, or even on the entire national level?
Complicating things in our field is that we do not even have a suitable mechanism for debating and resolving our strategies on an ongoing basis. The governing board of this association is not an adequate body for that. And even if everyone here were to agree to all or most of my strategy proposals, where would we go to achieve a larger scale consensus?
What is needed is something like an ongoing think tank and/or an ongoing series of national meetings that include wise participants, not merely organization representatives, and that try to evolve rational policies and strategies to present when they are needed.
Since 2001, my earlier speaking on the upcoming crunch took on greater urgency, but despite the 9/11 disaster, and the later Hurricane Katrina disaster, people still did not seem to be listening. It is like talking to the institution people in 1970, who were absolutely convinced that their institutions would last forever. So do not fall into this recurring error, but be imaginative, less fearful, and think ahead, and keep the welfare of people with impairments upmost.
I have come to the end of my presentation. You should count yourself fortunate that you heard me say today some of the same things that financial expert Suze Orman tells people for $80,000 a shot (Kolhatkar, 2009).
This article is based on a presentation given at the annual conference of the American Association on Intellectual and Developmental Disabilities in New Orleans, LA, June 11, 2009.
Originally published in 2010: Intellectual and Developmental Disabilities, 48, 148–162.