If you choose premium, you also choose to pay more for premium

I really hate to get into this topic because it will could be detrimental to many in the community and I really do not want to force anyone out of their home – but given that, I believe it is important for you all to know what the actual costs of care for people with high support needs is.

Yes, it is true that there are many in the community with high support needs.  I would ask you all to ask Don Clintsman or Mark Eliason to gather the daily costs for these clients and what those costs cover.  This will most likely be direct care only since that is the majority of the costs that DDD pays for.

The folks in DDD and DSHS can easily acquire this information.  They know who is the most expensive and what their costs are.  Rather than looking at the “average” for all on the waiver, look at the costs for those with the highest support needs.  I believe when you receive this information you will have a much clearer understanding of what the costs are in the community for those with high support needs.

Listen again to what Lance Morehouse said on September 25.  He stated that with the help of 19 hours a day of licensed nursing care his son was able to be at home in the community.  Now try to imagine what the cost of care for him was.  Surely it was much higher than the average cost of care for COMPREHENSIVE care in the RHC.  Just because a person with high support needs can live in the community does not mean that it is equitable and fair and if you want to talk about rationing costs and services, look at these folks too.

If families chose to use community care which is more expensive for those with high support needs, should they not be expected to pay a little more too?  Why would this be any different than how insurance companies pay a percentage?  Or when you want premium gas you have to pay a little more.  I believe if you are choosing “premium” then you are also choosing to pitch in a little more rather than taking more of your share because you can.

This is what I talk about when I say that community care for those with high support needs is more expensive in the community.  If the issues are about cost, then this issue really needs to be looked at accurately.   I would love to see a graph of the numbers of people in the community settings by their average daily cost connected to their support needs.

I do not like to talk about this issue this way because I believe it may be hurtful to many and I would never wish to force someone out of their environment due to the cost.  A human life is priceless. We do need to think about finite resources and how to share those resources better.  We hear so often that those in the RHC are taking more than their fair share but what about those in the community with high support needs?  No one talks about the piece of the pie that they are taking.

In WAC 388-845-0110 regarding limitations of the Home and Community Based Service Waivers it states:

(4) The cost of your waiver services cannot exceed the average daily cost of care in an ICF/MR.

Taking this information into consideration, I would be interested to know how many of those on the waivers have a higher daily cost than the average cost of care in the RHC. When thinking of this it would also be good to keep in mind that this would only be the DDD costs which would be mostly direct care costs.  Therefore, those in the community could have a higher cost for direct care because the average cost of care for the RHC is all-inclusive.

So, when looking at this, I wonder about what is really being spent on individuals in the community.  Is there a way to divvy up the resources that are already there to better share those equitably?  Maybe use a cap of the average daily RHC rate as the WAC states rather than let the costs for individuals get out of hand.

I fully support community care and I also have to think about sharing services so that more people can have services.  That means that some will have to go without some of the services they have had and they may need to look elsewhere for some help but it also means that there will be more to share with those who are not receiving anything.  Isn’t this the fair and equitable way?

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