Sunday, August 12, 2012

Beckoned or drawn?

The angel bugging Elijah under the broom tree
 In his homily this morning Fr. Larry said that the beloved hymn, I Am the Bread of Life, has misled a generation of Catholics, beginning when the word "beckon" replaced "draw" in the line, "Unless the Father draw him," this in order to protect the tender sensibilities of that part of the populace that has a hissy fit at the notion of using a pronoun to stand in for all of, pardon me, humankind.

If we are drawn to something, it exerts a hold on us, often one we can't explain.  There is a sense of being reeled in, pulled inexorably toward the object of our fascination. 

If we're beckoned, we're free to go or not. 

But if the Father draws us, at some point we will have to say yes, I accept, or no, I reject.  And let's face it, the Father doesn't make things easy for us.  Most of the time the thing he's asking us to accept is, well, pretty unacceptable.  We're about as enthusiastic over the notion that he knows what's best for us as our kids are about the notion we know what's best for them.

Poor Elijah sat under the broomtree ready to close his eyes and die, discouraged and betrayed.  But would God leave him alone?  Heck no, he kept nudging him with an angel and leaving bread and water and poking him to get going again.

When our baby Kelly was born with Down syndrome, Jerry prayed his first prayer in 25 years, and it was not one of gratitude or acceptance.  But within the same hour he also said our assembled daughters, "Now we find out who we are as a family." 

God had begun to reel him in.

Friday, August 10, 2012

Hands on vs. bureaucratic love

Fr. Charles Susai
 We had a visit a few weeks ago from our friend Alan Graham of Mobile Loaves and Fishes, a ministry to the homeless here in Austin. 

Alan brought along Fr. Charles Susai of the Missionaries of the Poor, an international Catholic organization serving the poor, the homeless, the destitute, and the abandoned, along with an MOP supporter John Scarpatti, who has been involved with the MOP mission in Kingston, Jamaica, for years.

Alan, like my Jerry, is a visionary.  My mom used to say of Jerry, "That man reminds me of that old song that goes 'Now what makes that little old ant, think he'll move that rubber tree plant...'"

"Whoops!  There goes another rubber tree plant!"

I'm sure similar things were said about Alan.  Currently he is working on a plan for what you might call homes for the homeless, 27 acres in far East Austin with shelters ranging from sturdy platform tents to tiny cottages and RVs, with lots of outdoor space and barbecue pits and benches and gardens and chicken runs and areas for contemplation. 

Alan says, "You know, lots of homeless people really just like being outside." 

At our Friday night dinner we talked of many things.  The men stayed overnight in our cabins here in the Village, and the next day Jerry picked them up for a tour of Down Home Ranch

Needless to say, Fr. Charles was astounded by our real estate here at the Ranch.  We serve our 32 Ranchers in large, beautiful homes, with private bedrooms for all, surrounded by other buildings that offer room for recreation, education, and job training.

Fr. Charles and his brothers serve the 600 souls in his keeping in pavilions open on four sides to the tropical sun and rain, with modest structures for the hospice patients and the ill.

Naturally, by the end of their visit, Jerry and I had signed on to go to Jamaica in September for a five-day stint with Alan and his entire staff.  We will get a chance to work for a few days with the MOP brothers in service to Kingston's poor, face to face. 

"Sure you want to do this?" Alan asked before he left.

"Don't worry!" I said, "I've done it all."

And we have.  The first year we did camp we became intimately involved with strangers' bodily functions, learned that you can't leave a camper alone in a bathroom with a full can of Comet (don't ask), and that applying sunblock can occupy more of your working day than you ever could have imagined.

We ran Gabriel House for 4 1/2 years, and those were in many ways the most satisfying years of my 20 so far at the Ranch.  I loved cooking for the guys, who loved eating my food.  I loved their brotherly interactions with Kelly, still in high school and considered the pesky little sister of the house.

We had no weekends off, and both continued in our day jobs as Executive Director and Program Director.  Gabriel House was our life.

Since then my work has step by step taken me further and further away from what I call "hands-on" love.  I now spend my days in what I call "bureaucractic love," since resuming the post of Program Director in May. 

You don't have to remind yourself what hands-on love means.  It's immediate, you're there, the object of your love, your service, stands before you in the flesh.

Spending hours filling in forms, gathering information, training staff, figuring out schedules, reporting to agencies, going to meetings...I have to stop during the day and remind myself why I am doing this. 

Sometimes the forms, the meetings, the agency reports distance me so from the reality of why the Ranch was founded I have to bop down to the Pavilion to mingle with our Ranchers, hear the rumor of the day, and get a hug or two to get centered again.

Jerry and I are both in our 70s, and I guess in Jamaica we'll find out if we actually can still do it all, especially in the tropical heat.  Regardless, this whole experience has been good as we refocus our priorities for the Ranch and return to our original vision, look back at how we got from there to here, and consider what it all means.

I have had a decades-long fascination with and interest in St. Benedict, and this time around as Program Director know that I was ill-equipped to take on the task of shepherding of souls who were employees of the Ranch.  I made lots of mistakes with the best of intentions.  I have tried to learn from those mistakes.

So daily, I ask St. Benedict, who wrote the book on management with his Rule of St. Benedict, for his intercession and guidance in my role as I support the work of those who now do provide the hands-on love to our Ranchers.

And I can't help but notice that our schedule in Jamaica will include morning, evening, and night prayer and daily Mass and contemplation.

In other words, to do this work well, we must connect to the Source of why we do it at all. 

Tuesday, August 7, 2012

Dog Day Jeremiads, con't.

It's interesting that my last blog followed the one about Ranch neighbor Dud Morris, WWII vet.  Dud and his war buddies were the human line of defense against Japan and Germany's intent to take over the world.  We owe them our freedom. 

Jay Leno roams around asking young people questions about our nation's history.  They think the Civil War happened 50 years ago and never heard of the Revolutionary War. 

They've heard of Ben Franklin and think he might have been a president.

Jefferson wrote, in a passage we all used to know well because we had to memorize it that we are "...endowed by our Creator with certain unalienable rights."   As Americans, we officially believe that our rights are God-granted

That confers, rightly, enormous dignity on the individual.  It was the basis for ending slavery in the 1800s and granting of full rights of citizenship to African-Americans in the 1960s.  (Jefferson was posthumously hoisted on his own petard, as it were.)

In the intervening years, these these e rights were claimed by others, including people with disabilities.  A person with Down syndrome can today seek redress for violations of his civil rights.

IF he can manage to get born.

The government of Denmark has just announced that there will be no babies born with Down syndrome in Denmark by the year 2030.  Announced, proudly, without irony, that individuals with an identifiable disability shall be systematically targeted and eliminated as being unworthy of life (do the Danes recall who gave the world that little phrase?)

Not a problem for most Americans, who abort babies with disabilities at a 90+ percent rate. 
To do this, they pretend they are not human, which is what we say of of people we consider nuisances.  Ask the Jews, the Tutsis, the Albanians, the Native Americans of long ago, the baby girls of China.

We do this because they are very small and very weak.  Because we don't want them.  Because we are careless with the gifts God gives us.

Every life comes into the world bearing a message from God. 

Don't kill the messenger.

Friday, August 3, 2012

Gifts from God and the Government

It's hot again.  Dog days.  Lots of jeremiads in my daily scripture readings, so I thought
I'd write one of my own.

A lovely family visited on Wednesday.  I greeted them, answered some questions, and then sent them off with Mark for a tour of the Ranch.  Their daughter was politely disinterested until Mark and the other Ranchers showed up, and then she lit up like a Christmas tree! 

After they returned they had more questions, largely concerning funding of the Ranch and how it works.  Whenever I need to explain these things I think back to the early days of the Ranch, when I labored in utter mystification and ignorance of "The System."

The System encompasses--for a start--the agencies of: Social Security Administration, federal and state Health and Human Services, the Centers for Medicare and Medicaid, the Department of Aging and Disability Services, Mental Retardation Authorities of the state of Texas, state and local fire marshals and life and safety agencies, the Texas Dept. of Health and Sanitation, etc. 

And that's just for your run-of-the-mill kid with Down syndrome.  You can also get involved with a plethora of other agencies with an investment in your child should you have complicating medical, psychiatric, or other needs.

I recall a friend in the early days who showed up for what she thought would be a routine meeting with her school's special ed team and discovered a hoard of representatives present for the "transition" of her son, who was turning 18, all with papers for her to sign and plans for her boy.  (This was in the days when there was money for this sort of thing.  Theoretically, anyway.)

"I was horrified!" she cried.  "It was like they were there to take custody of him!"

Back then it was almost impossible to figure The System out from scratch.  Today, it's not easy, but it's possible due to the 'net.  Not easy, but possible.  DADS has a good website that explains the different programs.

Which brings me to the point of all this, the heart of my jeremaid, which is the distinction between the two major publically-funded residential programs for people with intellectual disabilities.  Settle in for a long story...

Back in the mid 1800s, believe it or not, there were a fair number of places something like Down Home Ranch, located in the country, centered on providing a humane, decent life and care for people with IDDs, then classified into three major divisions: Idiots, Morons, and Imbeciles. 

Yes, those were scientific terms.

They were charitable in nature, and arose from a desire to help.  Their residents did farm chores and lived together in a small community that they seldom if ever left.  Their live spans, lacking today's medical interventions, were generally short.

At some point that model was taken over by the state.  These communities became bona fide institutions, and over time became ever more crowded, dumping grounds for unwanted souls.  Medical researchers began using their inmates, which of course included children, for medical experiments, some of which were quite comparable to those carried out by the Nazis.

By the time Robert Kennedy carried out his investigations (thank you Geraldo Rivera and the Kennedy family) of how our nation's mentally ill and mentally incompetent were treated, conditions had reached a state that would surely--surely--break the heart of any decent human being.

I cannot bear to give examples.  Google if you dare.

In the 70s things began to change due to outcries over the revelations of the federal investigations.  The Education for All Children Act was passed.  And the feds took over the delivery systems of mental health/mental retardation of several states, Texas included.

State "schools" began to improve dramatically as states were forced to step up the funding of them.  Although the campus-based model for service delivery was coming to be seen as undesireable and in some way causative of the conditions that had so horrified the nation, they improved to the point where the parents of those who lived in them actually formed advocacy groups to keep them open.

To get people out of the institutions, the desireable model came to be seen as "living in the community," and so the Intermediate Care Facility for Mentally Retarded (ICF-MR) was born.

ICFs-MR allowed people to live in smaller aggregations (generally six to 32), and were intended to get them out of state schools and nursing homes, until then the only alternatives to remaining at home with Mom and Dad.

ICFs-MR were located in regular neighborhoods (initially there were lawsuits to keep them out but fair-housing acts prevailed).

ICFs-MR bettered the lives of a lot of people.  Some of them were the people served, and some of them were the people who set up compaies to serve them as ICFs-MR became cash cows.  (Which, by the way, didn't necessarily mean that those companies did not do a good job--back in the day there was enough funding available to allow for some very tidy profits.)

Down Home Ranch is today an ICF-MR.  Long gone are the days of lavish reimbursements for caring for people with IDDs, which is a very, very expensive undertaking.  Although the basic reimbursement sounds generous, when a provider takes in a client (or "consumer" as they're called these days, though I can't bear that term and refuse to use it) it assumes total and complete responsibility for every aspect of his or her care--health, wealth, and pursuit of happiness.

It costs a lot of money, so much money in fact that the feds decided in the 90s to phase out the program and figure out a way to save some of it.  Happily, a lot of academics and agency thinkers were deciding that the ICF-MR model was outmoded and what was really need was choice for the consumer--choice of where to live, with whom to live, how to live.  The "Money Follows the Person" model was born!

And HCS, or Home and Community Based Services, began to be rolled out in various states as a "Medicaid-Waiver" program, along with a handful of others.  (What are you "waiving" you may well ask.  The answer is: the right to live in a nursing facility which is the technical classification of an ICF-MR.  I wondered for years!)

HCS was touted far and wide, high and low, as the best thing to be invented since cheese.  Clients were put on waiting lists for HCS, under which, we were promised, we would find the sweet promised land, our beloved children living in loft apartments in downtown Austin, taking the bus to work at Whole Foods, enjoying the fine urban life.

The waiting lists grew, and grew, and grew.  And one day we woke up to discover just about all the people in Texas with IDDs were on it, several tens of thousands of them.  They had projected waits of from seven to 67 years (yes, really, one of our Ranchers was told he could expect a wait of 67 years).

Headlines blared that 40,000 people in Texas were waiting for services.  Meanwhile, ICFs-MR were sitting vacant, ready to be moved into tomorrow as families erroneously believed that you also had to wait to get into one of those.

But...if you wait that long for something, it must be really, really valuable, right?  Well, maybe.   Here are the interesting facts:

Yes, HCS is an alternative offering more choice, but that choice comes at a cost.  One of the costs is that the family assumes (or retains) more of the risk and responsibility for caring for the client.  Not necessarily a bad thing, but remember this: Whereas the academics and agency thinkers were desiring more freedom of choice, the government money-mavens were desiring lower funding of services.

So HCS funding for any client is capped at 80% of what it would cost to care for a person in an ICF-MR facility.  It's a cheaper alternative!  Who knew?!

I hear all the time:  "We've been told that HCS is the Cadillac of the service delivery programs."  Parents are shocked when I tell them the facts: that they will have to justify every service they want for their child under HCS.  Under ICF-MR regs those services are mandated.

The upshot?  It will prove ever easier to choke down funding under HCS as our public funds continue to dry up.  (We've already sustained significant cuts and fully expect more to come.)

There are other problematic aspects of HCS, and one big one is that providers must agree to abide by is the "zero-reject" policy.  A common problem in the small group HCS homes is that a client leaves and a new client appears on a first-come, first-serve basis and this client turns out not to be somebody you would want your child living with.

We parents have most of us been through this before in our child's public schools.  We removed our daughter from school twice because of the presence of students who were a physical menace--first from middle school, and second from high school when they moved up from middle school--and not so much because we feared for her physical safety as because of the fact that all resources were now shifted to maintaining effective control over these boys.

One of those boys could show up on our doorstep tomorrow and demand to be served, and if we had an HSC opening, we would have to serve them, no matter the costs--financial and otherwise--this would impose on us, and (much more to the point) the cost in degradation of quality of life it would impose on the other two men in that home and the other clients in the providers' program.

There are other problems with HCS, too, such as the implied assumption that other people with disabilities are not fit to be friends of people with disabilities.  We had a resident years ago on HCS who had a Community Integration Specialist (or something of that ilk) assigned to him to "take him out in the community" on a weekly basis--you know, go to a movie, shop, go bowling.

He was all for it but wanted a buddy to go with him.

If the buddy had not had a handicap, there would have been no problem, but as it was one of the buddies he lived with and he did have a handicap, he was not eligible, because he had a handicap.  Got it?

He wound up having to go with his CIS on outings he came to dread in order to keep on consuming his HCS services and not lose his slot. 

But that's how these things work, alas.  The Health Department would come out in the days before we had a real pool and make us put an 8' fence with a locked gate around our 3' above the ground splash pool but ignored the 20' deep pond a few hundred yards away because they only had jurisdiction over the 3' pool.

I suspect this was something of a waste of taxpayers' money, but I can't prove it because it's possible 12 people did not drown because of that 8' fence...I guess.

More tomorrow...I gotta to go work.