There ought to be a law...

I am currently in Iowa getting ready for Part II of a presentation on Community at the Brain Injury Association of Iowa's annual conference. There are 300 people here for the conference, a combination of people with personal experiences, professionals and providers. There are a lot of programs in Iowa and, like all states, they are experiencing budget cuts.

Now here's the maddening thing that has been going on since the early 1980s. States send people with brain injuries out of state for services, using precious tax dollars, with no plan to bring people home. Iowa has 50 people with brain injuries out of state for services, costing 4x more per person than in state. Kansas has 22 people out of state at a cost of over $700 per day, when the average of instate services is only $120 per day for comparable services. There are some people who do need short term hospitalization for medication stabilization but once someone leaves the state, they are usually gone for a year or more.

There are several reasons states continue to use this avenue. First, archaic laws make institutional services an "entitlement" and community based services an exception or "waiver." Second, heavy marketing from out of state providers and no accountability for said providers combined with state agency staff who are overworked already and you have a formula for more people going out of state. And finally, there are providers who think it's just easier to send someone out of state rather than train staff on how to provide positive behavioral supports or address the individual needs of the person.

You would think someone would pay attention to millions of Kansas dollars going out of state. We can serve 300 people at home for a year for the same amount of money as 22 people out of state. There ought to be a law...