Saturday, September 27, 2014

People Love “Facilities”

Exterior photo of a typical nursing home
It is one of the fundamental questions to ask about any approach to helping disabled people and their families … Should we fund services to individuals wherever they are, or fund the building of “facilities" where they can go to get services?

Since at least the late 19th / early 20th century, the answer has mostly been “build a place”. In the last 20 years or so, the pendulum seems to be swinging very, very slowly in the other direction, away from nursing homes, day treatment centers, sheltered workshops, and the like, towards directly funding the individual personnel and equipment supports people need, in their own homes and workplaces.

Aside from the functional and ideological arguments for and against disability-related “facilities,” it seems to me that “facilities” have certain specific qualities that make them appealing to non-disabled people, even though almost no disabled people really, truly like them, especially if they are aware of the alternatives.
- Building a facility is something to do for disabled people, when you’re not sure you actually know what to do for them. When there’s a facility for “that” kind of person or condition, people feel like something is being done, the problem isn’t being neglected.
- They look impressive, professional. When they are new, bright, clean, and modern, it makes you feel like you are giving disabled people “the best”.
- You can give them cool names. You can name them after a politician, a philanthropist, or even yourself, especially if you are dead.
- They have definite price tags, so it’s simple, (if not easy), to raise money for them. That is party because donors and supporters find it easy to comprehend what they are supporting. Unless they have direct experience with disability issues, most people would rather give money to build the “Awesome Disabled People Center” than to fund “personal assistance services for X number of people”.
- Facilities are easy to quantify. They have X number of “beds”. They have Y number of “slots”. The project will create over Z new jobs!
- Facilities generate lots of jobs, at all skill levels, even after they are built … administrators, comptrollers, supervisors, direct services staff, cooks, and maintenance staff.
- Facilities are great for “revitalizing" small, struggling towns. Either they refurbish abandoned buildings, or add new, impressive visual landmarks to neighborhoods.
- Facilities grant the illusion of safety, order, and control, which many families of disabled people crave … and probably some disabled people, too, though advocates like me don’t like to think about that.
Look, I know that “one size doesn’t fit all”. I know some disabled people might “need” more institutional services. Obviously, there have to be some. But no matter how nice you make them look, facilities almost always suck. If not right away, then more certainly as the years and decades go by.

Plus, once you build them, it is very, very, VERY hard to change your mind and do something different with the money. Facilities take on a life and purpose of their own, separate from the needs and preferences of the people they are supposed to serve. Personalized, directly funded services, on the other hand, can turn on a dime, and a change for one person only affects that person.

Just say no to “facilities”.