Nonprofit Leadership Podcast · Dr. Rob Harter

How One Organization is Greatly Improving the Care for Individuals with Disabilities

·31 min·2 clips

They slid an envelope across the table: a non-disclosure, and an offer of "nosebleed money" to take over Community Options.

1. The Nonprofit Leadership Podcast, hosted by Dr. Rob Harder, examines how people with intellectual and developmental disabilities are cared for, covering private equity, state institutions, and sub-minimum wage. 2. Guest Robert Stack is president and CEO of Community Options and author of the book "Silent No Longer," which Harder says some universities use as a primer for students entering the field. 3. Stack's central argument is that care is shaped by funding incentives, and that he has seen "a lot of room for us to grow" in both care and employment. 4. Stack traces his start to age 13 in a Butler, Pennsylvania seminary, where he volunteered with children with severe disabilities, and says he began Community Options over 30 years ago with three houses in New Jersey. 5. He says the organization now runs almost 800 homes of about three people each across 12 states, and that a private equity group slid an envelope with a non-disclosure agreement across the table, which he declined. 6. Stack says Texas institutions cost $450,000 to $600,000 per person per year and that local legislators protect them as employers, and he names Pennsylvania's Selinsgrove-style institution (which he calls "Ceilings Grove") as a similar case. 7. He explains that Medicaid is matched by states, so a $1,000 service draws $1,000 federal match, and says low rates in Mississippi leave "absolutely no providers" while Texas waiting lists run 15 to 20 years. 8. Stack describes legal practices he opposes, including restraints, electric-shock backpacks, and cattle-prod "aversion therapy" in Massachusetts, and a 1939 law allowing wages based on productivity, such as $1 an hour for one widget. 9. He says institutional populations fell from over 100,000 to about 20,000 in 20 years but calls it "whack-a-mole" because some children aged 8 to 15 are now placed in nursing homes, and he describes Community Options' approach as four questions: what you like, don't like, want to do, and don't want to do. 10. Suited to nonprofit leaders, disability advocates, and social work students.

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