The Evolution of the Quality of Care in Developmental Disabilities

Jim Conroy: In thinking about a thumbnail of what's happened to quality thinking in the past 50 years, it really is not that complicated. It is a process that goes from institutional, segregated, service domination thinking toward, individual empowerment and consideration of, individual wants, approach. The… first principle, I think, that we have to stick with—and this is a hard one—is that quality is the same for people whether you're young or old, male or female, no matter what the race, no matter whether you have disabilities. The building blocks of quality, as I… may be mixed differently, but the blocks are the same.

And every time we try to build a system or measure a system or accredit, monitor a system that's made just for folks with disabilities, then we start thinking of the quality of the disabled life, and that's a terrible mistake to fall into. It is much more enlightening for me, after many years to figure out that folks with or without disabilities want pretty much the same things, in different mixes, of course. But that's central, and I… really think same, not different, has to become the first principle of quality assurance. We have universal human aspirations that we should assist people to reach just like anyone.

So that is… one of the guiding principles that will lead us, I think, to the next stage, which is…getting away from quality of service—this is closely related—and thinking about quality of life. We've, again, spent over a century trying to track and monitor quality of services, and we've been ignoring quality of life. So, once again, somebody could be in a…a sheltered workshop that gets accredited and gets very high scores, but people in that sheltered workshop say "You know, I…I just come here and I… I don't do anything I enjoy, and I never get to meet other people. I don't like it much."

So you can have high quality scores for services without high quality of life. We've got to focus on quality of life. Those two principles, I think, would, would summarize what I shared with the Council, this morning.