I have a few thoughts to share today as I muse on some work I am doing on an historical report of annual newspaper headlines which describe the poor conditions of Louisiana’s children. I may ramble as I go, but here goes.
The well-being of Louisiana’s children has lagged the nation for 30 years. Well, “lagged” is not quite accurate. The situation for children in Louisiana is much worse than that. Since 1989, Louisiana has averaged 49th among the states when ranked for child well-being.
Louisiana’s adults are so inured to this condition that it seems normal to us for our children to live without sufficient mental health and social services, to live in poverty and conditions of poor health. Having lived only in Louisiana, our children are not aware that a better life is possible and that it exists in 48 other states.
These conditions should not exist, but they do.
There are gaps, shortages of care for children, in every community. These gaps are opportunities for nonprofits to step up and deliver care. Unfortunately, Louisiana is poor enough that community health services are insufficiently funded to allow nonprofits to survive. Nonprofits cannot sustain the financial losses of delivering care in rural areas.
Some believe Louisiana is such a poor state that we cannot provide the services our children require and deserve. That is a simple argument, but it does not hold water. I believe Louisiana’s children fare poorly because we miss-prioritize the use of the sufficient funds we have available in Louisiana. Essentially, states get what they prioritize, promote, and pay for.
Louisiana, more than any state in the nation, needs a healthier, more robust community of nonprofit organizations which focus on meeting the primary needs of our children. Without a philosophical shift that focuses on ensuring the survival of providers over management companies, Louisiana’s children will never have advantage of the true value of an integrated system of care – robust networks of providers who are strong enough to coordinate together to meet the needs of children and families. This is true in child welfare and behavioral health.
While it is a myth that nonprofits are required by law to give it all and then some, many nonprofits in Louisiana do just that. And they fail. There must be an equitable balance between the losses which limit nonprofits versus the profits that enrich the businesses that “manage care”.
The profit motive pulls companies to Louisiana, but the distribution of those same profits to shareholders and owners who live beyond our borders, prevents Louisiana’s funds from being used to deliver services to those who require care. Also, what is clear from Louisiana’s child welfare and behavioral health history is that when a for-profit provider comes to Louisiana and discovers profits are not possible, they pull up their tent stakes and leave the state.
During a meeting with a state official in 2013 concerning Louisiana’s implementation of managed care for behavioral health, I was told, “Rick, nonprofits will have to bring more to the table.” I still wonder which stunned me more, the blatant expression of entitlement, or the irony that the pressure to “do more with less” was being applied to nonprofit providers at the same time Louisiana was about to guarantee a 2% profit to publicly held corporations contracted to “manage” the services delivered to Louisiana’s children and families by the nonprofits being squeezed to “bring more to the table.”
In a publicly held corporation, profits go to the victors. Owners own and distribute profits as they wish without limitation.
In a nonprofit (a poorly chosen word because no law prevents a nonprofit from generating a surplus), profits may be used for four reasons: research, new programs, staff development, and to build a reserve. Nonprofit surpluses do not go to the owners. Rather, through one of those four channels (research, services, staffing, and reserves), operating surpluses are used to enhance the lives of those in the nonprofit’s care.
No government can directly provide the care citizens require. Governments never have. Long before governments became involved in child welfare, nonprofit (often faith-related) providers cared for children; nonprofit, faith-related hospitals treated the ill; almshouses cared for the homeless. Due to regulations, which drive costs and complexity of care, which require expertise and abilities that government agencies lack, services for children and families are best delivered by public/private partnerships.
Private provider organizations have the expertise, experience, and facilities to provide care. Governments regulate and provide funds to support the services they contract.
If Louisiana wants to ensure that funds spent on contracts remain in our communities and are used for services, employees, research, and reserves against our state’s frequent disasters, then contracting with Louisiana’s own nonprofit providers is our state’s best way forward. Louisiana’s child welfare and child behavioral health providers are the unsung backbone of child well-being in Louisiana. Louisiana must focus closer to home.