An interview with Tom Watkins: Reflections as We Approach 2012

Nov 10, 2011 by

Michael F. Shaughnessy
Eastern New Mexico University
Portales, New Mexico

Tom Watkins is a leader who has addressed complex issues facing children, seniors and persons with disabilities as a leader of the Michigan’s state education and mental health system, as a business leader and as an advocate.

In this interview he discusses concerns and responds to questions about some of the most pressing issues of our time

1) Tom you have had a most eclectic career, having held leadership positions in everything from pre-K-12 education, higher education, juvenile justice, workforce development, aging, mental health, business, media, government and politics. We have talked about education, workforce development and globalization on these pages numerous times in the past.

What are the other issues that are keeping you up at night and why?

Clearly, there are a number of issues that impact our schools and children that remain unresolved. Yet, there are other societal issues that are equally important and are competing for the time, attention and resource allocation policymakers.

One such area is the long term care for seniors and people developmental disabilities. At the federal, state and local level, due to both policy changes and fiscal pressure brought about by the nations debt crisis, the economic downturn combined with the aging of U.S citizens (people age 60 and over, soon to be the largest group in America) which will increase the demand for long term care services, the US government funded services to the most vulnerable citizens (seniors and people with disabilities) could be at risk as costs increase and funding decreases.

At the state level, to date, even with tough fiscal issues, Michigan’s Governor Snyder has worked diligently to change the system and also continue to support the service programs for Michigan’s must vulnerable citizens. For this we are grateful but we are also mindful that more changes are necessary and will occur as the governor attempts to balance Michigan’s budget deficits and develop sustainable long term care programs.

It is the goal of advocates and the people impacted by these changes that the integrity of the community based system remains and that people continue to get the help they so desperately need.

Altering or compromising Michigan’s carefully constructed system of specialty supports and services for persons with developmental disabilities should be approached very cautiously.

The current system has provided not only lives which they and their families value, in and of the community, but has reduced hospitalizations to less than half the rate of others who have dual eligibility, and has resulted in flat funding while other health care costs and Medicaid have risen significantly.

We need to proceed with caution and by engaging people in meaningful ways that are impacted by any changes. We need to progress as we change.

2) Michigan has been a progressive leader in providing community based supportive services to children and adults with developmental disabilities and has begun to expand these same options for seniors.

There are programs designed to move seniors out of nursing homes and help them avoid going back in and recent changes in policy resulted in Michigan being the largest state that closed all it state institutions for people with developmental disabilities. How will Michigan sustain these services within Michigan’s and America’s current economy?

It is going to be a battle as our national, state and local lawmakers seek a balance between fiscal integrity and human decency. Those of us that have made our life’s work working with seniors and with people who have disabilities, have demonstrated that given flexibility in the uses of federal and state resources, we can maintain high quality services and a fiscally sensible ways.

A good example of this flexibility are the programs that keep people living in their homes and communities and support people having more control over their services and the resources for those services.  These approaches are called person centered planning or patient directed care and self-determination.

These approaches insure professionals are listening to and heeding what people want and that there is wise and fiscally responsible use of these public dollars.  They are considered best practices and there has been some evidence, nationally, that these models cost less and have better outcomes for people in LTC. The majority of these flexible service models are funded through Federal Medicaid Waivers.

The Centers for Medicare and Medicaid (CMS) have studied this issue and their data indicates that the group of people who use the bulk of these funding dollars are the dual eligible population. These are people who are eligible for both Medicaid and Medicare simultaneously. The dual eligible population is also the most vulnerable and medically involved group, people who have disabilities, elderly, frail and poor who require care for long term chronic medical and mental health needs.

CMS has offered states the opportunity to redesign their long term care systems for people who are dual eligible and have committed to working with states to allow more flexibility so that they can integrate or combine systems in ways that are to result in better outcomes for people and costs savings for the system.  Michigan is one of the states pursuing these changes.It is critical that as the federal bureaucracy and state officials make changes to the federal programs that are managed by the state, they actively engage persons with disabilities, their parents and families, advocates and service providers in these changes. I am not talking about simply token “input” but active engagement in helping to shape any changes being contemplated.

3) As you know, I am a special education professor and recently read a thoughtful essay you wrote entitled; “New Life.” The article is about how far Michigan has come in creating a system where people with disabilities can live authentic lives in their community. I was impressed by the article and equally pleased with the over one hundred comments from persons with disabilities and their family and friends. Is this essay still available and where can it be found?

Thanks. Yes, the New Life essay can be found at:

You are absolutely right– the power of the comments exceeded my attempt to express how far we have come in Michigan and why we cannot retreat.The comments from consumers and parents are extremely powerful.

Read comment # 78, from Ms. Louise Symalski who describes how her physician convinced her to place her son in an institution as a child, how he moved to a group home 20 years later and how he now lives with a friend in a small home with a job and community involvement.  That says it all!

4) While you have lead two major departments of state government in Michigan (Education and Mental Health) you seem to always keep a pulse on the thoughts and feelings of students, parents, consumers and family members in the mental health system.  Why is this important?

I have learned that those who are served by our publicly funded system and their allies, family, friends, etc are the real experts on what works and what doesn’t work and can save the government time and money if we will listen to them and actively involve them in change deliberations. It is not enough just to get their input but to involve them in all aspects of designing Michigan’s and America’s Long Term Care System.

Clearly, there is a place for professionals and “experts” but government should not discount the “expertise” of persons with disabilities and seniors and those in our communities supporting them.

It is my firm belief, built on 30 plus years of experience that this is the way to design and sustain a successful Long Term Care system.

State and Federal officials should heed the advice of the Chinese saying: “God gave you two ears and one mouth– so you could listen twice as much as you speak.” Listen – and learn.

5) I hear you and others uses “self determination” and “person centered budgeting”. Can you define these terms and provide links where our readers can learn more?

Person centered planning or patient centered care is a model of supporting the individual at the head (not the tail) of the planning process.

The individual knows best what they need and how they should be supported. The system supporting them must be flexible, be tailored to the individual and their allies and provide them with options they desire and need.

Self-determination builds upon person centered planning by ensuring that the individual and/or their trusted allies have authority over how financial resources are spent in a wise and responsible manner for their supports and services.

It has been proven that when individuals have control over how public funds are spent on their supports, they do so more cost effectively than the system does. So cost savings are realized and they result in a better life with outcomes they desire.

For example, when public funds are available to keep people in their own homes instead of institutions or nursing homes, the cost of those supports are far less with their quality of life being far better.  A win-win situation.

For more information click on: or

6) Is there an organization that even comes close to offering services to people with disabilities that follow these principals?

As the former State Mental Health Director for Michigan, I am proud of having been part of a movement to transition a “system of care” from large, impersonal state institutions to a community base system of care.

Today, Michigan is a national icon having a system and network of agencies and service providers working with and for persons with disabilities to support them in enjoying their rights and joys as an American citizens.Michigan is a progressive state because it historically engaged persons with disabilities, seniors and their families and advocates in planning the system.

Organizations such as the ARC/Michigan, ( the Michigan Protection and Advocacy Services (, United Cerebral Palsy, and the Michigan Disability Rights Coalition and more have been strong advocacy groups helping to navigate on a statewide basis access to true Person Centered Planning and Self-determination principles.

7) It seems from what you described as needs for persons with disabilities, that these same issues impact us all because we are all aging and will need these supports or are perhaps struggling to provide support to our parents. Am I right?

Absolutely, and the innovative approach described above is also provided to older adults.  As we grow older, the familiar becomes even more important to us.  Our homes and communities are an essential part of aging happily in this country.

Historically the only option for seniors who can live without support and cannot afford assisted living was a nursing home.  Today they can remain at home much longer at far less cost of public assistance.

The Michigan Long Term care Waivers are an essential element in assuring this type of flexibility in publicly-funded services.

7) What are some of the problems with the federal programs (Medicaid and Medicare) that thwart quality services to person with disabilities?

Some of the rules and regulations associated with standard Medicaid and Medicare funded programs can keep people in hospitals and nursing homes and institutions, the Waivers developed in Michigan to allow those rules to be waived so that people can get the same level of care in their homes and communities.

Advocates need to be vigilant to prevent any change that would interfere with the progress or cause us to slide back to the old ways of supporting people in the least preferred, most restrictive and expensive places with the worst outcomes. I am referring to institutions, and facility-based nursing home care.

8) Your new Governor Snyder has been real clear – he does not want to hear advocates simply beg and plead for more money. Are the issues you discuss simply a matter of more money or are the issues holding us back beyond money?

We believe in maximizing public resources and always attempting to spend tax dollars as if it was our own money. There is no excuse for waste or abuse.

In Michigan, there is a push for what many see as rapid change within the Long Term Care (LTC) system for those who are dual eligible.

The change proposes to integrate all the current systems of long term care and have a manager referred to as an ACO or Accountable Care Organization to manage the LTC system.

The changes proposed have the goal of improving the system. It is our collective responsibility to assure that change also equals progress.

Governor Snyder is on a mission to reinvent our state. He is as inpatient as we hope he will be thoughtful as he seeks reforms, improvements and reinvention. It is not being dramatic when I say the changes being contemplated are literally life and death for seniors and persons with disabilities.

Whenever you are dealing with people’s lives, especially those who are the sickest and most vulnerable of our citizens, who rely on the care they are receiving from the system they are currently in, in some cases, for their very lives, we should never rush changes but thoughtfully plan and fully consider and implement change so that it helps, not hurts people.

As the Doctor’ Hippocratic Oath says: “First do no harm.”

This can only be done by involving the people supported by this system in the plans for making the change.

To date, the state has done a excellent job in seeking input for all.

9) Throughout your career you have always advocated for sensible change and challenged the conventional wisdom or status quo.

Is the status quo holding us back in helping to meet the needs of Americans with disabilities and seniors?

Yes. We need to listen and learn from those in the system. Community based organizations like those referenced earlier have demonstrated time and again by embracing the concepts of self determination they can reduce cost and improve service.

10) There seems to be anger at government at all levels. Yet, most of us benefit from taxes collected for such expected services as: public education, road, bridges airports, social security. etc. It is almost– well, crazy when you hear people say things like: “keep your government hands off my Medicare, Medicaid and Social Security.”

Is there a societal disconnect here and what can be done about it?

Yes. Ironic isn’t it? While the rhetoric is government is “bad” it is doing a great deal of good for people across this great land.

Imagine where our country would be without quality public schools, Social Security and health care for the elderly and persons with disabilities. It does not take a giant leap to imagine us a 3rd world country without these services.

Government can be and is a force for good. Clearly, those of us who have responsibility to manage government system have a responsibility to do so well.

Michigan and America are great because we have been willing to invest in ALL people.

Yes, we need to continue to invest limited public resources wisely and adapt to change. We must never retreat from the values that have made America great.

11) Thanks for taking the time to sit down with to discuss these critical issues.  How can people reach you and any parting thoughts you want to leave with our readers?

Everyone needs to pay attention. Change is coming.

Without engagement, thought, and advocacy, the gains we have made to assure ALL Americans can actively and appropriately participate fully in all our great country has to offer is at risk

Thanks for listening. Feel free to reach me at:

As usual, great thoughtful questions. Thank you and Jimmy Kilpatrick for the opportunity to express my thoughts.

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