The most immovable impediments to a culture of gentleness rest in how an agency is managed—a business management model too often fails to have a sharp focus on those served. We have to find ways to take care of the economics of an agency without putting those served in a secondary position. Rarely does an agency deliberately put the folks served in a secondary status; however, today’s trend is to manage agencies as if they were profit making businesses. The bottom line becomes the primary value rather than the quality of services rendered.

The old medical model has morphed into the business model where human needs are prioritized according to cost and case closures. Of course, we all have a duty to spend public money prudently. In fact, this should mean that those with the most needs should receive the resources that they need. It also means that varying degrees of support might be needed across the lifespan and case closures can be synonymous with dumping human beings when they exceed costs. The principal factor in any equation must be the human being and his/her needs. Money should be a tool for services and supports. Likewise, caregivers and clinicians should not be expected to be accountants since this conflicts with their duty to directly and completely serve others. Although person-centered planning is a legitimate tool, it is more crucial to focus on surround each person with a circle of companions who will come together with the person and form a plan based on the the groups dialog. It should not be just an exercise in “What I want” but the evolution of a sense of community and what all of us want and need for the person.