Good Rehabilitation Not Enough

Courage Center Models Holistic Rehabilitation In a recent interview with Access Press, Jan Malcolm reflects on her first year as […]

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Courage Center Models Holistic Rehabilitation

In a recent interview with Access Press, Jan Malcolm reflects on her first year as Courage Center’s Chief Executive Officer.

How would you describe your first-year experience as the CEO of Courage Center?

“It’s been a year of learning. Courage is a complex organization with many parts, so I’d say I’m still climbing the learning curve, and will be for as long as I’m here! I’ve also developed a tremendous appreciation for several specific things about Courage: the professional skills and caring of our staff; the tremendous support we get from the community in terms of volunteering and charitable contributions to our mission; and the trust our clients put in us, the effort they give to setting and achieving their goals and the difference we are able to make together in the quality of their lives.”

How did your role as Commissioner of Health for the State of Minnesota from 1999 to 2003 prepare you for your role as CEO of Courage Center?

“The Health Department’s charge is to protect and improve the health of all Minnesotans, certainly including those with disabilities and other complex conditions. I hadn’t worked in a government public health agency before I became commissioner, just like I hadn’t worked in rehabilitation before joining Courage. My job as commissioner was to work with a lot of different stakeholders to help set an overall vision and direction for public health in the state; it was not to be an expert in every one of the many programs MDH runs. Similarly, my job at Courage is to provide leadership, and to help the organization play the strongest role it can in service to the disability community; it is not to do management at a detailed level—especially since we have very talented managers and operational leaders who know far more about rehabilitation than I ever will.”

What is your current operations budget? How has it changed since you stepped into the role as CEO?

“We have total revenues of just under $40 million dollars. Our 2007 budget grew by about 15%. About 2/3 of our revenues come from reimbursement for services like our inpatient and outpatient therapies. Between 25% and 30% of the budget comes from the community’s philanthropic support—individual donors, corporate and foundation grants, and special events like the Walk ‘N Roll with Courage and the annual Celebration of Courage.”

Are you still actively involved with federal health care initiatives? And how do these health care initiatives benefit/support people with disabilities?

“Nancy Larkin, our Chief Operating Officer, and John Tschida are both active in national rehabilitation organizations such as the American Congress of Rehabilitation Medicine, a research and policy group, and the American Medical Rehabilitation Providers Association. There are some real concerns at the federal level about where Medicaid and Medicare are headed. The rehabilitation industry continues to be challenged by Medicare changes that are investing fewer dollars in the equipment people with disabilities need, such as wheelchairs. We’re also seeing Medicare reimbursement changes that are not creating the kind of consumer-focused financial incentives that contribute to positive health and independence outcomes. Medicaid changes in the last year could also mean higher co-payments for people with disabilities, and we know people can’t afford the co-pays we have in place today. We’re hopeful that the next Congress will take us in a more positive direction.

My own focus is now more specific to state-level policy, but I am still involved with a couple of national organizations having to do with public health administration and health services research. While not specific to disability concerns, these organizations are working on improving access to health services, and improving health status for all people. I believe that part of what we in the disability community need to do is to be at the “big table” of health reform, so that the needs of the people we serve are central to the design of health policies, not an afterthought.”

Do you support stem cell research? Why do you or do you not believe stem cell research may benefit people who live with spinal cord injuries, Parkinson’s disease, and/or blindness?

“My personal belief is that stem cell research offers a lot of promise and certainly ought to be pursued. I do worry that our cultural biases toward searching for “cures”—and spending almost without limit for new technologies—can (if we’re not careful) crowd out basic investments in therapies and social supports that help people with disabilities to live as independently as possible. I hope we will always take a “both/and” rather than an “either/or” approach that recognizes the need for balanced funding. Technological and research advances over the last 50 years have created our first elderly generation of people with disabilities, and this is a good thing. People are living longer and happier lives because of the incremental advances that science has achieved. Disability is a natural part of life that we’ll all experience someday if we live long enough. Science will never change this reality. But as an organization we’re open to any scientific breakthroughs that positively contribute to quality of life — for those with and without disabilities.”

Reflecting back on one year as a leader of Courage Center, how are your directives as CEO different from those of your predecessors?

“I’d like to acknowledge the important contributions of all of Courage’s past leaders. Wilko Schoenbaum was a real visionary, and he clearly never knew the meaning of “can’t do.” He saw a world of greater opportunity for people with disabilities and did so much to help create it. Dave Hershey worked with Wilko for many years and Dave took over the directorship of Courage Center when Wilko moved over to help build the Courage Foundation. Dave unfortunately died after just one year, but contributed greatly at Wilko’s side. Dave Phillips brought great fundraising skills to Courage and deepened Courage’s relationships across the community. Eric Stevens brought new strengths in business and financial management and strategic planning. I have the opportunity to build on all of these strengths to help position Courage for the next stage of our long and distinguished history. I have more of a health care background than my predecessors, so I hope I can help to solidify Courage’s place in the larger health care continuum. I do strongly believe, though, that health and independence require more than just good medical rehabilitation. Courage’s holistic approach to health, vocational and social integration is an important model of how the system should work in a coordinated, client-centered way.”

To learn more about Courage Center, go to or call 763-588-0811.

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