Episode Overview

Podcast: Nonprofit Leadership Podcast
Episode: How One Organization is Greatly Improving the Care for Individuals with Disabilities
Host: Dr. Rob Harter
Guest: Robert Stack, President & CEO, Community Options
Date: January 4, 2026

Main Theme:
This episode dives into the landscape of care for individuals with intellectual and developmental disabilities in the United States, focusing especially on the role of nonprofit organizations, the challenges posed by private equity and state institutions, ongoing issues with abuse and dignity, and the critical need for inclusive employment opportunities. Guest Robert Stack shares insights from his three decades leading Community Options—a nonprofit dedicated to dignified, safe community-based care—and his broader advocacy for systemic reform.

Key Discussion Points & Insights

1. Robert Stack’s Path to Advocacy & Leadership

• Early Motivation ([04:19]):
  • Stack’s desire to serve began as a teenager, volunteering with disabled children while preparing for the priesthood. This exposure led to a lifelong commitment—rooted in firsthand experiences of systemic shortcomings and closures of poorly managed institutions.
  • “I just fell in love with the ramifications of what I could do, and it worked out really well.” — Robert Stack (04:44)

2. Private Equity’s Impact on Disability Care

• Transformation of the Sector ([05:51]):
  • Growth of private equity investment in care facilities often prioritizes financial returns over quality care.
  • Unlike nonprofits, PE ventures focus on strategies to maximize profits: cutting staff, exploiting Medicaid, leveraging tax deductions, and sometimes sacrificing care standards.
  • Stack recounts being approached with a buyout proposal:
    • “For about 30 seconds I sat there thinking, I never flew private...and then I thought...I will not be. I don’t have shareholders. I answer to the people...with severe disabilities and their families.” — Robert Stack (09:55)
  • Key Quote:
    • “It’s not about anything with private equity except the Benjamins. That’s what they do.” — Robert Stack (10:54)

3. State-Run Institutions & Legislative Barriers

• Role of States ([12:06]):
  • Many states continue to operate costly, large-scale institutions, driven partly by local economic interests in institutional employment.
  • Example: Texas institutions can cost $450,000–$600,000 per person per year; shifting care to smaller community homes could save 60-70%.
  • Medicaid Matching: States have substantial control over Medicaid funding rates, creating huge disparities and long waiting lists—up to 20 years in Texas, 10 years in Pennsylvania.
  • “They can keep that because...the institutional staff work there...the local legislators...look at those big buildings as a way of providing employment for the local community.” — Robert Stack (13:20)

4. Persistent Abuse & Exploitation

• Legalized Harm ([16:18]):
  • There remain tragic, legal practices that constitute abuse. In Massachusetts, physical restraints and aversion therapy (e.g., electric shocks) are still sanctioned.
  • “In this state, in Massachusetts, there’s a place that allows you to be tied up, have ammonia squirt in your face or be shocked. They actually have a backpack that you wear...every time you do something, they can shock you. And that’s legal.” — Robert Stack (16:33)
  • Outdated federal laws (from 1939) allow disabled workers to be paid subminimum wages, as little as 30 cents an hour, justified by “productivity measures.”

5. The Importance of Inclusive Employment

• Philosophy of Inclusion ([20:47]):

  • Work is not only about pay, but about social connection, which directly impacts well-being.
  • Community Options focuses on placing individuals in real, integrated jobs matching their preferences, which has led to thousands of successful placements.
  • “There’s a direct relationship between the severity of your disability and your level of loneliness...We all work for relationships so that we can have meaningful interactions with other people.” — Robert Stack (21:00)

• Core Question Framework:

  • At Community Options, program planning is person-centered, based on four simple questions:
    1. What do you like?
    2. What don’t you like?
    3. What do you want to do?
    4. What don’t you want to do?
       (22:33–23:32)

• Mentorship: Ongoing mentorship is a key strategy for job success.

  • “Everyone can become a mentor…and help you do what you need to get done in order to succeed in your job.” — Robert Stack (23:43)

6. Systemic Change & Community Activism

• Key Lessons from Advocacy History ([24:33]):
  • Stack recounts how media exposure (e.g., Geraldo Rivera’s exposé) and high-profile allies (e.g., John Lennon) led to lawsuits and reforms in New York.
  • The book Silent no Longer urges readers to transition from awareness to collective action—engaging policymakers, community members, and employers.
  • “We should really start treating people with disabilities with dignity, and...as a group work together to...improve [their lives].” — Robert Stack (25:25)

7. Progress, Setbacks, and What’s Needed

• State of the Movement ([26:59]):

  • While there’s progress (declining institutional populations, greater media representation), new problems arise—such as placing children with disabilities in nursing homes for life, often managed by for-profit companies.
  • “It’s better than it was, but then again, it’s not as good as it should be.” — Robert Stack (27:59)

• Urgent Needs ([28:43]):

  • Reduce overregulation that shifts focus from care to paperwork.
  • Cut back on the influence of for-profit enterprises in care provision.
  • Expand public awareness and grassroots involvement.

Notable Quotes & Memorable Moments

• On private equity’s drawbacks:
  “It’s not about anything with private equity except the Benjamins.” — Robert Stack (10:54)

• On legal abuse and outdated laws:
  “They call it aversion therapy. And it’s a long cattle prod with batteries in it. And they shock him just like he was a cow. And that’s legal. And that’s today.” — Robert Stack (17:19)

• On the relationship between work, dignity, and belonging:
  “There’s a direct relationship between the severity of your disability and your level of loneliness...We also work for relationships.” — Robert Stack (21:00)

• On advocacy and collective action:
  “People have to get together and realize that people with disabilities are marginalized…we can, as a group, work together to vote, to deal with our local political leaders...and realize that things need to be improved.” — Robert Stack (25:25–25:55)

• On both progress and persisting challenges:
  “It’s better than it was, but then again it’s not as good as it should be.” — Robert Stack (27:59)

Timestamps for Major Segments

• 00:01–03:48 — Introduction & Guest Overview (Host)
• 04:19–05:00 — Stack’s Early Influences & Career Motivation
• 05:51–11:21 — Evolution of Disability Care: Private Equity’s Role
• 12:06–15:46 — State Institutions & Medicaid Disparities
• 16:18–19:42 — Abuse in Care Facilities & Subminimum Wages
• 20:47–23:32 — Community Options’ Approach to Inclusive Employment
• 23:43–24:10 — Value of Mentorship in Employment
• 24:33–26:36 — Lessons from Advocacy, Silent no Longer
• 26:59–28:26 — Progress, Persistent Issues, and the Trend Line
• 28:43–29:18 — Policy Reform and Awareness Recommendations
• 29:41–30:03 — How to Learn More / Connect

Summary

This episode offers a candid, wide-ranging look at the state of disability care in the US, exposing both egregious ongoing challenges and sources of hope. Robert Stack, drawing on decades of frontline leadership, explains the ethical dangers of profit-driven care, the stubbornness of institutional models, the persistence of legally sanctioned abuse, and the powerful difference made by person-centered service and inclusive employment. The episode is both informative and a call to collective action—urging listeners to advocate, vote, and engage locally to promote dignity, inclusion, and opportunity for all.

For more about Robert Stack and Community Options:

• communityoptions.org
• Silent no Longer (Book)