Donna Patché is 72 years old. In 1988, doctors diagnosed the Santa Maria resident with multiple sclerosis, a debilitating auto-immune disease that causes her constant physical pain. With no family to fall back on, she relies on the daily assistance of personal caregivers—whom she calls her “lifeblood”—to provide for her basic needs, such as helping her get out of bed, dressing her, and bathing her.
With no income of her own beyond Social Security, her help is paid for by In-Home Supportive Services, a program run by the state’s Department of Social Services. The state allocates hours and payroll money each month to low-income seniors and blind or disabled adults and children to pay for the help that enables them to remain in their own homes and out of licensed-care facilities.
Patché is one of thousands of people in Santa Barbara County’s IHSS program worried about what effect a state-imposed $226-million cut to the program will have on her services.
“When they talk about cutting hours, that would be desperately disastrous for me,” Patché said. “I need seven-day-a-week help, and I need hours that I can then arrange in such a manner that I can have coverage during the day and during the evening as necessary.”
Cost containment measures in the new state budget include raising the bar for participation in the IHSS program. The qualifications are based on a Functionality Index score that evaluates who needs the program the most.
According to Kathy Gallagher, director of the county’s Department of Social Services, the new regulations mean about 650 of the county’s 3,000 current IHSS recipients will completely lose their eligibility to have their caregivers paid for by the state.
She’s concerned that those participants—many of whom are elderly and have some form of physical disability or cognitive impairment—will have nowhere else to turn.
“Government is the back-up system. When people don’t have family or close friends to take care of them, we’re the safety net,” Gallagher said. “Now that’s gone. We don’t know what’s going to happen to them.”
Other recipients stand to lose at least some portion of their current services.
Brad Parks, program manager of the department’s Adult Protective Services, said 800 more locals will lose domestic services such as house cleaning, shopping, meal preparation, and laundry. In all, half of all current recipients will see some drop-off in their service.
The rule changes take effect on Sept. 1. Gallagher said her staff is in the process of identifying the affected cases and sending out official notices of ineligibility or reduced hours.
In the meantime, those in the program must wait it out.
To Patché, whose workers have had to deal with recent pay cuts as well, the consequences of losing care run deeper than most can imagine.
“The public isn’t going to be aware of how deeply people like myself are affected with this kind of cut,” Patché said. “[Cuts were made] without really thinking about what it really means. But the Legislature goes on—they are paid, they have their perks, and everything just continues on, yet they’re doing these things that affect the most vulnerable.”
Jay’s story
When he worked as a nurse in Santa Maria, Jay Smith never thought the day would come when he’d be too sick to take care of himself.
That changed in January 1993, when Smith was shot during a robbery attempt while visiting a friend in Los Angeles. The incident left him a quadriplegic and in need of daily living assistance.
Caring for Smith was taxing on his wife Lisa, who worked during the day in the medical field and was later diagnosed with chronic fatigue syndrome. As a result, Smith would stay in bed most of the day, watching television and reading.
That sedentary existence took its toll on Smith’s psyche.
“That’s no kind of life,” he said. “It gets old really fast, and your mental aspect of life makes you think that you’re not good for anything anymore.”
Unable to obtain insurance due to his condition, he followed the advice of a neighbor in his
assisted-living complex and applied for IHSS in 1995. For Smith, now 50 years old, the program came as a godsend.
“I wouldn’t be able to afford anything like that,” Smith said. “I was able to go on with my life, get up, and still proceed in being productive.”
Presently, two caregivers run split shifts to get him out of bed in the morning, dress him, and get him into bed at night. They also clean his apartment and shop for him.
During the day, Smith phones other shut-ins, offering them counseling or a friendly and knowledgeable ear. He tries to limit his IHSS need as much as he can because he knows there are people worse off than he is who could use the benefits of the program.
“There’s people with a really dire need of around-the-clock care, and the state provides that,” Smith said. “To take it away would really hamper a lot of people. It’s not just me. It’s a worthwhile, beneficial program that helps a lot of people get back into the mainstream, even if it’s just being able to interact with people in a regular manner instead of thinking that ‘Now, I’m no more worthy to be in society.’”
For many in a similar situation, Smith said, the state-run IHSS program is the only care option.
“When you have an injury such as this or you do get sick or elderly and you need assistance, there’s always the thing in your mind that ‘I wish I could take care of myself,’” Smith said. “I’m sure there’s some people that want to take advantage of it and that’s why they want to cut a program such as this, but there’s a lot of people who need it to keep going and be able to take care of themselves.”
Anti-fraud measures
Under the IHSS program, recipients select their own care providers, who fill out timesheets for the hours they work. The sheets are then signed by the recipient and sent to the county.
According to Gallagher, the system has the potential for fraud, where the caregiver could inflate the number of hours actually worked. While fraud hasn’t been a problem in Santa Barbara County, Gallagher said, it has been in larger counties, where caregivers have been found with criminal backgrounds and paid for providing assistance in multiple counties.
Based in part on findings by the Sacramento County Grand Jury in March, Gov. Arnold Schwarzenegger made IHSS fraud a major issue, pushing for legislators to include a slew of anti-fraud measures in the budget. He got his wish.
Beginning later this year, all IHSS recipients will be required to be fingerprinted, at their own expense, to ensure they’re not receiving aid under different names or under addresses in multiple counties. All providers will be fingerprinted and subject to background checks by June of 2010. They’ll also be required to enroll with county social workers face-to-face, with proof of ID and Social Security cards.
In addition, over the next few years, IHSS staffers will also make unannounced home visits to ensure services are being provided as reported. If the recipient refuses, the department has the right to drop him or her from the program entirely.
Gallagher said the measures represent an increased workload for her agency.
“We don’t know what the rules are going to be and if they’re going to give us the funding,” Gallagher said. “These are all new mandates. They cut the IHSS allocation, so there’s no money there to fund these new activities.”
The anti-fraud measures are drawing a mixed reaction from other IHSS administrators, who don’t believe they’re justified.
Dr. Ken Jensen, deputy director of Santa Barbara County Department of Social Services, said the measures constitute a “presumption of fraud” and present a logistic challenge to the already cash-strapped agency.
“The judicious expense of public monies is something that we take very seriously,” Jensen said. “We’re very judicious in how we spend, and I’m perplexed with the degree of fraud being alleged.”
The agency already has a system in place to deal with fraud, according to APS’s Parks, and the problem isn’t as rampant as Schwarzenegger claims.
“I myself don’t think that fingerprinting recipients is an effective way to prevent fraud,” Parks said. “Although I think some fraud measures are appropriate in the program, I think that this latest legislation is excessive, and some of it is not necessarily going to be particularly effective in terms of what it’s intended to do.”
While he’s in favor of face-to-face meetings with providers, Parks said, he’s concerned about how recipients will respond to being fingerprinted.
“I think if I were an IHSS recipient of services, and I were a frail and elderly person for example, I would be puzzled and confused and unhappy about having to be fingerprinted by my IHSS social worker,” Parks said. “That part of these fraud measures doesn’t make a whole lot of sense to me, quite honestly, and I don’t blame somebody for being put off by it. There’s kind of an unstated implication there.”
Longtime IHSS recipients like Patché and Smith have mixed feelings about the new requirements.
Patché said IHSS personnel should be more familiar with who’s in their program and hopes the measures will be implemented with an understanding of her physical limitations.
“I don’t personally like the idea. In a sense it almost offends me,” Patché said. “I’m a person who follows what it is I’m supposed to do. So do my people. I can understand that they’ve got a problem in some areas—fine and dandy, go out there and check them out. But they don’t need to bother me and bother my time.”
Smith, who chose his providers through ads placed at Allan Hancock College, said he personally doesn’t mind most of the security measures because he has nothing to hide. However, he does object to being forced to cover the expense out of his own pocket.
“I know the state is in pretty bad shape,” Smith said. “But it seems like they must have another way to do it than make people on a limited income pay for something like that.”
At what cost?
After the negative attention heaped on IHSS during the summer, county program administrators hope the positive benefits of the program don’t get lost in the shuffle.
“With all of the emphasis on fraud, it’s a shame that what gets lost is the human element,” Parks said. “The program has been very successful in terms of providing the kind of support that it’s intended and designed to provide.”
When he was working, Smith said he didn’t even know the program existed. But when he needed it, he was grateful it was there.
While he’s likely to remain eligible for IHSS, he hopes that lawmakers see the validity of the program and recognize the full impact the cuts will have on others like him, who worked and paid taxes before falling on hard times.
“I think that they don’t sometimes see the need to keep these programs alive,” Smith said. “I think they look at it as, ‘We can just cut these off, and the people will survive another way,’ and it doesn’t always work that way.”
Unfortunately, Smith said, the elderly and disabled are oftentimes the first to have their benefits cut in times of economic lows, because of the perception that the state gets nothing in return for their investment.
“In a way, I can understand that,” Smith said. “But I look at it this way: I didn’t ask to be in this position, and if I had the chance to get out of this chair, I’d go back to being a nurse in a heartbeat, paying taxes and doing my fair share. But I can’t do that.
“Productivity isn’t just working,” Smith added. “It’s a state of mind.”
Patché said she’d appeal any cut to her hours and hopes legislators would be more compassionate when it comes to making future budget decisions.
“To use a hatchet to make cuts in things that so desperately affect the lives and well being of those people shows that you have not used very good statesmanship nor what I would call good planning or management,” Patché said.
“No one else really knows that much about it except the ones who are affected,” Patché added. “We’re an easy target.”
Staff Writer Jeremy Thomas can be contacted at jthomas@santamariasun.com.
Budget axe cuts a wide swath
Clients of the county’s In-Home Supportive Services aren’t the only social services beneficiaries losing their safety net.
The upcoming fall semester was supposed to be 27-year-old Davida Hernandez’s last at Allan Hancock College. Now, everything is on hold.
A single mother with a 19-month-old daughter, Hernandez planned on transferring to Fresno State to continue her studies in speech pathology.
On Aug. 6, just two weeks before the start of the semester, Hernandez received notice that her childcare assistance from CalWORKs’ Welfare to Work program would be cut off on Sept. 1 because her child is younger than 2.
“There are families that depend on this program. It seems like they would’ve let us know ahead of time,” Hernandez said. “At this point, I have no idea what to do.”
Hernandez said she’s getting frantic phone calls from other mothers wondering the same thing.
“We’re trying to work together to find out something that we can do to get each other through school,” she said.
Fellow Hancock student Adelina Pozos is facing a similar dilemma.
Forced to care for her younger brother after her parents’ death and with two children of her own, Pozos enrolled in CalWORKS and the Welfare to Work program to help her pay for childcare, books, and transportation to and from school.
A Hancock employee paid by the CalWORKs program, the 21-year-old planned to graduate next May.
“The only reason I went to school was to get a better job and to set a better example for my kids,” Pozos said. “I’m afraid I’m going to lose the job at Hancock because they’re not going to be able to pay me. It also means I’d have to spend less time with my kids. It’s going to affect me really bad.”
Pozos will remain on the program until December. If she loses her childcare benefits, Pozos said she’ll have to switch to full time at her retail night job to save money and hold off on school indefinitely.
According to Kathy Gallagher, director of the county’s Department of Social Services, single mothers who had children at a young age will be most affected by the cuts to the Welfare to Work program.
“In this economy, when we have more people coming on cash assistance, we’re not going to have the money to put them into job training or into education classes or help them become self-sufficient again,” Gallagher said.
The state Legislature’s approval of a $375-million cut to the CalWORKS budget will result in an overall 25-percent reduction of the 3,000 families in the county’s program, Gallagher said.
The budget change will keep mothers of children younger than 2, who are currently required to be in the Welfare to Work program, from participating in the program until their child turns 2. Mothers of two or more children younger than 6 will also be excluded.
Frank Mejia, division chief of CalWORKs for the county, said those recipients can still receive cash assistance and food stamps until at least 2010, but won’t benefit from job training and childcare assistance in the employment program.
The state’s Department of Social Services was dealt a further blow by Gov. Arnold Schwarzenegger, who used his line-item veto power to cut $80 million from the agency’s Child Welfare Services.
The cut won’t affect clients, Gallagher said, but it will reduce staff and diminish the ability of the department to perform its state mandates.
“We’re not going to have the capacity to respond and investigate child abuse complaints at the level we’ve been funded to do,” Gallagher said. “We’re going to have to do it with about a quarter of the staff we have today.”
According to Dr. Ken Jensen, Santa Barbara County Department of Social Services deputy director, the agency receives about 4,500 child abuse referrals from doctors, police, friends, and family each year—a large percentage from North County.
“We’ve been doing extremely well, however the cuts would make our work extremely challenging,” Jensen said. “We’re going to end up, though, with less people doing more work. That’s unfortunate. These children really deserve more. They’re not bad kids. They deserve better.”
The new budget also calls for reduced rates paid to foster parents. While county-licensed foster homes will be untouched, rates for family foster agencies and group homes, which house children with behavioral difficulties, will take a 10-percent cut.
Jensen said he expects the cuts to cause more families to decide they can’t afford to be foster parents. More children are also likely to be placed in group homes, where costs for care are higher.
“The cost-saving measure actually will most likely culminate in costing the county more,” Jensen said.
According to Gallagher, the statewide County Welfare Directors Association is conducting research into the legality of the governor’s line- item veto because the money was already appropriated for use by Child Welfare Services in February.
She called the cuts “devastating” to her agency.
“This is an illustration of how serious the state budget situation is, that we’ve cut this deep into basic human services that support the community,” Gallagher said. “We have to call upon our community members to be aware of their elderly neighbors’ needs, be aware of child abuse issues within their own families, because the government services aren’t going to be there anymore to support some of these services that we’ve provided in the past.”
—Jeremy Thomas
This article appears in Aug 13-20, 2009.