Budget cuts to clients with disabilities burdens families and agencies.
For years, Sheryl Kaminer has dreamed of the day her daughter, Elana, 26, would move into a home of her own, with full-time caregivers to meet the special needs of Elana and her roommates. Last year, Sheryl and her husband, Dennis, found the perfect house in north Oak Park, a three-bedroom ranch just a few blocks from their own home.
Kaminer and two other moms, longtime friends who also have daughters with special needs, had always hoped their daughters would share a home after they turned 26, the age when public school education ends in Michigan.
The parents had a series of meetings to plan for the transition; they spoke with representatives from JARC, the agency they chose to provide staffing for the home, and with their respective case workers from MORC (Macomb Oakland Regional Center), the agency that funds many of the services provided to individuals with special needs and their families. While neither agency could make any guarantees, the agency staff members seemed optimistic, and a move-in target date was set for March of this year. The three young women spent time together socially in preparation for becoming housemates.
Today, because of massive funding cuts to mental health services budgets throughout the state of Michigan, Elana and her potential roommates are still living with their families, and the Kaminers have leased the young women’s would-be home to a tenant until the situation is resolved. Kaminer is shocked, overwhelmed and discouraged.
“My husband has already had two heart attacks; I don’t know how much longer we can continue to take care of Elana at home,” Kaminer said. “She needs help with everything, and it’s so demanding.”
Marlowe Robinson B’sheart, a high school English teacher in West Bloomfield, is the parent of six children, including a 10-year-old daughter, Moby, who has developmental delays and cognitive impairment. For the past five years, B’sheart has received a monthly respite allowance from MORC, which provides parents of children with disabilities with a much-needed break.
“It was invaluable,” she said. “It enhanced my ability to be a healthier parent, to have one-on-one time with my other typical children. It allowed me to regroup and re-energize to honor my other children’s needs.”
Last August, B’sheart was notified her annual budget had been cut and her respite services would be discontinued. When she requested an appointment with her MORC caseworker to have her case reviewed, she was told the cuts were going to take place and there was no need for an appointment.
“Two weeks later, my services ended, just in time for the school year,” B’sheart said. “I was getting 60 hours [of respite care] a month. It was a dramatic shift to go from 60 hours to zero overnight.”
Losing respite care has been detrimental to Moby now that B’sheart can no longer spend as much individual time with her.
“It affects her ability to make progress — I don’t have the time and energy to facilitate her therapy and academic learning at home,” B’sheart said.
Her other children, who range in age from 8 to12, have been affected, too.
“There is no longer any way for them to have one-on-one time with me, and it impacts them to have a parent who is utterly and completely exhausted,” B’sheart said. “We’re still acclimating.”
B’sheart said she has heard of hundreds of other families who have completely lost their services. Families whose income is low enough to qualify for Medicaid were able to keep respite care benefits; it is middle-income parents like B’sheart who were hit hardest by the latest round of budget cuts.
“I’m a teacher, so my salary puts me above poverty level, but I don’t make enough to pay for respite care,” she said.
B’sheart and Kaminer are among thousands who have been affected by the budget cuts, which are attributable to several causes. For fiscal year 2014, the Oakland County Community Mental Health Authority (OCCMHA), which distributes money to several service providers in Oakland County, experienced a $14.5 million reduction in Medicaid revenue from the Michigan Department of Community Health (MDCH). This was the result of “rebasing,” a redistribution process intended to equalize Medicaid funds across the state. As a result, funding to counties such as Oakland, Macomb and Wayne was significantly reduced. In addition, reductions in the MDCH budget caused an additional $8 million decrease in state funding to OCCMHA. At the same time, the demand for services in Oakland County increased by $7 million.
While OCCMHA used reserves to cover a portion of its shortfall, a deficit of approximately $11.5 million was passed along to its providers, which includes MORC, in addition to other smaller organizations such as Easter Seals and Community Living Services of Oakland County. Across-the-board budget cuts of 6 percent were imposed on agencies that contract with MORC to provide direct care services, such as JARC, Kadima and JVS.
“Because Medicaid funding has remained relatively flat over the last decade, it is the direct care providers who are left to make up the shortfall,” said Carol Kaczander, who is the strategic gifts associate for JARC as well as the parent of Robbie, 35, who has disabilities and lives in a JARC home.
In the Jewish community, these providers include JARC, which provides residential options for people with developmental disabilities; Kadima, which provides housing and support services for individuals with mental illness; and Jewish Vocational Service (JVS), which offers vocational programs and other support services for people with disabilities as well as to the general community.
Because the majority of these agency budgets is devoted to staffing, this is the area that suffered the strongest blow.
According to Lisa Rothberger, JARC’s chief talent officer, the agency has cut administrative staff and, last year, an across-the-board salary cut of 5 percent was imposed on all employees.
“We’ve always paid a premium wage and had great luck recruiting the best in the field,” said Rothberger, adding that cutting the starting wage of direct care workers from $11.09 per hour to $10 per hour had a detrimental impact on the agency’s applicant pool. “We used to get a minimum of 100 job applications a week; now a good week is about 20 applications.”
While the strongest impact has been on providers who primarily serve those with developmental disabilities, Kadima is also experiencing fallout from the budget cuts. When Eric Adelman attended his first meeting as executive director in February 2014, he learned one of the agency’s providers had eliminated its transportation reimbursement, a yearly amount of $36,000. While Kadima has not had to cut salaries or services, Adelman said the agency is being indirectly affected through the service authorization process.
“We are getting a sense that the core providers are loathe to authorize residential services because they are expensive,” he said.
Despite Kadima’s starting salary of $10.02 per hour for direct care workers, the agency is experiencing annual staff turnover of 25-50 percent. According to Adelman, the industry average is about 50 percent.
“Especially for our clientele, knowing them, the things that trigger their mental health crises, the techniques that calm them and help them regain stability are of the utmost importance …,” Adelman said. “Turnover reduces stability and increases the risk of mental health crises.”
Ironically, the long-awaited improvement in the overall economy, including the increase in minimum wages by employers such as McDonalds and Wal-Mart, is having a negative impact on the business of providing mental health services.
“Why would someone work here for $10 an hour, doing work which is emotionally and physically demanding, when they could flip burgers for the same wage?” Adelman asked.
At JVS, which has not received an increase from MORC, the agency’s major funding source, in 14 years, the budget cuts have necessitated laying-off some employees and reducing the hours worked by others.
“Less hours means less time to plan for the day because the employees arrive a half-hour later than they used to,” said Kirk Jude Goddard, vice president of habilitation services at JVS.
In addition to the challenge of maintaining quality services with fewer personnel, the agencies are coping with declining employee morale and quality of applicants, direct results of the budget cuts.
According to Kaczander, the statewide average is $8 an hour for direct-care providers. Even with the premium paid by JARC and other local agencies, caregivers are feeling pinched, especially after the recent salary cuts.
“It’s not really a living wage for people who are providing life-saving care,” Kaczander said. “Most have second and even third jobs to make ends meet.”
Goddard, who acknowledged the budget crisis has caused employee morale to decline, worries about the ramifications of future cuts, which will likely mean increased caseloads for support service coordinators.
“Morale has suffered here; we’re all struggling to recruit and retain staff,” Goddard said.
Those experiencing the devastation caused by the tsunami of funding cuts fear the situation is likely to worsen rather than improve in the near future. There has been talk of more cuts for the upcoming fiscal year, which starts in October, including additional rebasing.
“One of the most significant impacts is on parents who are waiting for services,” Kaczander said.
This includes Kaminer, who was hit with a “double whammy” this year: In addition to learning she may have to keep Elana at home indefinitely, she was told there may only be enough funding for three days (per week) of vocational programming, rather than the five days she was counting on.
Vocational training and other day programs for individuals with disabilities, such as those provided by JVS, are crucial to those who have aged out of the public special education system. For many of these people, government-funded vocational programs are the only thing keeping them from spending their days at home in front of a computer or TV.
“I work every day,” Kaminer said. “What am I supposed to do if Elana is home two days a week, quit my job?”
Other parents whose sons and daughters already participate in day programs have been told their budgets will undergo significant scrutiny before funding is renewed for the upcoming year.
“My daughter has her own job coach,” said an Oakland County mother who asked to remain anonymous. “Without that support, she would not be able to participate in her program, which gives her a place to go every day where she can be with other people and feel productive. I don’t want to think about what will happen to her if we lose that funding.”
Rena Friedberg, JARC’s interim CEO, said community support is more critical than ever before if JARC is to maintain its commitment to its clients and high standards of care. She, along with other agency administrators, fear continuing budget cuts will undermine the principles on which their organizations are based.
“If a community is judged on how we care for our most vulnerable citizens, what does that say about us? As Jews, we’re all responsible for each other,” Kaczander said.
Adelman has similar concerns.
“The impact of continued funding reductions to agencies like Kadima is going to be devastating … when one combines the expected cuts from this system with the reality of increased need for mental health services — especially for young clients with pervasive and complex needs and older clients dealing with age-related illness … The sky isn’t falling yet — but the cracks are there. And the victims will be our clients, among the most vulnerable people in our community.”
By Ronelle Grier, Contributing Writer
Call to Action
Mental healthcare professionals agree that advocacy is the most effective way to influence legislators and government agencies to take steps to alleviate the current and impending funding crisis.
Here are some helpful tips for communicating with public officials and representatives:
- Send separate letters to state and county officials.
- Parents and family members, tell your personal story. Describe the special needs of your child(ren), what services they need, how the budget cuts have affected your family.
- Be persistent. Write each representative on a regular basis as often as possible.
State of Michigan:
- Gov. Rick Snyder, P.O. Box 30013, Lansing, Michigan 48909; (517) 335-7858, Constituent Services.
- Nick Lyon, director, Michigan Department of Community Health, Capitol View Building, 201 Townsend St., Lansing, Michigan 48913; (517) 373-3740.
- Your local senator and state representative (available on www.michigan.gov).
- L. Brooks Patterson, Oakland County executive, 2100 Pontiac Lake Road, Building 41 W, Waterford, MI 48328-0409.
- Willie Brooks, director, Oakland County Community Mental Health Authority, 2011 Executive Hills Drive, Auburn Hills, MI 48326.
- Your local Oakland County Commissioner (available on www.oakgov.com).