Doing More with Nothing
A Case for Re-examining the Drastic Budget Cuts Proposed for the 2011 Legislative Session
by Staci Coleman, Cassie Murray, and Tinamarie Schmidt
Washington Department of Health and Human Services mission is “to improve the safety and health of individuals, families and communities” and has been the survival mechanism for Washington’s most vulnerable populations; the indigent and the disabled. The proposed budget cuts to be decided upon in the 2011 Legislative Session are an unfortunate result of the recent economic downturn that has affected people in all socioeconomic strata. However, some of these proposals are unnecessarily harsh. Many of Washington’s most vulnerable will suffer needlessly and any cost savings to the state in one department will be offset by costs imposed in other areas, such as jails and hospitals, not to mention the immeasurable social costs of homelessness, untreated illness and death. We would specifically like to address the $40 million cuts to Skilled Nursing, $9 million cuts to the ADATSA program and $39.4 Million cuts to the Adult Pharmacy benefits. These are some examples of our state’s most vulnerable adult populations.
Skilled Nursing/Long Term Care Facilities
The $40 million dollar budget cut for Long Term Care is hurting some of the most vulnerable citizens we have in Washington State. Our elderly and developmentally delayed citizens need comprehensive care and services to help them remain independent and as self sufficient as they can be. When they cannot live independently, we need to ensure care standards and services are available and accessible to all, not just those with the financial solvency to self pay. Delaying necessary training and certification for care providers, reducing rate compensations for nursing homes, and reducing home care and aid services will negatively affect our most vulnerable citizens.
A Medicaid patient in need of a skilled nursing facility was in the hospital for weeks longer than necessary because she required specialized therapies that nursing homes in the community couldn’t afford with her Medicaid compensation. The staff social worker called over 15 local skilled nursing facilities asking for availability of any female Medicaid beds and over and over again was informed none were available. These facilities had beds, just none allocated Medicaid. Of the 5 homes that had a Medicaid bed available, once informed that this patient needed Occupational Therapy, Physical Therapy and a Wound Vac (a device used to seal and treat an open wound), only one facility remained that could or would take this patient. Due to the state’s Medicaid reimbursement rates, it is cost prohibitive for nursing homes to take Medicaid patients that need ancillary care because those costs come directly from the small rate of reimbursement from the state, usually resulting in a net loss in cost. The final facility available for this patient was in such a degenerated state, routinely ranking in the worst care facilities in Washington state that the patient was fearful of the care and resisted discharge until another facility could be located.
Alcohol and Drug Abuse Treatment and Support Act (ADATSA)
Research indicates that in the state of Washington, low income recipients who were provided with chemical dependency treatment had fewer arrests, reduced medical costs, increased earnings contributing to the tax base and were “less likely to die” and that the benefits “are persistent even five years after treatment.” (Shah, Mancuso, Yakup, & Felver, 2009)
Jennifer* had been sexually abused by her stepfather from age 5 to 9, began using drugs and alcohol by age 14 to try to deal with her feelings surrounding the abuse, and by age 18 was fully engulfed in addiction. By age 25 Jennifer was using methamphetamine and heroin daily and had lost custody of 4 children; she was prostituting herself to pay for the drugs, and was often noticed by law enforcement. Jennifer eventually got arrested and ended up serving time in the county jail. During that time Jennifer decided that she needed to get some help for her drug issues. Jennifer had never held a job, and had no insurance. The diversion specialist in the jail was able to get an ADATSA evaluation scheduled while Jennifer was still in custody. Jennifer was approved for ADATSA funding, and was able to be released from the jail to attend inpatient chemical dependency treatment. During those 90 days Jennifer began to deal with her past abuse issues and the reasons for her use. When Jennifer was returned to the jail, she was able to be released a few weeks later and moved into a half-way house. Over the next year Jennifer remained committed to her treatment. For the first time in many years Jennifer was happy with where she was heading. Jennifer continued to follow the principles that she learned in treatment, and was able to get a full time job. Jennifer continues to improve; she has begun schooling to become a dental assistant, she continues to work, has gotten her own place and is working to regain custody of her 2 youngest children. Jennifer continues to work daily to remain clean and sober. It has been over 2 years since Jennifer last used. The proposed cuts in ADATSA services will make it unlikely that people like Jennifer will be able to access treatment services that have made such a difference in her and her children’s lives.
Adult Pharmacy Benefits
Studies have shown that indigent populations are increased risk for a decline in their health status if they are no longer provided with assistance to obtain medications (Piette, Heisler, Horne, & Alexander, 2006). They are also more than twice as likely to utilize other more significantly costly services such as emergency rooms and hospitals, and are also significantly more likely to experience death due to under-use of prescription medications due to cost (Piette, Heisler, Horne, & Alexander, 2006).
Mr. W. is 24 years old. He worked hard and graduated from high school, got a job with a landscape business and was working his way up in the firm when he had his first psychotic break. He became increasingly erratic, disorganized, paranoid, and began hearing voices that commented on his every thought and action, calling him stupid and other hateful names. As a result of his erratic and disorganized behavior, he lost his job, and soon lost his apartment and became homeless. Within a few months as a result of homelessness, inability to take care of himself and increased mental health symptoms including suicidal thoughts and voices encouraging him to “do it!!” he finally attempted suicide. He survived and was taken to the hospital. He was diagnosed with schizoaffective disorder and was prescribed an anti-depressant and an anti-psychotic medication. For the first time in a long time the voices quieted. He was able to function. He could think clearly and have a “normal” conversation with someone without fear and paranoia. The antipsychotic and antidepressant medications that he is currently taking are very expensive. His prescriber has tried several different combinations of medications and the current regimen is the only regimen that keeps him stable enough to allow him to live independently. If Mr. W were to lose coverage for his medication, he would require institutionalization or would be homeless and using drugs and alcohol, which leaves him more vulnerable to suicide and/or victimization from others and at significantly higher risk for becoming hospitalized, or in jail.
With a reduction in services and reimbursement rates for long term care, ADATSA and adult pharmacy benefits, examples as above will abound. There will be an increase in the use of hospital emergency rooms and an increase in criminal recidivism and nuisance crimes due to persons with mental illness “acting out” as a result of going off of the medications. As a community and state, we need to be helping our clients stay independent in their homes as long as it is medically safe to do so. When citizens need care beyond what can take place in the home, financial circumstances shouldn’t be a barrier.
The repeated budget deficits are forcing all of us to do more with less. By making these sweeping indiscriminate budget cuts, you are asking the most vulnerable populations in our state to do more with nothing. More people will be homeless, or in jail, and some may die. We strongly urge you to reconsider completely cutting those benefits that are vital to the health and even the survival of many of our state’s most vulnerable populations.
We URGE you to contact your local representatives - let them know these are UNACCEPTABLE budget cuts - tell them you know this, they need to know this and as their constituent, your voice needs to be heard!
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