Dane County's Long Term Care System in Crisis
By Frances Bicknell
Most of us take our good fortune for granted. We live our independent lives, forgetting that some of our fellow citizens must wait for someone to help them get dressed in the morning; plan, buy and cook their meals; supervise their medications and/or arrange for special transportation so that they can leave their homes. One of the "inside jokes" is that we lucky ones are the "temporarily-abled". Our time will come!
As we begin to age, or think of our aging parents, we realize that long term care is expensive. If we are fortunate, we can afford to buy long term care insurance or "self insure". But what about those who are disabled from childhood or early adulthood? Most families cannot afford long term care for their elderly members. Even fewer can provide for a lifetime of care for a family member. When we find that over 57% of the Human Services Budget is for Adult Community Services, (64% if county nursing home budget is included) it follows that most of the adults who receive services from Dane County are frail, elderly or disabled.
Advocates have worked for over thirty years, at all levels of government, for community services instead of institutional care. Legislation and court decisions have affirmed the rights of people to live in their own communities. Wisconsin was a national leader among the states in the 1970's and 1980's and developed programs like the Community Options Program (COP) to allow frail elderly citizens and people with physical or developmental disabilities to live in their communities with services primarily provided by state funding. Community supports were also developed for people with severe and persistent mental illness, but these programs have not received as much state support.
Dane County has developed an excellent long term care system over the past thirty years. Services are provided by private agencies that have creatively met the individual needs of the frail elderly and those with disabilities. However, over the past 15 years the Cost Price Index has gone up over 42% while the Cost of Living Adjustments to the agencies from Dane County has only gone up about 29%. The funding to provide services has eroded almost 1% per year while all costs go up and the cost of health insurance has exploded. The community services in Dane County are now in crisis!
The fiscal pressures on the service system have increased each year. In addition to the cuts in purchasing power, the provider agencies for those with developmental disabilities were cut about 4% for 2004. Most agencies report that they have not been able to give wage increases without increased employee costs for health insurance. An informal poll has shown that 18 agencies have cut 74.75 positions. Other agencies have cut their workers' schedules to 80% of full time. Some agencies have cut both staff and staff hours. Workers are trying to serve as many people, in a safe and effective way, with less time to do so. Many are also working second jobs. We are not rewarding our most faithful workers.
Dane County did adopt a Living Wage Ordinance in 1999 that guarantees that the lowest paid workers will receive wages equal to the poverty level for a family of four. These workers will receive an increase of 22 cents per hour or 2.4%. This effort is appreciated but there are still problems. These are still poverty level wages, and the agencies are suffering wage compression problems when the employees who earn slightly more than the official living wage receive less (or no) wage increases. The proposed budget does provide for an increase of 1% for these workers who are just above the poverty level. However, the agencies serving those with developmental disabilities will receive almost a 1% budget cut, only partially offset by the wage increases. There are no proposed increases for any employees who make over $13.60 per hour. Agencies report that there are often no applicants for advertised positions.
All of these cuts have had an adverse effect on the lives of the consumers. They are subject to multiple staff changes as staff turnover increases. The new workers are often not as experienced and there is less time for training. In addition, many of the clients have been required to move and to live with additional housemates. Consumers in both the mental health system and the DD system have lost staff support for employment and adequate job development has not been available for those who are unemployed.
Then there are the waiting lists! About a thousand individuals who are disabled or frail elderly are waiting for services. Some can receive some limited support services while they wait. Others are living with aging parents or other family members. Some must go into nursing homes.
Failing to fund services has many consequences. People who do not get appropriate mental health services may be among the homeless or in jail. Many individuals with disabilities or mental illness may not be able to work if they do not receive proper supports and treatment. Some family members, and particularly single parents, may be unable to work if there is no after school program for children (and teens) with disabilities or support services for adults who are disabled or frail elderly.
The League of Women Voters has a long-standing position supporting quality services for people in need of care. We have testified at the annual Dane County Budget Hearings in support of adequate funding for the agencies providing services, and at least, to keep up with inflation. Our support has been for children at risk, as well as vulnerable adults.
The League recently studied and updated our position on long term care. Our study described a system in crisis. Our Board of Directors recently approved support for a modest tax increase to meet the current fiscal pressures on community services for adults, as well as on services for children.
We are pleased to learn that 69% of Dane County residents share our commitment for a modest increase in our county property tax levy to support human services. (According to a poll conducted by SOSDane, a new coalition dedicated to saving human services in Dane County). The proposed increase, of no more than $20 on an average home, would still keep the mill rate below the 2004 level.
The League favors more progressive forms of taxation, such as the income tax, and we will continue to work for adequate state funding. In the meantime, we must not forget our most vulnerable citizens in Dane County. We continue to believe, quoting Oliver Wendell Holmes, Jr., that "taxes are the price we pay for civilized society". Now is the time to call your County Board Supervisor to support an increase in the Human Services Budget.