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Are social services savings real or just an illusion?

Sleight of hand 

Are social services savings real or just an illusion?

It's not so much a feeling of desperation; that implies a certain quickness --- a racing, clinging quality.

            No, the mood in the St. Paul waiting area is slower, somehow. Men sleep. People wander in and out, checking the jobs-posting boards --- nearly empty at 3:30 p.m. on this particular Friday --- and to monitor family members' progress through leaden lines.

            "This is nothing. You should come in the morning," says one woman who asks not to be identified. She's accompanying her daughter, who is applying for assistance from the county Department of Human and Health Services.

            "Every person you know is a contact!" screams a flier hanging on the wall, in a bit of otherworldly cheerfulness. The flier urges job seekers to hit up their barber, waitress, and people they meet on the Internet for leads.

            "Her appointment was at 9:30 and we didn't leave here till 12:30," the woman says. "She's been here sometimes when she has to wait most of the day."

            It's not unusual, in fact, for people with appointments to wait 90 minutes. Don't have an appointment? You could be waiting four hours or more, according to Bob Ingram, organizer for the welfare-rights organization Empower.

            The horror stories since the county's reform of social services, known as "Operation Transform," are well-documented. Now called the Department of Human and Health Services, the goal was to centralize applications for all financial programs such as Temporary Assistance, Medicaid, Day Care, and Food Stamps. Prior to the reorganization, applicants had to fill our multiple applications and participate in separate interviews for each program.

            The merger has already saved $29.2 million, the county says, through everything from closure of ineligible Medicaid cases and reduction in opening and increased closure of public assistance cases, to reduced administrative costs.

            "Today we can show that the savings due to Operation Transform are real and making a difference for county taxpayers," says County Executive Jack Doyle.

            But critics charge that the county has offered no proof of the savings and that its clams are unbelievable because much of the projected savings was based on reduced caseloads that haven't materialized. They also argue Operation Transform has torn through social services like a cyclone, cutting a swath through human tissue along the way.

What happens when you lose 160 workers, nearly 25 percent of your workforce, including many of your top managers? Nothing good, say local Democrats and union leaders.

            "We do not have sufficient staff levels to cover all the cases," says Richard Hutchings, vice president of the Monroe County Federation of Social Workers. "There's hardly any oversight on some of our most critical cases."

            Workers are stressed to the point where 15 percent of the staff, according to Hutchings, is out on stress leave. Short staffing has also resulted in poor communication between case workers and clients, Hutchings says. Empower did a random survey of 20 welfare workers seven months ago. Of the 20 it tried to contact by phone, 17 calls either went to voicemail or the machine was full and the call went to a clerk.

            Because most of the managers are gone, the department was left with a knowledge vacuum, says Bryan Hetherington, attorney with the Public Interest Law Office of Rochester. This has resulted in mistakes, including lost documents, cases being closed inappropriately, and criteria for benefits being misapplied.

            "We have people come in with receipts for documents that the agency can't find," Hetherington says. "There are people who've applied one or two times and the agency claims not to have the application. This is a very significant issue in the community and people are being harmed."

            Many of the remaining workers, Hetherington says, are being asked to do jobs for which they haven't been adequately trained.

            "The effect of the buyout plan was to basically deprive the agency of much of the knowledge it needed to successfully operate," Hetherington says. "[Prior to the merger, caseworkers] would know it inside-and-out and would be very likely to get decisions right."

            These are matters that effect people's lives, he says.

            "About whether they're going to get medical care. About whether they're going to have food to eat tomorrow. About whether they're going to have shelter," he says. "The very means to live is what's involved in these programs. And you're going to put workers out there with inadequate training?"

            The Public Interest Law Office of Rochester provides free civil legal services for low-income people. The firm handles clients' litigation against the department, if their situation can't be worked out by the Monroe County Legal Assistance Corporation.

            The situation is so bad, Hetherington says, that the law office is considering a class-action suit against the department.

            The Monroe County Legal Assistance Corporation is the first line of defense for people who feel they've been unfairly denied benefits or whose benefits have been terminated.

            Ann Mason, a senior paralegal with the corporation, can't give exact numbers, but she says caseloads have increased dramatically since the merger.

            "They know they're making mistakes. They're addressing them in some ways effectively and in some ways, ineffectively. But they're imploding," she says. "It's just a never-ending nightmare. We've pretty much restricted direct representation for those suffering the worst."

            There are reports, Hetherington says, that overtime is available to department workers for closing cases but not to open new cases, even when they are overdue --- a sign of the department's new priorities.

            "Workers and supervisors feel they are under pressure to close cases --- a sort of 'thumb on the scale' --- whether those cases are appropriately closeable or not," Hetherington says.

            There is a "take no prisoners" attitude at the department now, Mason says. The focus is to get people off the rolls, she says, any way they can.

If that is the focus, it hasn't been working. Public assistance and Medicaid caseloads have continued to rise. It has been reported that public assistance caseloads are nearly 5,000 higher than projected and Medicaid caseloads are 9,000 higher.

            How in the world then, Hutchings says, can you still claim you're saving money?

            "Any simpleton could do the math and figure out something is wrong," he says.

            The county's cost-savings' claim is incredible to local Democrats. At a press conference last week, county executive candidate Bill Johnson, flanked by Democratic county legislators, demanded a detailed account of the savings.

            If these "illusionary" savings are included in the budget, Democrats say, that budget will have no basis in truth or fact.

            "It's absolutely reckless to lead the public to believe that county finances are on firm footing," Johnson says.

            The county has promised a more detailed explanation of the savings later this month. Until then, George Wiedemer, Republican chair of the county Legislature's Human Services committee, says he's taking a wait-and-see approach.

            "Now that they're making that claim, we obviously need to verify that," he says. "If we're not saving, then we've got a problem."

            Wiedemer wouldn't be surprised, he says, if caseloads are rising, given the state of the economy. Finances aside, Wiedemer doesn't believe there are serious problems in the way the department operates since the merger.

            "Over the long haul, it will be a better and more efficient system," for taxpayers and clients, he says.

            (A county spokesperson did not return calls for comment.)

            In previous discussions, county Republicans have said that change is painful, takes time, and have accused Democrats of taking a few isolated cases and trying to make them indicative of a flawed system.

            Of course the union's upset, they say. The merger resulted in the loss of union jobs.

What's that? You say you don't care? These are poor people's problems? Think again.

            "This is another reason people go out and do violence," says the waiting-room woman. "When they need help temporarily, [the county] won't give it to them."

            Unable to get assistance, she says, people might turn to crime to support their families.

            And here's something shocking from Bonnie DeVinney, executive director of the Finger Lakes Health Systems Agency, a nonprofit community health planning agency: Delays in determining Medicaid eligibility --- always a problem but worse since the merger --- are tying up hospital beds.

            The delays also mean that more people are uninsured, DeVinney says, and the uninsured often use emergency rooms as their safety nets.

            "Our capacity in this community since the closing of Genesee [Hospital] is quite tight. We have enough beds, assuming there's no flu epidemic or SARS epidemic --- a major event," DeVinney says. "But straining the capacity of hospitals are people who are in hospital beds, who should be in some other place for care."

            "For sure, it will be a crisis if a flu epidemic hits this community this winter," she adds. "We'd be hard-pressed to accommodate all the health needs."

            The fallout from the merger isn't the only factor, or even the primary one, DeVinney says. But it contributes.

            In addition to straining the capacity of local hospitals, more uninsured in emergency rooms costs money.

            "It's not a poor person's problem. Someone ends up paying for the uninsureds' care that the emergency room provides," DeVinney says. "It has to come from some pot. The caring isn't free."

            The money, DeVinney says, comes from three places: the state (meaning your taxes), commercial premiums, and philanthropy.

            On top of that, people without insurance don't undergo preventive care, so when they take ill, they're sicker than those with insurance coverage and require more extensive treatment.

            The county looked to the merger to save money, but one critic compared it to squeezing a balloon: You're just moving the air from one side to the other.

            "It's very important for people to understand that if they're not insured, somebody has to pay for their care," DeVinney says. "Now, which pocket do you want to take it out of?"

  • Are social services savings real or just an illusion?

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