* Oy…
The Illinois Department of Human Services is struggling to provide services as some workers face caseloads of more than a thousand people.
Michelle Saddler, the agency’s director, said that the department is understaffed. “Many of you have probably heard DHS is behind or DHS has a backlog,” she told a House human services budget committee today. “We at DHS overall need more realistic staffing.” The department is asking for $3.6 billion for fiscal year 2014, the same amount proposed under Gov. Pat Quinn’s budget. DHS is expected to spend more than $3.2 billion this fiscal year. The department was cut by almost $150 million under the current fiscal year’s budget.
Linda Saterfield, director of the division of family and community services at DHS, said some of her caseworkers have caseloads as big as 2,600. “If you calculate that out, that leaves that worker less than 45 minutes over the course of a year to serve that family.” The average caseload in the division, which administers such core safety net programs as Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance program, averages more than 900 cases per worker. That compares with the year 2000, when the average was just under 250 cases per worker. Saterfield said that one in four residents are served through one of the division’s programs. “Our caseload has grown dramatically, but our staffing levels have reduced so much that we are unable to adequately meet the needs for services,” she said.
Kevin Casey, director of the Division of Developmental Disabilities at DHS, said there are about 11,000 people with developmental disabilities waiting for services in Illinois. He said the wait time can be up to four years. “It really is a struggle to understand how they get from one day to another at times,” Casey told the committee. He said the department does have a plan to reduce the number of people on the wait list over the next few years. Casey told committee members that he would later calculate what it would cost to address the wait list immediately. “It’s a choker of a number. It would take a good deal of money to serve everyone on that waiting list.”
Theodora Binion, acting director of the Division of Mental Health at DHS, said that more than 80 percent of people in need of mental health services are not receiving them. “Eighty percent of the people who need mental health services aren’t getting them? Something fundamentally is wrong with that system,” said Rep. David Leitch, who serves on the committee. Leitch said that he thinks lawmakers should prioritize mental health funding over other requests the department might have. “To overlook this, to me, is quite a crisis. I think we should as a committee take a very hard look [at it] before we add a lot of new employees at DHS and do some of the other things.” Binion said steps are being taken to serve more people through managed care programs. “I think that there are plans afoot to increase the capacity.”
* Oy…
Social service advocates say agencies providing in-home care for seniors could be at risk if additional state money is not set aside to pay them.
The Illinois Department of Aging notified service providers in a letter March 7 that it would soon run out of money to fund the Community Care Program for the current fiscal year, which ends on June 30. Providers say that $173 million is needed to properly fund service through the end of Fiscal Year 2013. Kimberly Parker, the Department of Aging’s spokeswoman, said in an email it was “common knowledge” the legislature did not give the agency enough money to continue to pay providers through the entire fiscal year and that administrators are hopeful additional money could be found. She said that so far, providers have continued to administer services, but without more funding, payment would likely be delayed until the start of next fiscal year.
The program serves mainly lower-income seniors who apply for assistance through the state for home-based long-term care assistance, with everyday needs ranging from preparing meals and running errands to dressing and bathing, according to the agency’s website. The program helps to care for an estimated 80,000 senior citizens in the state. Aside from at-home providers, it also helps to pay for background checks for at-home caregivers, adult day centers that watch elderly clients during the day and a program designed to preventing elderly spouses from being burdened by their spouses in-home care and falling into poverty. To qualify, Illinois residents must be at least 60 years old, the state must determine that they need long-term care and they must have less than $17,500 in assets aside from their home, car and furniture.
* Meanwhile, the mother of a Murray Developmental Center resident confronted the governor this week, and WUIS’ Amanda Vinicky jumped in…
WINKELER: “It is not safe, one size does not fit all…”
QUINN: “Well I understand that.”
Winkeler’s son, Mark, is 28-years-old…
WINKELER: “He functions like a nine-month old, has an IQ of twelve, needs total round the clock care, diaper changing, feeding, clothing.”
Like the kind care she says he gets at Murray.
Winkler says Quinn might realize that if he ever saw it firsthand.
VINICKY: “Governor, actually have you visited Murray Center, or Jacksonville Developmental Center?”
QUINN: “I made a decision based on what I think was right for the people of Illinois, it’s not an easy decision but a necessary one.”
VINICKY: “But did you visit either of them ever?”
QUINN: “No. I have not. I’ve seen plenty of information about it.”
*** UPDATE *** From the governor’s office…
The one-size-fits-all approach is exactly what we are moving away from. Before Governor Quinn took office, Illinois institutionalized more people than any other state. Now we are rebalancing the way the state provides services for people with developmental disabilities and mental health challenges, increasing community care so that families have more choices and people have a higher quality of life.
Whether it be an institution (once Murray is closed, there will be six institutions left Illinois); community care (which is proven to provide a higher quality of life, which is why we have increased community care and are building more capacity every day); or private intermediate care facilities (of which there are 298 across Illinois) — this is the opposite of a one-size-fits-all approach.
[ *** End Of Update *** ]
* Related…
* The state of mental health funding in Illinois is ill.
* Illinois lawmakers eye $2.5 bln bond deal to pay bills
* Harris: “We’re not solving the problem” by borrowing $2B to pay old Medicaid bills
* Illinois looks to borrow $2 billion
* House votes to end access to state pension system for part-time board members
- Hans Sannity - Friday, Apr 12, 13 @ 1:33 pm:
Hold up Rep. Harris’ pay.
See what says when he is the one waiting for payment.
- Out Here In The Middle - Friday, Apr 12, 13 @ 1:44 pm:
Proof that doing more with less is not a sustainable long term strategy.
- wordslinger - Friday, Apr 12, 13 @ 1:51 pm:
Regarding the bonding proposal:
–Supporters of the bill said the five-year bonds would cost Illinois about $40 million in interest. The alternative is to pay $60 million over the same period in the form of late-payment penalties to health-care providers and other vendors, supporters said.–
How hard is that to understand?
- truthteller - Friday, Apr 12, 13 @ 2:00 pm:
Sticking to the House budget numbers will only make matters worse. When will those members of the G.A. who express support for human services stand up for them instead of bowing down to their leaders?
- Bill White - Friday, Apr 12, 13 @ 2:01 pm:
== Supporters of the bill said the five-year bonds would cost Illinois about $40 million in interest. The alternative is to pay $60 million over the same period in the form of late-payment penalties to health-care providers and other vendors, supporters said. ==
Also too, won’t these payments be taxable income for the many of the providers?
Illinois can refinance at a lower rate, give the economy a Keynesian stimulus, AND get some of the money back via the IL income tax.
Pay $40 million in interest rather than
- Give Me A Break - Friday, Apr 12, 13 @ 2:07 pm:
To clarify something, the Rep. Harris against borrowing is Rep. David Harris, not Rep. Greg Harris the Chair of the House Human Services Apprp. Committee.
- dupage dan - Friday, Apr 12, 13 @ 2:14 pm:
As a slight digression, there is legislation being considered (HB948) that seeks to move the services of adult protective services from the Office of Inspector General (OIG) to the Dept on Aging. You might recall the investigators at OIG (there are only 5 of them for the WHOLE STATE) were exoriated for some difficult cases about a year or so ago. If the legislation passes and is signed into law, DOA is supposed to handle cases from age 18 and up (currently 60 & up). If it is done the same way it was done when OIG was pressed into service there will be NO INCREASE in funding. I am not the only person who works in this arena who is skeptical of this - not because of the elder abuse investigators. I find them to be, for the most part, dedicated and tireless in their duties. But then, I know the 5 OIG investigators and believe they, too, are dedicated and tireless in pursuit of their duties. I believe the OIG investigators (remember, 5 persons covering 102 counties) were mistakenly blamed for problems they didn’t create - they were basically set up to fail by the way the Domestic Abuse Project was created, it’s policies and lack of funding. If the Dept on Aging gets this duty but doesn’t get the funding needed, we will see more difficult cases in the future.
Okay - digression is over.
- dupage dan - Friday, Apr 12, 13 @ 2:17 pm:
I believe that a Keynesian stimulus is a pipe dream. Nonetheless - the logic is hard to refute - sell bonds to pay off the debt and spend less money over the long haul. However, the history of the GA and the gov is that when the pressure is off, they just spend more. How do we stop that?
- zatoichi - Friday, Apr 12, 13 @ 2:23 pm:
Came out yesterday that DHS’s Div of Developmental Disabities has exhausted their appropriations authority to pay community based providers for CILA and DT services for the remainder of the current year. That means no appropriations to pay providers until August. CILAs are residential homes where many of the people who lived at JDC (and future homes for people from Murray) were moved and DT is the day program they attend. No pressure, no problem.
- Empty Chair - Friday, Apr 12, 13 @ 2:24 pm:
I really hate the whole “you have to see it to understand it” argument. It’s completely absurd. Too much law is made off anecdotes, stories that prod at emotion, and other small pieces of information. Good policy is made with data and evaluation - both quantitative and qualitative. They’re policy makers elected by the public, not by one person with a specific problem. The move to community care for DD/MH services is a GOOD one - for both the overwhelming majority of patients and the state’s fiscal health. I applaud the Gov for moving in the right direction. He doesn’t get enough credit for these tough decisions.
- wordslinger - Friday, Apr 12, 13 @ 2:26 pm:
Recent history has been the GA cutting everything to make full pension contributions.
- Bill White - Friday, Apr 12, 13 @ 2:28 pm:
@DuPage Dan
=== When the pressure is off, they just spend more. How do we stop that? ===
Offer specific proposals on what spending you want cut. It’s easy to say “Spend less!” It is harder to cut specific programs. Gosh, even the Washington GOP is coming out against chained CPI.
But also remember that total combined state and local taxes in Illinois are among the lowest of states with a large urban area. If not the lowest.
Yes, many rural states have lower taxation but that is because those states have lower per capita income and less property.
- Cincinnatus - Friday, Apr 12, 13 @ 2:32 pm:
Word,
Cannot the $20M in extra interest be considered an extra incentive to close the budget deficit? Does not the bond then remove a, let’s call it “moral hazard” associated with improper state spending priorities.
This bond issue really tears at me because I absolutely agree with you about wanting to decrease the overall amount of money the state owes, but man, I hate letting the GA off the hook in any way for the fear that unbalanced budgets (I know they are technically balanced, but c’mon) stretch off to the horizon.
- wordslinger - Friday, Apr 12, 13 @ 2:33 pm:
I’m sure some would see a $2.5 billion tax cut as stimulative. It seems to me accelerating $2.5 billion in payments would be the same.
I know that when I get paid, I spend some money.
- anon - Friday, Apr 12, 13 @ 2:49 pm:
@emppty chair there should not be a cookie cutter approach to providing I/DD services. Some individuals need the services and care centers like JDC and Murray provide. It literally can mean life or death for these fragile individuals
- mr. whipple - Friday, Apr 12, 13 @ 2:54 pm:
Is this the same DHS that paid hundreds of providers big dollars in interest for fiscal 2011 because payments were so late and then sent an unsigned letter demanding providers give back most of the money back because DHS miscalculated the formula? Is this the same DHS that can’t explain to providers how they got to the numbers? The same DHS that hasn’t paid providers any interest for the unconscionable delays in fiscal 2012 payments?
It’s a tribute to providers that they are still willing to deal with DHS. Is Secretary Saddler making a case for the providers while she asks for more staff?
- walkinfool - Friday, Apr 12, 13 @ 2:55 pm:
David Harris should know better. Greg Harris does.
- Small Town Liberal - Friday, Apr 12, 13 @ 3:03 pm:
- there should not be a cookie cutter approach -
There isn’t. Some individuals will remain in institutional care, and their well being and safety is the top priority.
The JDC transition went very well and there are many families that were very opposed that are now very happy. That side of the story never seems to make it into the news.
- Anon - Friday, Apr 12, 13 @ 3:06 pm:
This reminds of the article the WSJ ran a few weeks ago on Vendor Advantage LLC - that is a factoring company for state vendors front the cash for payments owed. I am not familiar enough with the topic to know for sure but Medicaid payments, I believe, are prohibited from being factored?
- Empty Chair - Friday, Apr 12, 13 @ 3:31 pm:
@anon - saying “there is no cookie cutter approach” and then advocating for institutionalization is laughable. Institutionalization is the definition of cookie cutter approach. It’s everyone under one roof, no matter what their differences. Community care inherently assumes that different levels of care will be provided by different organizations within different communities to those with different needs. Yes, some people will need 24/7 care/supervision. But that doesn’t mean we should keep the larger majority of those who don’t in institutions, just to keep the places operating. The “cater to a few” argument ignores the needs of the majority of DD/MH patients much more so than your contention that community care would lead to the lack of care for those in need of 24/7 care.
- cassandra - Friday, Apr 12, 13 @ 3:50 pm:
Will the implementation of ACA shorten those waiting lists for mental health services. After January, a far greater percentage of the population will be insured, either with subsidized private insurance obtained through the exchanges or expanded Medicaid. The feds will be paying for most of this. And private policies will be required to include mental health coverage.
I hope DHS will be coordinating with DHFS, to ensure that those on the waiting list are not waiting because of lack of insurance. They should be doing that planning now.
- Boondocks - Friday, Apr 12, 13 @ 3:54 pm:
I know 2 people who work at DHS….the department is excessively top heavy, paying people large salaries for little to no work….the case workers are over burdened because the agency hires mid-manager political types with little to no experience and fewer real responsibilities. I assume all agencies in state government are the same. It has always been this way, but it has gotten worse over the past decade, and in today’s economic climate and with the state’s fiscal woes, it would be refreshing to eliminate these high salary management positions in return for more case worker positions.
- Give Me A Break - Friday, Apr 12, 13 @ 4:01 pm:
Boondocks, care to share those postions and titles that you define as top heavy? Any rank and file staff member in the public or private sector would most likely say their employer is top heavy (and they may be right). But when you go from 20,000 staff to a few over 12,000 you can’t tell me the 12,000 left are managers. The simply fact is, this is what smaller governtment looks like and this how it works or does not work.
- cassandra - Friday, Apr 12, 13 @ 4:01 pm:
I think Boondocks is probably right, but I also wonder why somebody on food stamps needs a caseworker. Or somebody on TANF, for that matter. I thought the notion that people who are receiving some form of govt economic assistance need a government caseworker checking on them was kind of old hat. Other forms of government checks don’t come with a caseworker. Social Security, for example. Unemployment comp.
- Grandson of Man - Friday, Apr 12, 13 @ 4:53 pm:
“If you calculate that out, that leaves that worker less than 45 minutes over the course of a year to serve that family.”
Yes, caseloads are now quite substantial. When caseloads were smaller, workers spent more time with clients and helped them with referrals for jobs and other organizations.
I would like to see more workers and smaller caseloads, updated computers that are faster and access to more databases, so that we can have a better view of clients’ circumstances, which would help clients and also taxpayers by having more means to prevent fraud.