In Washington state, disabled mother, blind daughter exemplify dangers of in-home service cuts

From the Yakima Herald-Republic in Wash.:

YAKIMA, Wash. -- Wanda Schmidt (pictured) was scared when she first heard about the governor’s proposed health care cuts. Now she’s outraged.

In the past two years, the state has slashed in-home care for Schmidt and her disabled daughter, Cathy, from 35 to 29 hours a week. In January, that number was cut again, and Schmidt worries for her and her daughter’s health and safety.

"If an emergency came up, we couldn’t handle it," said 79-year-old Schmidt of Yakima, who suffers from kidney failure. "There would be nothing we could do."

People like Schmidt, who relies on Medicaid for health insurance, along with the disabled and mentally ill would receive fewer benefits under Gov. Chris Gregoire’s no-frills proposal, which would cut nearly $5 billion from the next two-year, $32 billion spending plan.

The cuts would come on top of $550 million that lawmakers still need to cut in the current budget cycle that ends June 30.

Grants to community clinics and funding for a medical-interpreter program were cut in January, and money for the Basic Health Plan and Disability Lifeline is slated to run out March 1. Basic Health provides medical insurance to 56,000 working poor; Disability Lifeline gives grants and medical care to people unable to work because of a disability.

Gregoire admits to hating her budget and is hoping for more palatable alternatives from the Legislature. So far, budget proposals have been a moving target with no clear picture in sight.

Senate and House Democrats are talking about restoring some funding to Disability Lifeline and preserving a much smaller Basic Health Plan this year. At the same time, lawmakers are searching for a way to fund Basic Health until 2014, when the new federal health care law would assume nearly all of the costs.

More than 136,000 people are on the waiting list for Basic Health, which has 7,282 enrollees in Yakima County.

To balance the budget without raising taxes, lawmakers say extreme cuts are necessary. Others say the cuts mean that more people will seek medical care in emergency rooms and nursing homes, creating a greater expense for all taxpayers.

"These really aren’t good ideas," said Lori Brown, director of Aging and Long Term Care for Central Washington. "People need to be willing to look at longer-term solutions."

Schmidt is one victim of the budget cuts. Beginning Jan. 1, Medicaid — the state and federal health program for the poor — slashed her in-home care to 25 hours a week, down from the 35 she had about a year ago.

The service is not only for Schmidt, but for her 51-year-old daughter, Cathy. Doctors removed a tumor from Cathy’s brain when she was 11, leaving her blind, paralyzed and developmentally disabled.

Wanda, a divorced mother of five children, refused to put Cathy in a nursing home. So, with help from her own mother, she carved out a living by working in canneries and collecting unemployment.

By her early 60s, Wanda retired and cared for Cathy on her own — feeding her, dressing her and bathing her. For fun, the two regularly visited a nearby bingo hall, and Cathy made necklaces by stringing beads together.
Everything changed in 2007 when Wanda’s health deteriorated. She fell and broke her hip. She had knee surgery. And doctors discovered she had severe osteoporosis and arthritis, leaving her unable to walk.

Wanda was later diagnosed with Stage 4 renal failure, which means her kidneys are failing. Wanda said she was born with one deformed kidney that never functioned properly, while an inoperable tumor is growing on the other. This kidney functions at 15 percent. If it drops any lower, she will begin dialysis.

"My life fell apart," Wanda said about her declining health. "In the blink of an eye, it was gone."

Wanda and Cathy found refuge with Wanda’s youngest daughter, who cares for the two with help from her husband. When they’re at work, Danielle Young from Home Care Services of Yakima watches over the Schmidts.

But it’s not enough. Even though everyone has rearranged their schedules to care for the Schmidts, Wanda and Cathy are still left alone for at least an hour a day.

"It concerns me," said Young of Moxee. "If someone broke in, what would they do? If there was a fire, they couldn’t get out."

With 60 percent of spending protected by federal or state constitutional restrictions, Brown realizes that lawmakers’ options are limited. But as director of Aging and Long Term Care for Central Washington, she’s against cuts that hurt the most vulnerable.

She said many seniors can’t afford co-pays, as Gregoire proposes. If forced to absorb this expense, Brown believes they’ll end up choosing between food and medication.

"It’s not like they can go out and get a second job," Brown said. "They are not able to be employed because they have medical issues."

Cutting in-home care services also baffles Brown. The Schmidts are among nearly 2,000 Yakima County residents who rely on the help, a service that is far cheaper than nursing home care, she said.

Jon Gould, deputy director of Children’s Alliance in Seattle, is concerned about how Gregoire’s proposal will affect the health and safety of children. One of her biggest proposals for the next two-year budget would strip medical coverage to an estimated 27,000 children whose legal status is unclear under the Apple Health for Kids program, for a savings of $59 million.

If those cuts take effect, 3,493 Yakima County youths would be ineligible for medical benefits, he said. Gould contends the Constitution gives all children rights to basic education, and they must be healthy to learn.

"We believe there is no such thing as an illegal child," he said. "Children are children, and their health needs don’t change based on where they were born."

In recent weeks, Gregoire has given temporary reprieves for Medicaid recipients who need hospice and end-of-life care as well as prescription coverage for adults. She’s restored coverage for noncitizens with potentially terminal conditions, and she’s asked lawmakers to reinstate some Medicaid services that had expired Jan. 1, including dental coverage for seniors and pregnant women, and hearing and vision care for adults.

To save Basic Health and Disability Lifeline, the federal government has agreed to provide additional Medicaid money to the state. But even with this, lawmakers say they don’t have enough money to pay the state’s share of Basic Health — let alone allow anyone else to join — beyond March 1.

The Washington Health Program, available to Washington residents through the state’s Health Care Authority, may work for some people who can’t afford individual policies. Although unsubsidized, it’s more affordable because it limits coverage to $75,000 or $100,000 a year.

Other patients may be able to afford state or federal high-risk pool coverage or may be eligible for other federal programs, which will be implemented over the next three years through the new federal health care reform law.

Republicans have generally favored cutting social programs before education, but Rep. Norm Johnson, R-Yakima, says he’s trying to find answers as a member of the Health and Human Services Appropriations & Oversight Committee, which makes funding recommendations to the Ways and Means Committee.

Johnson wants to keep Basic Health, but believes a co-pay — in addition to the premiums that subscribers already pay — may be required in the future.
He also wants to keep open clinics that offer sliding-scale fees and treat Medicaid patients. He calls places like the Yakima Valley Farm Workers Clinic and Yakima Neighborhood Health Services the "front-line defense" against people flooding emergency rooms.

"It’s incumbent upon us to be looking at not only short-term solutions, but long-term solutions," he said, noting that education, health care and public safety are his top priorities.

"We won’t accept short-term cuts if they cost more money because we don’t have more money. ... Hopefully, we’ll make cuts that cause the least amount of hurt."

All of this is of little comfort to Danielle Young. She’s worked as an in-home caregiver for 12 years, spending the last two overseeing Wanda and Cathy Schmidt.

Young said she’s grown attached to the Schmidts and doesn’t want to leave them. But her weekly hours have been slashed from 35 to 25, and she’s having difficulty making ends meet.

"I’m frustrated," she said, adding she’d have to quit if she didn’t have help from her husband. "I’d like to get more hours, but I don’t want to leave these guys. (The cuts) are mind-boggling to me. I don’t know what to do."

According to SEIU 775 NW, a union that represents 40,000 home care and nursing home workers, Gregoire’s proposal takes Washington in the wrong direction. It calls for trimming 27,035 hours and $11 million in income from Yakima County workers in the next biennium. These workers make $15,000 to $20,000 a year.

"They’re living month to month, paycheck to paycheck, as it is," said Adam Glickman, union vice president and director of public affairs. "They could be forced to take other jobs. ... Then what happens to our clients?"
The last thing Wanda wants for herself and her daughter is to live in a nursing home. In that way, she said she’s lucky. She has family support. Some have no one to turn to for help.

"I know Gregoire probably lives in a vacuum," she said. "She doesn’t get out to see people like me and Cathy. ... (But) to cut things from the lowest of the low, it’s terrible."