Developmentally disabled face longer waits, less service
By Kathleen Wilson
Wednesday, April 1, 2009
Thousands of developmentally disabled people are facing delays and lower levels of supervision in the wake of a decision to allow rising caseloads for workers coordinating their care, officials said.
As part of the budget deal reached in February, legislators and Gov. Arnold Schwarzenegger lifted the requirement that case managers could average no more than 66 clients.
The maximum of 84 was lifted as well. There is now no limit for almost half the cases in Ventura County and likely tens of thousands of others served through the state’s network of 21 regional centers.
Since Feb. 1, the average ratio has crept to 70, and officials predict it could rise to more than 90 people if funding conditions don’t improve.
The ceiling is scheduled to lapse June 30, 2010, but social work director Frank Bush fears the caseloads will only grow with the numbers of disabled clients rising by 4 percent annually and hiring stalled.
“I’m not optimistic,” he said.
The decision affects more than 2,400 Ventura County adults and children diagnosed with mental retardation, autism, cerebral palsy and epilepsy.
The workers known as service coordinators help them get speech therapy, housing benefits, instruction in daily living skills from cooking to financial management, and other support to live as independently as possible.
State says limits were optional
“The impact is going to be huge,” said Omar Noorzad, executive director of the Tri-Counties Regional Center, a nonprofit agency that connects disabled children and adults with state-paid services.
“With caseload ratios continuing to creep up, service coordinators are not going to be able to meet the needs of the people we serve at the same level.”
State officials said they gave Tri-Counties and other regional centers the option to set aside the limits as long as health and safety were not affected. That was done to give them the flexibility to manage a 3 percent cut in their operating funds, said Dorsey Griffith, spokeswoman for the state Department of Developmental Services.
Noorzad acknowledged that’s true but said managers of regional centers had no choice but to lift the ratios.
“If we didn’t do this, we couldn’t make ends meet,” he said. “Even though the Legislature is saying yes, it’s optional, in fact it’s not.”
Bush, chief social worker for Tri-Counties, said the agency is trying to ensure basic health and safety, but that injuries and financial abuse of clients could rise with lower levels of supervision.
Possibly manageable in short term
For now, he said, clients are seeing the effect in delays and fewer face-to-face meetings where case managers can advocate for their needs.
Others, though, say the caseload increases may be manageable in the short term. Much of the effect depends on who’s managing the care, said Laura Valdez, the mother of three children with disabilities.
Back in the mid-90s, case managers for her children had more than 100 clients, she said.
“In some cases there was no difference if they had 50 kids or 100 kids,” said the Camarillo resident. “There are some that are really on the ball and do a fabulous job, but others have difficulty juggling.”
Lisa Fox, a case manager at Tri-Counties, said delays rose dramatically during those years.
“They changed standards for how often we had to see families,” said Fox, who spoke as a member of the Service Employees International Union. “For many years, we didn’t have to see them except once every three years. People didn’t realize they still had an active case at the regional center. They would tell their teacher or doctor they weren’t eligible for services anymore and wouldn’t contact us when they had a need for other services.”
The change exempts children from infants through age 3, individuals who have moved out of the state institutions known as developmental centers, and those covered by a federal funding program aimed at helping people with higher levels of disability.
Rates paid to group homes cut
Those who remain live in the community, often with their families, in group homes or in their own apartments with assistance.
Brian Homa, 41, of Port Hueneme counts on case manager Dan Van Keuren to help him navigate through life.
“If I have a problem, I call him up,” Homa said.
The developmentally disabled man was working at an Arc day program in Ventura late last week when Van Keuren stopped by to help him fill out a crucial government document. Homa has to submit the document every year so he can requalify for his Social Security disability check of $830 a month, virtually his entire income.
The master’s-level social worker also helped him get his low-rent apartment, allowing him to move out of an Oxnard group home. Homa hopes the man he calls Dan can help him with his dreams, too.
“I’d like to get a job in the community doing landscaping,” he said. “I want to get a Ford Ranger truck.”
Van Keuren is a veteran case manager who has worked in the field for more than 30 years. His caseload has risen from 66 to 73 since the ratio was lifted.
All his clients are adults from age 18 into their 70s.
They range significantly in their need for support, from those receiving 20 hours of care monthly to medically fragile people who need around-the-clock care.
Van Keuren said the increasing caseload makes his job more difficult, but he’s more concerned about the 3 percent cuts to the rates paid to group homes and other care providers, and the prospect of an additional 7 percent in the next fiscal year.
“We would then begin to have our provider network dismantled itself,” he said.
Workers’ duties are varied
Under state law, coordinators work with clients and their families to identify what clients need, find ways to accomplish it and monitor their progress.
They help parents do a huge job, said Camarillo resident Jeanine Kloeris, whose 16-year-old son, Brandon McCullen, has autism.
She spoke with the boy’s service coordinator every other week when he became violent and aggressive in his early teens, Kloeris said.
He is now doing well, but it still “takes a village,” she said. “I don’t think any one person could handle a child like this without these supports,” she said.
Sha Azedi, who oversees the case managers in Tri-Counties’ Oxnard office, said his staff’s workload has increased by 50 percent. There’s also a limit to clients’ patience, he said.
“Clients understand the situation is bad, and the economy is bad, but still they want their calls returned,” he said. “There hasn’t been a dramatic shift in what parents used to ask us and what they are asking now.”
E.W. Scripps Co.