Proposed budget cuts could hurt disability services

Knoxville, TN, January 29, 2015 – By Kristi L. Nelson – Knoxville News Sentinel

Video by Kristi Nelson
Around 25 years ago, Linda Bacon made the gut-wrenching decision to move her daughter, Page, into a group home operated by what is now Open Arms Care. Bacon worried that no one could care for Page as well as she did. But she needed to work, and Page, then 17, needed full-time medical supervision. Born with cerebral palsy, Page, 42, is nonverbal and uses a wheelchair. She also has a serious lung condition and a tracheotomy, and she frequently needs suctioning.These days, Bacon worries about her daughter for an entirely different reason. Page adjusted “beautifully” to her new home, where one particular nurse has cared for her for 15 years, Bacon said. And not only are her medical needs met, Bacon said, but Open Arms supports her love of the arts, taking her to see the movies, plays and concerts she’s able to communicate her appreciation of.

Proposed cuts to TennCare in the upcoming state budget, however, now threaten her daughter’s secure and enriched life, Bacon said.

Before last month’s budget hearings, Gov. Bill Haslam asked all state departments to come up with possible ways to cut 7 percent of their overall budgets.

One of the Bureau of TennCare’s recommendations was a 4 percent funding cut to intermediate care facilities like Open Arms, which operates group homes and day centers throughout the state. The bureau estimated this cut could save $198 million in medical costs and $8.7 million in payments to facilities, like Open Arms, that care for the medically fragile — although TennCare’s chief financial officer, Casey Dungan, told Haslam, “The across-the-board rate reductions are not our preferred way of reducing program costs; however, cuts at this level are needed to reach 7 percent.”

Other departments also have proposed cuts that affect services to the same population. The state’s Department of Intellectual and Developmental Disabilities has on the table a 2.75 percent cut in the waiver program that pays services providers, which would cause a loss of federal matching funds as well. Up for elimination is the Family Support Program, which gives small grants to families caring for their loved ones, to pay for things like wheelchair ramps or respite care. That program cut has been proposed in previous budgets but so far has survived.

Since all of Open Arms’ clients qualify for TennCare, it’s the TennCare cut that most worries Charles Schnell, executive director for the Brentwood-based provider’s Knoxville-area operations.

“We’ve taken cuts, we’ve taken cuts, and we’ve taken cuts,” Schnell said. “We’ve worked with these cuts, we’ve talked with legislators … but the cuts keep coming. At this point, another cut is devastating.”

In Knoxville, Open Arms serves 64 people and has about a dozen more on a waiting list. Schnell said the 4 percent cut would translate to about $350,000 for Open Arms.

In previous years, Open Arms cut administrative costs and quality control, Schnell said. It hasn’t increased its food budget in five years.

“The only thing left is direct-care staff, if we’re going to make any more cuts,” he said. “It’s a really hard pill to swallow.”

Without intermediate care facilities, Open Arms’ clients would need nursing-home care, a more expensive proposition for the state, Schnell said. But it would also cost the clients quality of life.

Carolyn Abel Lewis’s 35-year-old daughter, Katie, is severely mentally disabled and needs supervision to keep her safe. Katie Abel has lived in an Open Arms group home for more than 16 years and attends day services at its Ball Road center, where she has classes in art, music and daily living skills and gets physical and occupational therapy.

To reduce those services “would force someone like my child into a nursing home,” Lewis said. “She would just simply exist there. Here, they specifically tailor programs to her needs.”

Abel’s father is deceased, and Lewis works. She wanted her daughter firmly settled where she could have good medical care and quality of life as both of them age.

“I expect, and I hope and pray, that my daughter is going to outlive me,” Lewis said. “When I go, who is going to take care of my daughter — not just the services she needs for health and safety, but to give her a purposeful life?”

Both DIDD and TennCare cuts would affect Kingston’s Michael Dunn Center, said its president, Mike McElhinney. Michael Dunn provides housing, day services and a workshop to some 400 children and adults.

“Our administrative staff has been cut to bare bones,” he said. “We would have to cut wages to employees, or hours employees are working.”

Haslam hasn’t yet finalized his budget, and it’s likely at least some of the cuts ultimately won’t be as drastic as recommended. But McElhinney said DIDD has not given providers a rate increase since 2006, and the proposed 2.75 percent cut would negate the last two increases — totaling 1.9 percent — they did get.

About 8,000 intellectually and developmentally disabled Tennesseans get services through the state. Some 7,200 more are on a waiting list.

“These are devastating cuts for people with developmental disabilities,” Schnell said. “On top of the cuts or reductions we’ve already faced over the years, there’s no way the quality of services cannot be affected if we implement these further cuts.”

Bacon said her daughter is “locked in a bad body, and she’s very aware. … They see beyond the trach and the oxygen. They see the person.

“This is your best value, if you care about Page’s life.”