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?”
This article appears in Oct 8-14, 2003.
