Will I feel any pain?

The human toll of State and City Budget Cuts: Testimony from sixty social workers, colleagues and consumers

By Deborah K. Shepherd, CSW, Assistant Director
(April 1995)

Consider these stories: A young man is murdered on the street at the very hour he would otherwise have been at his teen center had it not had to cut its hours; the Child Welfare Administration's adoption unit is "temporarily" closed to new referrals, leaving some children's long awaited adoptions in limbo; social workers in schools are witnessing increased signs of dropping out, violence and suicide attempts; nursing homes are experiencing premature placements of the elderly as a result of cutbacks in home care hours; a man with a dual diagnosis of mental illness and chemical dependency who has been off drugs for 11 months, swallows 351 tablets of Prozac, Hycodan and Welbutrin the week that he is informed by Social Security that policy changes will deny him benefits and that he will lose his subsidized housing.

For a number of months, staff and leadership of the Chapter have fielded requests from government officials, the press, members and other colleagues, to provide documentation of the human dimension of already implemented and proposed budget cuts in the City. The Chapter sent out surveys to members, asking them to tell us how the cuts would play out with real people--their clients. The response was both gratifying--because of the number of people who put much thought and time into their replies--and deeply disturbing--because of the extent of human misery that has already been generated by cutbacks and that will continue to escalate if proposed cuts go through.

On February 27 and 28, 1995, the Chapter held hearings on the impact of the cuts: Sixty social workers, clients, and other colleagues provided testimony to the Chapter's Board of Directors and Social Action Committee.

AN ATTACK ON THE POOR FROM THREE TIERS OF GOVERNMENT

"We're hearing a lot these days from City Hall, Albany and Washington about failed welfare policies, about irresponsible teenage mothers, about opportunistic families that go into the homeless system only because they want better housing...What's always missing from these accusations is an accurate portrait of the real people who struggle every day to keep their sights on a better future for themselves and their families while living in sub-standard housing, feeding their families on an inadequate public assistance allowance, and trying to achieve economic self-sufficiency," a settlement house social worker testified.

State proposals to cut grants to "employable" Home Relief beneficiaries to 90 days and cutting the basic needs allowance grants to AFDC families by 15% will increase by tens of thousands the number of homeless people in New York City, and will ultimately cost the City rather than save money.

One testifier noted: "These proposals are placing the poor in harms way. Mayor Giuliani will leave people without teachers, health care and food. Governor Pataki's 15% AFDC cut will throw thousands of poor families out on the streets or into overcrowded housing. If implemented in full, the Republican Contract With America will leave 5 million children and 2.5 million mother-only families in this country without any welfare support."

A social worker whose agency produces and manages low and moderate income housing units reported at the hearing that, because of budget cuts, 250,000 units of public housing are in jeopardy and that the City is in danger of losing $200 million in Section Eight subsidies (for families that came from the shelter system). She also pointed out the very strong link between the reductions in health care, youth services, day care, HRA funded programs and existing housing and the quality of life in the City's communities. For example, a housing project in the Bronx consists of mixed income units: thirty percent are subsidized by Section Eight. The project also houses a large number of City employees who are particularly vulnerable to layoffs in the current fiscal climate. The social worker anticipates that many tenants will soon be out of work and won't be able to pay their rent; special emergency grants "will be a thing of the past...These families will return to welfare after a long struggle to get off the roles...Without the rental income, it will be difficult to run our buildings, provide security, and keep up with maintenance and repairs. This project transformed a neighborhood from a burned out, impoverished and abandoned block into a vital, thriving, safe community...We're worried about being able to support our tenants' efforts to improve their lives."

A POOR PROGNOSIS FOR CHILDREN AND THEIR FAMILIES

The Child Welfare Administration (CWA), which is charged with protecting children from abuse and neglect, is an agency already hard hit by cutbacks and is facing further cuts in the next fiscal year. Preventive programs such as the Family Rehabilitation Program (FRP), which provides drug treatment and parenting classes to mothers, have been slashed; foster care reimbursement rates are being cut; caseload sizes, already way above the recommended levels, are spiralling out of control; and if Governor Pataki's Child and Family Block Grant is passed, we may very well see the dismantling of the State's child welfare system and the dissolution of its ability to protect children from being abused and murdered.

Numerous CWA employees responded to the NASW surveys, but they were afraid to testify at the public forum, lest they lose their jobs. This is what we learned: Caseworkers are so depleted that they cannot do the mammoth job they already have; they do not receive enough training to do thorough investigations; lack of case managers and specialized units means that workers will not be able to make appropriate assessments; high caseloads in field offices means that there is no time to close cases. It also means that some caseworkers are doing clerical work because support staff have been let go, thus adding to the high caseloads of other workers, and that courts will hold up adoptions because there is no support staff to complete appropriate paper work. This means that children will remain in care longer at public expense.

In the midst of all this, funding for professional social work education for CWA workers is drying up. Those responding to the Chapter's survey have also told us that a number of MSWs are accepting severance packages or are being redeployed out of CWA into other HRA departments.

At the hearing, one former FRP worker (who lost her job when funding was cut) spoke about the day she had to tell one client that the program would close down in one month. Ms. M., a 27 year old mother of five, had been a crack cocaine user but, thanks to the FRP, had been clean for two years. This is how the worker described Ms. M's reaction to the news: "The way I saw her break down that day was heartbreaking. She just held me and cried. Finally she looked up at me and said `Today I could try to deal with this. However, I'm crying for all the other women who may never know what it feels like to love yourself." Ms. M's implication was that the ability of these women to stay off drugs was being undermined by the closing of the programs.

The progress of school children will also be undermined by the cuts. School social workers see children, youth and their families in the public school. Many of these families may never be seen by any social service agency. New York City's school system is facing $300 to $600 million cuts this year, and school social work services may be on the chopping block.

Caseload size is already up to 90 children per week, children who are at risk of dropping out, exhibiting violent behavior, or showing suicidal tendencies.

A school social worker testified: "Mostly, we see students with poor self-esteem or uncontrollable, inappropriate behaviors that manifest in class because the children have an inability to express their anger and emotions appropriately. With limited or no services and no school counseling, these children would be left to cope with these situations alone."

YOUTH CENTER CUTS MEAN MORE KIDS ON THE STREETS

Service's to the City's youth include both State and City funded programs. Services include street outreach, peer counseling, after-school programs, evening teen centers, college and career counseling and tutoring, pregnancy prevention, and summer job and recreation programs. A number of programs in the City have had to shut down due to the latest City budget cuts. Upcoming State cuts may doom numerous others.

A director of youth services for a community center noted that the families who lost the after-school services because they could not afford to pay the modest fees that are now being charged were the families most in need:

"I do not want to speculate on who is caring for the children in the interim; as it is, I often see children who are on our waiting list in the street unsupervised after school. The teens have lost an alternative to delinquent activity as well as a safe haven in which to hang out at night."

She went on to say, " Several weeks ago, a young man who attended our teen center was murdered during a fight in the streets during hours when he was accustomed to attending the teen center, hours which were cut due to the budget. The members and staff at the center feel strongly that he would still be alive today if we had not lost funding, as he was in the center until it closed that night, and went to the place where he was killed only because he had no safe place to hang out."

CHANGES IN HEALTH CARE WITH NO THOUGHT FOR RESULTS

Proposed Medicaid cuts will total $1.3 billion. The State's mandate to enroll all non-elderly Medicaid recipients in a managed care program in the next twelve months is targeted to save the State anywhere from $29 to $100 million. This mandate, however, when coupled with proposed program cuts, could have dire effects on the City's health care system.

A hospital social worker reported on the already felt impacts of budget cuts on the health of her clients and on the health of the system: "Staffing cuts at Medicaid have dramatically increased waiting time for processing applications...clients may have to wait 60 to 120 days...These people will be forced into emergency rooms and preventable, protracted hospitalizations as they go longer and longer without medical care...Because of these delays, organ transplant patients can't pay for lifesaving medications; cancer patients can't continue their chemotherapy...Clients are skipping doctor visits and not filling their prescriptions because they cannot afford to. One man was hospitalized in diabetic shock after taking only half his insulin in the hopes that he could make it last twice as long."

Although AIDS specific funding has not been proposed for cuts, the health of people with HIV/AIDS will be compromised because of cuts in a number of other areas. New York State currently has over 81,000 AIDS cases.

The mandate to enroll all the State's Medicaid recipients in managed care will endanger people with AIDS because, social workers note, managed care at this time is not set up for anyone with a chronic illness.

The Health and Hospital Corporation, which receives 70% of its funding from Medicaid, will be "devastated by Medicaid cuts...the clinics at greatest risk are in economically depressed areas where AIDS is overrepresented...primary care sites will disappear...everyone will have to depend on emergency rooms," testified a social worker who works with people with AIDS.

FOR AGING, ANY REDUCTIONS WOULD CUT TO THE BONE

"Services to the aging are poorly funded to begin with; there is no fat and little muscle, so that any cuts would be cut to the bone," testified a social worker who heads a center for the elderly.

Of particular concern to the elderly (and also to people who are severely disabled) are the Governor's proposed Medicaid Home Care cuts. For most clients, home care is a lifeline: Mr. W. suffers with severe emphysema and asthma, is on oxygen 24 hours a day, and requires 12 hours of home care each day while his son, who cares for him at night, is at work. "After working hard all my life, I am unable to do things for myself. Without home care, I would be unable to survive."

According to a social worker who works with this population, home care cuts would have the following effects: most of the agencies' cases would require immediate institutionalization, at a projected cost to the state of millions of dollars more than home care. Costs to the state would also rise when 47,000 home care workers (who are currently covered by health care plans) lose their jobs; a majority would be forced onto the welfare roles.

BALANCED BUDGETS-- UNBALANCED LIVES: CUTS TO MENTAL HEALTH SERVICES

On top of cuts that have already been implemented, community mental health services will be severely reduced in the Executive budget. Social workers testified that these cuts will "...undermine the community based system of care so many families, professional social workers, civic leaders, government, consumers of service and ordinary citizens have struggled to build over the past twenty years."

One social worker spoke about the effects the cuts would have on one of her clients, a ten-year-old girl who suffers from pica, a disorder in which an individual eats non-nutritive items. This particular child has ingested metal, glass, wood, and coins. In the last six months, the child and her social worker have made great strides in the treatment of this disorder. Due to recent budget cuts, the program is now charging a fee for its services. The child's mother, recently laid off due to the same City budget cuts, cannot afford the fee. If this child is not treated, said her social worker "...the best case scenario...will be that she ends up in a hospital. It could be a mental hospital. It could be a medical hospital. But with [her] clinical diagnosis...she could very well end up in a morgue."

Another social worker, who heads an intensive case management program, wondered what would happen as a result of cuts to this program, which provides linkages, coordination and advocacy 24 hours a day, 7 days a week to people with serious and persistent mental illness: "Who will assure that these clients receive appropriate care when they're on their own without intensive case management services? Who will assist them in their activities for daily living and in finding housing? Who will provide clinical and emotional support in times of crisis and provide needed advocacy to lead these clients through the complex and fragmented mental health, entitlement and housing bureaucracies?"

TREATMENT CENTERS CLOSE WHILE CLIENTS WAIT FOR BEDS

While the incidence of alcohol and substance abuse goes up in the City, the opportunities for treatment go down. The Executive budget will cut six alcoholism/drug treatment centers in New York State. Three are in New York City.

One former client, who now works as a peer counselor in a program for woman who are mentally ill/chemical abusers, testified from personal experience what the cuts might mean for the women she counsels: "Being a recovering addict myself, I know what many of the women are going through trying to piece their lives together again. These women are in desperate need of help, but their greatest need is to have someone who cares enough about their well-being to help them help themselves. These women can once again, or for the first time, become productive members of society."

"The $59 million cuts in OASAS (Office of Alcohol and Substance Abuse Services) lead to a reduction in several thousand treatment slots and no funding for new ones. This will cripple the war on drugs and the City and State will turn desperate people back to the streets to engage in destructive behavior," testified the director of a program for ex-offenders.

A client of this program, who used drugs for 17 years but has been clean for two years, made a plea for retaining funding for programs like his: "I thought I would die in prison or on the streets... this program put a stop to my jail mentality. It built my self-esteem and it saved my life."

A social worker who provides social services to criminal defendants testified that "...many of our clients have psychiatric problems, are educationally handicapped, have histories of substance or sexual abuse...they are persons who are HIV positive, are dying of AIDS or have died of AIDS while incarcerated. They are first time and repeat offenders. It is our mission to provide the Court with accurate psycho-social assessments, and to suggest treatment plans, including alternatives to incarceration...since addressing the budget cuts, we continue to suffer a $1.7 million budget gap...this affects our ability as social workers to give the Court a responsible product."

CUTS WILL AFFECT OUR MOST VULNERABLE COMMUNITIES

A social worker in the Bedford Stuyvesant area of Brooklyn talked about a community coalition that has been instrumental in improving the lives and livelihoods of people in her community. It can be taken as testimony of what will happen in all of the poorer communities in the City as a result of the budget cuts.

"The unifying force within our program has been that residents, given appropriate resources, have the capacity to identify priorities and develop workable remedies for many of the problems which impact on the quality of life in the community....Some of the services funded directly through our Neighborhood Based Alliance are: a neighborhood crisis intervention and case management program; a community safety program; a technical assistance resource center for local service providers...the proposed and already in place cutbacks in government funding...threaten all the progress we have made including the growth in small business that has transformed our local commercial strip over the past ten years from a wasteland to one of thriving activity....the [Family Rehabilitation Program] that closed in January...[has already resulted in] a rise in the numbers of newborns whose mothers have histories of substance abuse being discharged to foster care...The combined budgetary reductions ...will be nothing short of catastrophic for my neighborhood."

The New York City Chapter of the National Association of Social Workers believes that all New Yorkers will bear the brunt of cuts in health and social services and that the reductions will be "nothing short of catastrophic" for the entire City. Readers are invited to consider the stories in this document and to formulate their own answers to the question: "Will I feel any pain?"