Dawn Sidell, RN: Balancing the budget: Thinking about the who along with the how

The social and economic fallout from COVID-19 has only just begun.

The negative impact to personal livelihoods threatens a collective impact to our state infrastructure and operations. As we grapple with significant reductions in projected revenues for who knows how long, our state agencies are instructed to create budget proposals reflecting spending reductions of 15% or more. But are all state agencies created equal? Are 15% across-the-board cuts an equitable proposition?

I understand the dilemma regarding both the requirements of state law and legislative responsibilities for determining how to manage our budget deficits. The choice between across-the-board cuts and special sessions of Legislature is not an easy one – especially as deficit projections fluctuate. Meanwhile, we all need to understand the critical impacts that budget cuts will have on those of us who need help the most.

Two primary agencies under the Department of Social and Health Services responsible for the care and support of individuals with disabilities are the Aging and Long-Term Support Administration and the Developmental Disabilities Administration.

Reduction strategies proposed by both of these agencies include restricting eligibility criteria for clients – effectively reducing the number of individuals being served by thousands, and those projected to be served by thousands more. Under these reductions, agencies will prioritize the care of persons identified with “intense needs” and end services for those deemed to have “lighter care” needs.

This is less logical than it sounds. Consider this scenario: Sarah, diagnosed with dementia, needs prompting to remember to eat, and to lift her fork to her mouth, but technically she is able to feed herself. Because her care is more supervisory, it is considered “lighter” than that of Jules, who does not have the motor capacity to feed himself and thus needs “intense care.” Under the proposed reductions, Sarah would lose her services; Jules would not. One would arguably starve sooner than the other.

This “Sophie’s Choice” of budget cuts across the board cannot possibly be part of our response to remediating a budget crisis, can it? How frightening for all of us if during this time of losing revenues, we lose our humanity, too.

Another reduction strategy is to decrease service provider rates by 2.4%. This proposal anticipates shifting the focus of service provision to those experiencing significantly higher and more complex needs. Both ALTSA and DDA already serve large numbers of clients with intense physical, behavioral and cognitive support needs; neither system has been able to meet the current demand. But clients with dementia and neurodevelopmental disabilities who struggle to communicate, to understand their surroundings, and to regulate their own emotions deserve the dignity of compassionate, professional care. We need to grow the space and resources for responding to these needs, not chip away at any progress we have managed to make.

These cuts will hurt all of us. Insufficient services for our most vulnerable individuals will inevitably lead to crisis care, as the loss of essential supports to each of these valuable human beings overloads other critical systems we all depend upon. Hospital ERs have long borne the brunt of inadequately funded disability/mental health/aging and long-term care systems. That burden will be nothing compared to what crisis care systems will face if these projected cuts are realized. Many thousands will suffer in ways we can only imagine.

And what of the moms and dads and brothers and sisters? My family is just one of many that has witnessed up close the fallout from inadequate and insufficient resources for the aging and for those with developmental disabilities – both conditions inherent to living and both often requiring more resources than any one family can afford or provide. The pain of watching a loved one medically and physically restrained when no “placement” exists – and no appropriate care is available – is absolutely heart-wrenching.

The painful consequences to family members valiantly trying to “fill the gaps” can include anything from loss of livelihood to loss of health and well-being.

The individuals served by ALTSA and DDA need us more now than ever, not less. As we pick our way through the pandemic rubble, let’s find a way to offer better, not less. Lend your voice and your vote to preserving care for our most vulnerable; support increased services for those in need and improved compensation for our front-line workers. Remove essential human service organizations from the cutting table and ensure their ability to increase care for those unable to care for themselves.

Dawn Sidell, RN, is executive director of the Northwest Autism Center.