SEADs Update

This is Farmer Rick reporting on a good government project (well, sort of good).

Because nursing home care is incredibly expensive, the Department of Health and Human Services (DHHS) launched the “NH Community Passport” (I’ll call it Passport for short).  Funded with a multi-million dollar 5-year “Money Follows the Person” (MFP) federal grant, Passport focuses on coordinating the transition of adults from nursing homes and connecting them with available resources within the community.  The services are paid for with Medicaid (federal/state/county money) and Medicare (federal).  In whole, it’s OUR taxpayer dollars at work. 

Now I don’t know about you, but I personally think that helping people get back home (safe and sound) is just the kind of thing I want my taxpayer dollars to pay for.  But with Passport, I’m concerned about what I call “the cookie jar” (the one holding our taxpayer dollars).  As is too often the case, there are too many hands in it.

Confused? 

Amidst a bursting state budget, where there isn’t enough money to actually deliver direct services, DHHS chose to spend money paying for contractors to shape and run Passport.  According to a DHHS March 2008 press release, Passport project “partners” are the NH Independent Case Management Association, the NH Health Care Association and Granite State Independent Living (GSIL)*.  They were hired under a contract (worth over $360,000) with DHHS to focus on education, training, marketing and to provide related services. 

Since I’m always on the lookout for government waste, I decided to research the MFP grant and found that states could choose whether they wanted to provide services with new or existing state employees or to contract out.  The site (at www.dhhs.gov) said some states had the upper hand because they could start MFP with new or existing staff rather than go through a lengthy procurement process.  The site also said that for other states, like those with hiring freezes or budget issues, going through procurement was easier because – to put it bluntly – using contractors was easier than breaking down bureaucracy.

In NH, there’s sufficient talent within HHS to not only design a good MFP program, but to hire a qualified staff do this job, do it well, efficiently and to make it wholly accountable and transparent to the public.   That would mean fewer hands in the cookie jar (and dare I dream, more money for direct services).

Sadly, HHS did not have leadership bold enough to fight for the direct route.  Instead, they found it easier to create an intricately woven network of contractors with their hands in the … (you know how to finish the sentence). It really burns me that we don’t have enough money for direct services, and yet we can somehow afford to spread money around to businesses to design, oversee, and market services.  Then we funnel more money through them for direct services because they can pay subcontractors, who pay their actual employees to deliver direct services.  All so that we don’t have to deal with legislative or public oversight, governor executive orders, or personnel cuts.

Don’t believe me that Passport is about getting around these things?  A quick look at the NH DHHS website, as well as the fed’s MFP website, provides the evidence:  The goals of NH’s program are….  “To eliminate barriers that prevent or restrict the flexible use of Medicaid funds to enable Medicaid-eligible individuals to receive support for ...”  Barriers is a super secret code word for the State’s red-tape bureaucracy!  (It’s not really a super secret code word…)
 
A November 15, 2009 Concord Monitor Letter to the Editor, penned by Sheila Zakre, provides a bird’s eye view into how the program works (or doesn’t work).  In it she describes the different hands involved (in that cookie jar…) that became her mother-in-law’s non-nursing home care option.  She reports the cost of that care is 2/3rd the nursing home cost but is it really?  Nursing homes provide 168 hours of care a week.  In-home alternatives provide a small fraction of those hours, plus they carry the added burden of private case managers and subcontractors that don’t pay enough for direct service workers to stay on the job.  Sheila’s story, according to one commenter’s post, is just one of many similarly situated families. 

In the long term, Passport money will be going through so many hands that in future budget fights, there will be a good supply of them willing to trot down to the State House to say “we need more money.”  My only question is:  after they’ve all had their hands in the cookie jar, how many crumbs will be left for direct services?  You know for simple things, like feeding, clothing, and caring for people in their homes.

I can only hope there will be enough.

*[In Granite State Independent Living’s 2008 Annual Report, they gave DHHS and the other two Passport “partners” the 2008 “Partnership Award” – an award given to an organization dedicated to independence and self-sufficiency for people with disabilities in NH.  Even though GSIL’s annual report doesn’t indicate it is a state contractor, check out the revenue section to see how many millions of our taxpayer dollars flow through this nonprofit’s programs.  In reality, they are our taxpayers’ programs although an unaware reader would think the programs are the good product of a nonprofit.]

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This is Planter Joanne reporting on the loss of a state employee who actually worked with the MFP grant.  The worker was laid off in October 2009.  Rubbing salt into the wound is that this worker’s vacant supervisory position ended up being filled. 

Wondering where the salt is?

Here you go:  the supervisor role was contracted out (contracting out isn't part of any executive order, like hiring state employees is).  Despite a few hundred layoffs, endless hiring freezes, and a workforce with some of the lowest morale levels many of us have seen in decades, HHS’ leadership continues to find contracting the easy way out.

I doubt this worker felt there was anything easy about it though.  Fortunately, the worker has landed another job in state service.

SEADs for Good Government:  DCYF’s Foster Care Health Program – Children in our Safety Net                 12/31/09 Second Edition

This is Farmer Rick reporting on another October 2009 cost cutter.  As part of the personnel reductions that Governor Lynch requested from the Legislature, the Division for Children, Youth and Families (DCYF) basically de boned its once-admired Foster Care Health Program.  Created in 1999, this program was an important element of the Department of Health and Human Services’ settlement of a class action lawsuit, “Eric L.”   

Not knowing a lot about the program, I decided to do a little digging.  The Foster Care Health Program provided Registered Nurses to coordinate health care for children that often have serious health issues.  These youngsters, after enduring abuse or neglect, enter into the State’s safety net called Foster Care.  Their health issues usually surpass the expertise that Foster Care social workers have, and their health care is usually more than the typical Foster family can manage.  The program had 14 positions when the cuts of October trimmed it down to only two!

According to the 2008 Healthy Kids Annual Report (Healthy Kids is the way NH’s Foster children get Medicaid), children in Foster Care are 5 times more likely to experience post-traumatic stress disorder than the general population.  In fact, Foster children typically use more than 3 times the medical services than the general population!  That’s a hefty investment of government resources and, it seems to me, is a good place to make sure we’ve got the most skilled professionals working to keep kids healthy and drive costs down.

I was pretty surprised to learn that the State cut this program even after it was nationally recognized for its excellence (after a Federal Case Practice Review in 2006).  That excellence came from the fine skills that NH’s Foster Care Nurses devoted to managing the health care needs for 80 or more children (per nurse) at a time.  Now it’s just one more thing – in a long list of things – that our Foster Care social workers are supposed to be able to manage. 

These social workers’ “To Do” lists include lots of things to monitor and coordinate for kids, like education, clothing, parent visits, family counseling, foster parent support, placing/moving children from one home or facility to another, court hearings, case record upkeep, and it goes on and on.  Hmmm, I wonder where health care is going to fit in?

Now I appreciate our dedicated social workers just as much as the next guy, but it seems probable that some of these kids are going to slip through the crack.  There are two nurses left in the program that are trying to offer some guidance to the social workers but will that be enough?  The folks I talked to didn’t think so. 

I think children in Foster Care deserve to have their health care needs met.  Just because they live within our safety net doesn’t mean we should risk their health.  If we don’t take care of them, who will? 

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Two former Foster Care Health Program Nurses, spoke passionately about the children and families they worked with through the years.  One stated that Foster families were devastated by the loss of support the program provided.  Another stated that children in Foster Care are entitled to receive the best possible health care available and the nurses were advocates for these children. 

It’s amazing!  Rather than dwell on the impact that being laid off is causing them and their families, these two dedicated nurses are focused on the harm that Foster children may now be exposed to.  As one nurse put it, “It’s a loss for DCYF.”

As I see it, it’s an unacceptable risk – one that demonstrates anything BUT good government.

This is Planter Joanne, proudly reporting on two great nurses, and of course, keeping my fingers crossed that they’ll be back on the job to watch over these children again soon.   

Today marks the launch of the “SEADs for Good Government” contract campaign!  SEADs is short for State Employee Association Discussions for Good Government – a 45 week campaign in which a team of SEA members and agency fee payers will, on a weekly basis, talk about the work we do, how it can be done better, and provides a more personalized view of our workforce.

Each edition will contain a story about the public services we provide and a story about a worker or workers who once provided public services – primarily those who were laid off this year due to insufficient funding and subsequent budget cuts.  Key to both components is that the stories are in the worker’s voice:  it is our reality, our truth and our story to tell.  Unfortunately, due to the fear of employer retaliation under the current Lynch Administration, some SEADs volunteers will be using pseudonyms in published stories.

This week’s edition provides you with a sneak peak into the campaign, its goals, what we mean by “Good Government,” and somewhat introduces you to the SEADs all-volunteer team.  SEADs for Good Government is a project of the Collective Bargaining Advisory Committee (CBAC).  If you would like to talk to a SEADs volunteer about a story in your workplace that you think needs telling, or if you would like to join SEADs, please complete the SEADs form on this website.

Definitions: 
“Good Government” means quality public services that the public wants and needs, at the right price, at the right time, and with the right amount of public support. 

“Discussion” means a brief description of the public service (or issue as it may affect a public service) and how it is currently being handled, countered with a viewpoint that plants SEADs for Good Government.

The SEADs Team Structure:
“Farmers” receive voluntarily reported information from members, research the information and develop a brief article that supports Good Government.  

“Planters” write the stories about the workers that were either laid off or restructured due to the budget crisis.

“Cultivators” blog on other websites to create public interest in SEADs and to stimulate online conversation about SEADs.

“Harvesters” are a steering committee that will serve as a filter and support system for the Farmers, Planters and Cultivators.  They will choose the stories to pair for the weekly release and will also work on the SEA website for publishing.

 
SEADs for Good Government:  A Sneak Peak!  12/29/09 First Edition

“Farmer Rick” reporting today:  As of December 23, the SEADs team consists of seven volunteers:  five SEA members and two agency fee payors.  The seven work in a variety of agencies (Employment Security, Health and Human Services, Corrections, Environmental Services, Administrative Services, and Safety) and come from all walks of life.  The team spans a wide range of public service careers:  mental health worker, lawyer, accountant, training specialist, manager, social worker, administrative support, and a certifying officer.  Some have been with the State nearly twenty years, others just a few.  The team lives in many different areas within the State and are really excited about being able to participate in SEADs from the comfort of their own homes!

It’s clear this group is committed to getting the good news out about the great work that’s being done for the people of New Hampshire.  One team member said, “We hope you will find SEADs worthwhile and will read our stories every week.” 

I couldn’t agree more!  Until next time, this is “Farmer Rick” wishing you and your family safe, healthy and happy holidays.

This is “Planter Joanne” writing today’s story about our workforce.  We have contacted many of the laid off workers to ask if we can share their personal stories.  Several have responded and agree that it’s important to give the public a bird’s eye view into the workers behind the public services. 

Such as the widow who is supporting three children.  Her job as an administrative support professional was the lifeline that kept her family afloat, and her spirits high enough that she could tackle anything that came her way.  Despite the fact that her roof leaked buckets of water (while she was trying to save up enough money for its repair), and that her house had just been broken into, she knew that going to her job every day meant that things were not going to get any worse. Until the day she got the news that she was being laid off.

I will tell you more about this worker in a future edition of SEADs.