Is Politics Failing Social Work or is Social Work Failing at Politics?

Mahatma-Gandhi-Politic-Quotes

Current news events seem to be rife with stories relevant to social work while continuing to highlight our lack of presence in those conversations. Suicide, police shootings, more school shootings, corporal punishment, and domestic violence are issues that stick out on a very long list . Various articles on this website have challenged us to think about social worker’s role in these mainstream stories.

The ultimate gauntlet was thrown by Dr. Steven Perry and his speech on C-SPAN that we are “too silent” on issues of access and social justice.  We are in the trenches on the frontline, and we need to increase public awareness on the efforts of social workers in order to affect public policy making decisions.

Prior to listening to Dr. Perry’s speech, I honestly thought the answer to this question was that politics has been failing social workers, but Dr. Perry calls us out on how we can do more and should be doing a lot more. As social workers, we are interested in making a change, but it is how we go about it that is coming into question. What the above speech and article do (excellently) is get us to think about where and how we want to be involved. Social Workers need to be involved more in politics.

Where I struggle with politics is the much talked about notion of “Policy to Practice”. As people in the helping profession, we all have a notion of what helping others entails. We have the power to help heal individuals, families, schools, and communities yet our voice is not always heard by policy makers. Similar to Dr. Perry, I wondered why our expertise and knowledge continues to not inform policy. What gets in the way?

Social work is becoming more and more about the bottom line. We get messages to use programs that are “evidence based”, “increase productivity”, and “reduce cost”. Interventions that accomplishes all three of these things may get the funding or not. However, despite meeting this criterion, these programs don’t always appear to “make the cut.”  Here are some examples to illustrate this further.

First, lumping together both foster care and juvenile justice together to discuss prevention programs and increasing outcomes. There appears to be a lot of concern about the money we are spending on foster care, out of home placement, and juvenile justice centers. As someone who coordinates care with young people who are at risk for out of home placement, there is a lack of intensive preventive services. There are huge waiting lists for the small amount of slots available. We know prevention services work, however my observation is that these programs are actually getting cut. Are politicians aware of this?

Another example of failed policies and lack of evidence based interventions being funded can be seen in how homelessness is being addressed. According to a press release by The U.S. Housing and Urban development in 2010,

“When an individual or a family becomes homeless for the first time, the cost of providing them housing and services can vary widely, from $581 a month for an individual’s stay in an emergency shelter in Des Moines, Iowa to as much as $3,530 for a family’s monthly stay in emergency shelter in Washington, D.C. The U.S. Department of Housing and Urban Development today released three studies on the cost of ‘first-time’ homelessness; life after transitional housing for homeless families; and strategies for improving access to mainstream benefits programs”

Services to prevent homelessness seem few and far between. For a homeless family, $3,000 per month can go a long way to finding someone permanent, stable housing. Social Workers are on the frontline, and we see what works as well as what our clients need. We apparently need to demonstrate to policy makers that what we do has “return on investment.”  Investing $3,000 a month to teach families to be more self-sufficient, knock down barriers to unemployment, and access to substance abuse and/or mental health treatment will save more money so individuals and families don’t need to become homeless in order to get services.

Are we ensuring policy makers know that we are fighting for the poor, marginalized, and oppressed on a daily basis to help improve their quality of life and to reduce dependency on government services? This is the challenge that we need to take head on, and Dr. Perry reminds us of how powerful social workers can be at the policy making level. To truly serve our clients, we have to address and engage on a policy level because helping one client at a time is only temporary fix which may be impeded further without proper funding.

To truly serve our clients, we have to address and engage on a policy level because helping one client at a time is only a temporary fix which may be impeded further without proper funding. Social Work has power and let’s take up the challenge to find new ways to use it. Dr. Perry has called us out and please find your way to answer the call.

2014 NC Short Session, Week 10: The Newest Medicaid Reform Plan

Bay Area Activists Protest Cuts To Medicaid

What a week at the General Assembly! The Senate decided to work on bills that were sitting in the Senate Rules Committee all last week and move them to the floor for votes.The most controversial was Medicaid Reform which the Senate proposes to create a completely new Department. The House did not meet last week and have nothing on their calendar for tonight, but it is possible that they meet later in the week to work on the bills the Senate is working through their Rules Committee.

Relevant Bills with Action:

HB 369 Criminal Law Changes: This is the omnibus bill that will expunge certain drug offenses and includes language on Erin’s Law. Under Section 4(a), the bill directs the Human Trafficking Commission to study the inclusion of age appropriate sexual abuse education in the classroom as well as gather information on sexual abuse in NC. Under the bill, the Commission is directed to work with several organizations to do this, including NASW-NC. The bill will be heard a third time tonight and, if it passes the Senate, will be sent to the House for concurrence.

HB 1181 North Carolina Medicaid Modernization: Last week, the Senate came up with an entirely new Medicaid plan. Under the new plan, the Division of Medical Assistance (DMA) would become an independent agency called the Department of Medical Benefits which would manage behavioral, physical and other specialized care for Medicaid and NC Health Choice recipients under a Managed Care Organization (MCO) or Accountable Care Organization (ACO) model.

The Senate scheduled this new Department to be created by August 1, 2014 and governed by a 7 member Board of Directors. The Senate plan also directs the Department of Health and Human Services to immediately cease any activities related to Medicaid reform. This plan is certainly fast-moving in the Senate and controversial among many. The bill is scheduled for a floor vote in the Senate tonight. If it passes, it will need to go to the House for concurrence. The Governor has already stated opposition to the new plan but the House has not spoken much for or against the bill.

Relevant Bills Filed:

HB 1276 Adjournment Sine Die: Yes, you read that correctly. The House bill filed last week sets adjournment for this Friday, July 25th. Keep in mind, the Senate filed an adjournment bill on June 27th, and legislators are still in session.

Aging-in-Place: It Can Be Detrimental to Your Health

Surveys show that most people when asked prefer to spend the last years of their lives in their homes rather than in a community or institutional setting. What they fail to consider…or don’t want to consider…is the prospect of being homebound and spending their last years alone with only an aide for companionship. As human beings, we are social animals who are meant to interact. Living in isolation, for most of us, is detrimental to our health and has been shown to be one of the leading health risk factors contributing to the downturn in the health of older adults.

home healthUnderstanding that most state governments no longer want to be in the nursing home business and that it is their assumption that it is less costly for both the government and the elderly to remain at home, I can see why the aging-in-place movement has gathered so much steam in recent years. Prevailing ageism also factors in when those who need assistance with activities of daily living choose to protect themselves from the ageist attitudes that pervade the public discourse on “old people.” It feels safer to stay at home.

There is another secret that the aging industrial complex does not like to talk about…the cost.

If ,I will come back to the “if” later on,an elderly person can get the optimum care and needs help 12-24 hours a day, adding this to the overhead of keeping a home, the cost can be astronomical. Because of longevity, the soaring costs of medical care and personal assistance, and the lack of a good long-term care program in this country, many seniors today run out of financial resources before the end of life. In my role as a political social worker, I know that Medicaid was not originally set up to be a long-term care provider; and I am also concerned about the financial strain this puts on government. There has to be a better way, and boomers all over our country are searching for better alternatives for living out their lives.

Why do I feel so strongly that aging-in-place is not the panacea that our government, our media, and the many senior service providers around the country are promoting?

My story starts with Hurricane Sandy. At the time that Sandy struck the east coast of New York, my elderly parents were aging-in-place in their co-op apartment in Long Beach on Long Island’s south shore. My dad, who has multiple chronic conditions that keep him wheelchair bound and unable to take care of his own personal needs, had an aide. His financial resources had already been depleted by the cost of his care for the two previous years, and he was receiving Medicaid benefits for home care. Although he really needed 24/7 care, the most that Medicaid would approve was 12 hour live-in. (This is where that “if” comes in).

Twelve hour live-in means that the aide lived in with my parents but only provided care for 12 hours a day. It seems that my 90 year old mom was determined to be able to care for him the other 12 hours. Well, let me tell you, a 90 year old cannot care for another 90 year old without compromising their own health and well-being. As a result, my parents became emergency room regulars at Long Beach hospital, just a few blocks from their home. In turn my sister and I were also emergency room regulars. A couple of months before Sandy hit we began to have a discussion about aging-in-place and that it might no longer a viable option for our family. And then came Sandy.

When people ask me about aging-in-place, I tell them, “It works until it doesn’t.”

After evacuating my parents with aide in tow and all the attendant chaos around relocating them, we came to the realization that they could not return to their home. All of the services they used were compromised or non-existent. The hospital was washed away and has not opened to this day. My mom’s doctor’s office was under water, leaving her with no medical records. Fortunately my dad’s medical care was being provided at home by the Veterans’ Administration, so his care could continue without too much interruption. The only blessing we could see at the time was their car, which floated down the road with every other automobile in Long Beach.

With the advocacy and support of my colleagues in the aging community of NYC, the Hebrew Home at Riverdale came through and provided a permanent home for mom and dad. My mom, who passed away this past January, spent the happiest year of the last ten years of her life there. She was 91 years old. Her life in Long Beach was becoming more and more an isolated existence.  Most of her friends had died and the burden of caring for my dad kept her from leaving her apartment except for her trips to the supermarket and doctor. With the responsibility for my dad lifted, she was now free. Although frail and deaf, her cognizance was excellent.

She made wonderful friends, joined in activities, began going to synagogue on Friday nights, went on shopping trips, and began to care again about what she wore and how she looked. Her best friend at the Hebrew Home was Rose, who was born deaf and was teaching my mom American Sign Language. She attended several 100 year old birthday parties. She and my dad celebrated their 70th wedding anniversary at the Hebrew Home with all their new friends in attendance. The other thing I noticed was that she was secure about having her own needs met…no more 911 calls and emergency room visits. She fully embraced her new home.

My dad, who needed 24/7 care resided in a different section of the facility, where he remains today. All the buildings on this beautiful campus are connected to each other, and my mom saw him every day and was his best friend and advocate. The common denominator among my dad’s floor mates is their inability to care for their own physical needs. There is, however, a huge cognizance spectrum. My dad seems to be located about mid-point on the spectrum. It is easy to discount the inner humanity among these people who are often confused, do not make sense even when talking to each other, and sometimes do not even seem to be aware of their surroundings. I must admit that my own ageist attitudes often came to the surface when I would visit his floor. One emotional and dear incident changed my entire perception of who these people are.

My mom died of congestive heart failure, and she did not suffer much at all. She had only been diagnosed about three months before her death and was only ill the last three weeks while spending the last week in the hospital. Although we tried to prepare my dad, his memory issues prevented him from fully grasping the situation. After she passed away, my sister and I went to tell him. He was in his dining room just about to sit down to dinner. We wheeled him out to a private area and broke the news as gently as we could…but there really is no gentle way. He reacted as was expected and appropriate. It was very sad.

When we were feeling the need to leave, dinner was over; and most of his floor mates were out wandering the halls in their wheelchairs and with their walkers. As you can imagine, we were having a difficult time leaving. I walked over to one of the aides, saying, “We really need to go, but it’s so hard for us to leave him alone and just say ‘bye dad, we’ll see you tomorrow’.” She waved her finger and said, “No, no. You see all these people. They are just hovering, waiting for the two of you to leave.”

As we waited for the elevator, my sister and I could see into the area where we left my dad. One by one, each of his floor mates came up to him, and each in their own way told him how sorry they were. Some just patted his arm, others hugged him, and as we were getting on the elevator, we watched the aides help them form a circle around dad. I turned to my sister and said, “He’s not alone.”

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