As many sons and daughters of infirm parents can attest, most workers who toil to keep our elders in their homes for relatively meager pay are a little like angels.
In-home supportive services workers care for more than 500,000 Californians and tamp down health care costs by enabling disabled people to stay out of nursing homes.
It’s not cheap. The cost of the program has more than doubled since the 2011-12 fiscal year to $3.5 billion this year. One reason is that caseloads are growing as baby boomers age. Not that we begrudge working people their pay, but another reason is that the Legislature and governor have made decisions that raise workers’ wages.
Counties stood to be on the hook for a cost increase of roughly $600 million in the coming fiscal year. Knowing counties cannot shoulder such a burden, Gov. Jerry Brown hit on a solution to shift costs. It makes perfect budget sense, except it comes at the expense of others in need, specifically mentally ill people.
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At a Senate budget subcommittee hearing last week, Brown administration officials explained a complex cost shift from county mental health care to in-home supportive services.
County mental health programs wouldn’t actually lose money. Rather, they would not receive increases to keep up with the rising number of psychiatric cases. By the administration’s estimate, mental health services would be shorted by $110 million between now and 2021.
“It would be, if carried out over five years, the biggest cut of mental health funding in state history that the Legislature will have ever passed on a one-time basis,” Rusty Selix, a lobbyist who represents nonprofit mental health care providers, told the subcommittee. He later said he had only been around for 31 years, but $110 million would be the biggest single reduction during his time in Sacramento.
Selix was all but alone, though a representative of the Steinberg Institute, named for Darrell Steinberg, later said the organization intends to submit a letter of opposition.
Other interested parties – associations that represent county supervisors and county welfare directors and labor unions – lauded the arrangement at the budget hearing. Lobbyists for county mental health directors and advocates for the mentally ill did not show up.
Speaking for the Brown administration, a Department of Finance official said mental health care services receive money from other sources, including the 2004 initiative that raised income taxes on wealthy people and generates more than $1.8 billion annually for mental health care.
By its terms, however, the 2004 initiative promoted by Steinberg, now Sacramento’s mayor, says its revenue cannot be used to backfill cuts in other mental health funding sources.
Of course, in-home support services must be funded. It is humane and helps people avoid nursing homes, which saves money. But its funding should not come at the expense of people suffering from mental illness.
The money that would be be diverted from mental health care would help fund services for the most severely mentally ill among us. But lacking many strong advocates inside government – California has no director of mental health care – mental health care funding is easy pickings.
Unless the Legislature intervenes, the result will be that mental health care for the most severally ill will get short-changed, again.