Cost-Cutting Move in Texas Endangers Welfare of Poor Elderly

Across the nation state lawmakers are finding ways to cut back and streamline social service programs due to budget overruns. But often these changes have a real impact on real people. This is the case in Texas, where to save money the state's Long Term Care Program, which determines eligibility for Medicaid long-term care services, will soon shift its service delivery from convenient local offices and home visits by case managers to three centralized "call centers." Most eligibility workers in the program will lose their jobs and the state estimates it will save more than $300 million.

In the article below, J.C. Frey, who works for the Long Term Care Program, reports on the impact this change will have on the elderly recipients of her program's services.

I am speaking here not as an employee of the Long-Term Care Program but as a concerned citizen of Texas.

Last year, state lawmakers passed a bill that reorganized state government. No problem there. However, the end result for our agency is that our services are now to be handled statewide in three call centers, with a few local offices to take care of emergency food stamp issuance. The logic is that the elderly population is now computer literate and can apply for services via the Internet. Those who lack Internet access will have to call one of the three call centers, where the caller will be required to process through a series of voice commands before speaking to an actual person.

I know from experience that neither of these options will work for the majority of the people I work with. First, most of them don't have computers and are unable to get to a center to use one. Even if the elderly could get to a computer, most of them wouldn't know how to use it. Applying for services, reporting changes, or just asking general questions by phoning a call center is not a viable option either. Many elderly persons do not have phones. For those that do, I suspect that many could not navigate the multi-leveled voice commands of these systems. An 83-year-old man recently told me he didn't understand why I didn't answer him when he called. He said that he could hear me talking to him and that he yelled real loud but I would not answer him. Of course, he had reached my voice mail. Those who succeed in navigating the call center system may be unable to stay on hold for what could be the hours required to speak to someone.

Also lost with the new system will be the personal, one-on-one contact that we now have with our clients, which literally saves lives. The truth is that we don't just determine eligibility for our programs; we are often an elderly person's only link to the outside world. We see needs that could not be identified over the phone, and we take steps to address these needs.

Recently I visited a 97-year-old client. She initially told me she was doing fine. But after asking her what she had had for breakfast, I learned that she had not eaten in several days. I offered to fix her something and when I went into the kitchen, I found that she had little food and no working can opener. Because of my visit and follow-up, she now has a provider who will be coming in three hours a day, six days a week to prepare her meals, give her a bath, do her laundry, tidy up the house and do her shopping. I also contacted her church to make them aware of her situation, and I will make a referral to Adult Protective Services so that they can continue a watch over her.

We see stories like this repeated every day because we are out there where the people are. I know that call centers will not and cannot address the needs of the elderly in Texas. Many elderly individuals will simply fall through the cracks without anyone ever knowing they existed.

The public, for the most part, is unaware of what is happening. Statewide public forums have been held, but there has been little advance notice of these hearings. Only a handful of newspapers around the state are reporting what is going on. Yes, I believe the state will save $300-plus million. But it will not be the result of the call center "efficiency". It will come as a result of Texas's neediest being unable to access the system and get the help that they need.

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