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The Unplanned Impact of the Supplemental Budget on Treatment Foster Families and Children

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THIS BEAR UNLOVED

Hallowell Maine: Mark Katz
The licensing division of the Office of Children and Family Services at DHHS as well as provider agencies contracting with licensed homes for treatment level care have long recognized that many children in state custody need a full-time parent at home. In the rules, both the department and agencies have explicitly acknowledged that reimbursement dollars may be used in determining the financial fitness of foster families. This has allowed many families, perhaps the vast majority, to open their homes to children and youth placed at treatment levels of care and to provide at least one full-time parent.

Children in specialized care have very busy schedules. In order that self-worth, social development, and general health be assured, enhanced, and preserved, children are encouraged and supported in the same normalizing activities engaged in by their peers. Ask any average soccer Mom about down-time. Imagine adding to this schedule by introducing weekly psychotherapy, habilitation services, psychiatric management and appointments, team meetings, P.E.T. and IEP meetings at school, meetings with caseworkers, family visits, visits by case managers, agency-supervised group activities, and one-hundred-and-fifty mile car trips to a MaineCare orthodontist. For teenagers, add on leadership trainings, advocacy groups, and community education and public speaking engagements.

Review a Specialized Foster Parents day-timer. In a typical month it is not unusual for fifty per cent of his or her weekdays to include doctors appointments, school appointments, planning meetings, trainings, advisory committees, ad hoc consultations and conferences, and an array of other responsibilities vital to the child(ren) in his care. Especially at the higher levels of care, these obligations during normal working hours make it difficult if not impossible for a treatment foster parent to find and to hold even part-time jobs outside of the home. Where there is a working spouse at home during the night, it may be possible for the primary foster parent to work the night shift. Naturally, the resulting sleep deficits will increase burn-out rates and downtime due to illness. Where patience, equanimity, empathy, alertness, and quick response times are the bread-and-butter of quality care, sleep deprivation is not what the doctor ordered.

The M.A.R.C. report released by the University of Maryland and the National Association of Public Welfare Administrators in October of 2007 provides a state-by-state analysis of the Minimum Acceptable Rates for Children in regular foster care. The results represent the minimal room and board or maintenance costs for children without special needs. Moreover, the MARC includes only expenses for which states would be eligible to receive federal funding under Title IV-E Maintenance and excludes other actual expenses incurred by foster parents which are not covered under those guidelines as well as excluding costs which can be defrayed by other federal funding sources, e.g. Title IV-E Administration and Title XIX Medicaid.

Adjusted for inflation and factoring in the recent rise in energy and food costs, the MARC for Maine youth is well over thirty dollars per day. This is the minimum amount that must be subtracted from a foster homes daily rate before calculating any contribution to offset opportunity cost. Here, opportunity cost refers to the lost wages incurred by a foster parent who must decline employment in order to care for a child in state custody. For most families, these are the wages that could be applied to local property taxes, health care and insurances, property maintenance, and dinner out at the local Chinese restaurant once every month or two.

In Maine, Level C refers to the lowest level of treatment foster care. This describes a child with emotional, mental, behavioral, and/or medical needs which are different from the norms for his or her age group and developmental stage. Under the Supplemental Budget proposed by the Governor for FY 2008-2009, the daily rate for a child at Level C is to be reduced to thirty dollars (a 30% reduction from current rates.) By lowering thermostats, using local food pantries, and reducing discretionary travel, most households may be able to cover minimum costs on this budget. They will not, of course, be able to offset any of their basic costs of living nor additional costs incurred as a result of the increased level of care. Primary foster parents with a child or children at Level C will probably be allowed by the licensing authority to apply for the weekend, night-shift as a Direct Support Provider, CNA, Personal Support Specialist, or CRMA medications assistant at a nursing home or residential facility in order that they may continue to meet mortgage and other expenses necessary to maintain their homes. All they will lose is sleep but, inevitably, it is the neediest child(ren) who will feel this loss the most.

At Level D, under the proposed new rates, the typical treatment foster home will receive nearly three-thousand dollars annually above the MARC rate. In many cases, this eight dollar daily increment will suffice to cover the increased costs associated with the substantially higher level of care. Some of this may even be applied to occasional respite care and other un-reimbursed costs. Again, the proposed rate provides no contribution to offset other basic expenses. Note also, the increased rate does not apply during the first three months of care for a child entering the system and that many children at this level will remain in placement for only six to nine months. Some foster parents will be successful locating employers who are willing to employ them on again, off again, for several weeks between placements. Many will not.

Interestingly, the legislature and human services planners and advocates have acknowledged recently the important contribution made by para-professional, direct-support providers. Such acknowledgment is a response to the potential amplification of the current care gap resulting from demographic and socio-economic currents. Legislation to increase access to health insurance and to elevate wages above minimum-wage rates has been passed to assist in the recruitment and retention of care-givers for children, adults, and seniors needing supports in the activities of daily living. Maine PASA, the Personal Assistance Services Association, continues to advocate and lobby for both caregivers and for those they serve. Also, this past year saw successful organizing efforts among those independent providers offering child care. These providers are now represented by MSEA and the SEIU.

Without effective organization and representation, the independent contractors providing treatment and care under foster home models continue to fall further behind. These trained providers assume responsibilities of case management, direct support, health-care, and behavioral management as well as the administrative and fiscal responsibilities associated with maintaining their facilities. MR Waiver programs for individuals with cognitive disabilities and Treatment Foster Care for youth remain the forgotten warriors, asked to further and disproportionately shoulder the increasing burden of limited resources. The true costs of a failure to support the care-givers is borne by the children and citizens already most at risk. You need not be an architect to understand that by diverting our attention from the foundation, we accelerate and guarantee the collapse of an entire structure. When we fail our children and families we fail the future of the entire social order, cradle and all.

Current curtailments and the proposed Supplemental Budget apply sledge hammers to the granite and mortar of our Treatment Care for the already traumatized children in state custody. Certainly, we must have learned by now that when the towers fall, we will all shudder.

Mark Katz

Hallowell

idotnet@roadrunner.com

January 22, 2008

January 29th, 2008 Posted by narsbars | Foster Children, Uncategorized | 4 comments

4 Comments

  1. While a readers are leaving comments at the blogspot location, feel free to leave them here also. People need to hear what is going on with the kids.

    Comment by narsbars | January 29, 2008

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  3. I have to say that the article you wrote is right on the mark! You nailed it all very consisely and I just pray that they listen as this is truly a case where the foundation has been rocked and things are going to come crashing down if these cuts pass. I hope that everyone that has an opening will refuse any placements just so that we can give a little bit of what is to come to DHHS in Augusta before it is too late! DHHS was left in a heap after the last bit of cuts and now this? Someone somewhere who had this bright idea needs to truly wake up and visit some of our homes for a meal. I would love nothing more than to see all of maines foster and adoptive children at the State House all at once unmedicated of course! Leave the legislature with them for about 15 minutes, of course we all know they would not last 15 seconds!

    Comment by Karen Grant-Tolman | January 29, 2008

  4. Hi, friends,
    Just met last night with Jim Beogher and Dan Despard, Directors at DHHS and authors of the streamlining proposals currently getting such RAVE reviews.

    For notes, please see this evening’s “Breaking News and Broken Promises” here at UnionMaine. Time to spread our wings, folks; we are about to be kicked from the nest.

    Today’s quote – “For those addicted to a quick fix, `streamlining’ is the new alternative to mainlining”

    And

    from Pogo (Walt Kelly hizself): We Have Met the Enemy and He Is Us

    Comment by Mark | January 31, 2008

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