For working folks struggling to maintain a home and family, the times are already hard enough. But for those relying on social services for a place to stay, necessary medical care, or drug or alcohol assistance, notions of individual responsibility and Tea Party-inspired austerity measures at the state and federal levels are poised to kick the legs out from under them. Notes from the Edge will examine how a variety of individuals are impacted by today’s difficult budget decisions and track their experiences through the months ahead.
By Monday night, it seemed budget negotiators in the Lege had started to prioritize some of the most vulnerable among us: the indigent elderly in Texas. The House’s budget had aimed to cut state Medicaid funding by 33 percent, something the Texas Association of Homes and Services for the Aging (TAHSA) claimed would spark a cascade of nursing home closures statewide. But a tentative agreement reached Monday could keep Medicaid reimbursement rates flat for the next two years.
Advocates say many nursing homes are already struggling to survive a 3-percent rate cut the state rolled out in September — a reduction that will continue over the next two years even if larger and more devastating cuts are avoided. With Texas reimbursement rates currently 49th in the country, nursing home administrators say they already lose $12 a day per resident on Medicaid. Ronnie Evans, who runs Autumn Winds Retirement Lodge with his wife Darlene, said, “We’ve already been forced to be so lean. We’re at a point where we’re just asking for rates to stay the same. … We should be asking for rate increases, frankly.” Over half of the 90 residents at Autumn Winds are Medicaid dependent.
And lawmakers may just be kicking the can down the road. The agreement struck Monday would be almost $5 billion short of covering the expected growth in Medicaid caseloads in the next two years. “We barely survived that 3-percent cut. We’re just barely making ends meet as it is,” said Barbara Duelm, who runs the Medicaid-only 60-bed Sarah Roberts French Home near Woodlawn Lake. Last year’s 3-percent cut forced Duelm to reduce nursing aid staff by one person per shift. While relieved that lawmakers may have found a way to keep rates flat, Duelm said, “The forest fire is still burning.”
With staccato speech, Ruth Lerette said, “I just can’t take care of myself, not any more.”
Lerette, 74, is in the advanced stages of Huntington’s disease, a degenerative disorder evidenced in random and uncontrollable movement and which eventually leads to difficulty thinking and dementia. In her small room, Lerette pointed to stuffed animals and framed photographs on her dresser and nightstand, saying, “I’ve made this home. Everything in here represents me from before I was sick.”
Autumn Winds helps provide therapy for Lerette’s disease, slowing the symptoms so she can still walk the hallways and move around on her own. Lerette also needs close monitoring to make sure she eats regularly — the constant shaking and jittering drains much of her energy. Lerette wears a belt of weights to help balance the jerky movements she can no longer control.
Dependent on Medicaid to cover her costs, Lerette has a son who lives nearby and visits often, but who can’t adequately care for her advancing disease. “If I lived alone, I’d be stuck in a bed,” she said. “I need the therapy and the nurses.”
Julia Aguillon ividly recalls moving from her hometown of Laredo to San Antonio’s Southside over 60 years ago when she met the man she’d later marry. At 94 years old, Aguillon’s hearing and eyesight are starting to fail, but her memory is still razor sharp. “I’m not bragging, but I’m pretty good with dates,” she laughed, rattling off fond stories from the years she worked with S.H. Kress & Co. in Laredo to the day in October of 1950 when her husband proposed at a San Antonio bus station.
With Social Security benefits of just over $200 a month, Aguillon moved to the Sarah Roberts French Home three years ago after a small group of nieces and nephews could no longer care for her. Aguillon’s husband died a decade ago, and she’s since outlived her five siblings. Aguillon’s daughter and granddaughter were killed in an automobile accident 30 years ago, and she has an estranged son who lives out of state.
Linda Joseph, struggling with schizophrenia and bipolar disorder, lived on her own as long as she could. But at a certain point her sister and brother-in-law decided she needed close monitoring and moved her to Autumn Winds after a number of incidents stemming from Joseph’s failure to take her medication.
Born in the Beaumont area, Joseph, now 53, said she and her family moved to San Antonio when she was a child. As an adult, she moved around frequently and was in and out of hospitals between Wyoming, Kansas, and Texas as she tried, unsuccessfully, to bring her schizophrenia under control. “I know I had at least one nervous breakdown in Wichita,” she said. “I just can’t live on my own. I get into trouble.”
Joseph is keenly aware of her dependence on Medicaid, and of what future reductions in the program could do to patients like her. She floated the idea of living in a shelter, like Haven for Hope, if it ever comes to a point where she can’t find a nursing home that will take her. “My sister and brother in law have said no, that me living with them just doesn’t work. So I’m not sure where I could go.”
