 |
MGH Community News |
|
MGH Community News |
| November 2014 | Volume 18 • Issue 11 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
City Plan for Homeless Crisis After Bridge Closure
Dr. Huy Nguyen, interim head of the Boston Public Health Commission, earlier this month laid out the city’s plan to address the homeless shelter crisis in the wake of last month’s sudden closure of the only bridge to Long Island, site of the city’s largest homeless shelter and a number of substance use disorder recovery programs. Nguyen said officials hope to open a shelter this winter at 300 Frontage Road Annex, the site of a former city-run methadone clinic on the edge of the South End. The shelter, which will cost $2.1 million, will have 450 emergency beds, he said. Additional recovery beds will also be available at health commission-owned property in Mattapan, Nguyen said. Felix Arroyo, the city’s health and human services chief, said officials plan to continue offering services on the island when the bridge is fixed, which could take five years. In addition, Arroyo has said the city is considering purchasing the recently closed Radius Specialty Hospital in Roxbury, which would probably be large enough to house all the recovery programs that were on Long Island. A passionate, spillover crowd of more than 300 homeless people and their supporters packed the public meeting in the South End to demand better options for those displaced last month from the Long Island shelter. Those attending the event at the Blackstone Community Center also called for more permanent housing and recovery services for the city’s homeless population, not just additional emergency shelters. In a statement released the day before Thanksgiving, Walsh’s office said the city plans to open 74 recovery beds, at a cost of $91,000, next month in Building N, a facility on a Boston Public Health Commission property on River Street in Mattapan. An additional 50 emergency beds, or 20 program beds, are slated to open in a separate area of the Mattapan property, at a cost of $22,500 in January 2015. |
According to Kate Norton, a spokeswoman for Walsh, the plan to open an emergency shelter this winter at the 300 Frontage Road Annex, the site of a former city-run methadone clinic on the edge of the South End, with 450 emergency beds is on schedule. “Frontage Road is still the most likely option,” Norton wrote in an e-mail, adding that officials expect to receive confirmation on shortly. The day before Thanksgiving, Mayor Martin J. Walsh’s office provided a phone number, 617-823-7676, that homeless people who were abruptly moved from the shelter can call to retrieve their personal belongings. The city will bring the requested items to the Woods Mullen Shelter in the South End for pickup. Additional public meetings are scheduled for Dec. 2 at 6 p.m. at the Mildred Ave Community Center Auditorium in Mattapan and Dec. 4 at 6 p.m. at the Trotter Elementary School in Dorchester. Sources and for More Information
Proposed Rules Would Offer New Assisted Living Protections Residents of assisted living homes would receive significant new protections under rules proposed this month by Massachusetts regulators — changes aimed at closing gaps that threatened elders’ safety. Under the strengthened regulations, assisted living residences would be prohibited from accepting residents so frail they need months of skilled nursing care. The rules also call for expanded training for workers, and require detailed emergency evacuation plans, including enough equipment and medicine if extreme weather threatens. Many elders who once would have moved to nursing homes when their health declined are instead choosing to remain in assisted living, often because the cost is significantly less than for nursing homes. As a result, the populations in these loosely regulated, apartment-like facilities have been profoundly transformed, with a growing segment of residents who are increasingly frail. The rules would prohibit the facilities from accepting residents, or allowing them to remain in the facility, if the patients require more than 90 consecutive days of skilled nursing care. The rules also require annual evacuation drills. Today, roughly 14,000 people in Massachusetts dwell in about 225 assisted living residences. Elder advocates have long lobbied state regulators to update the rules governing those residences, saying that guidelines to protect residents have not kept pace and have not been updated since 2006. While existing rules require substantial training for staffers, the updated guidelines mandate education in two areas of special concern: recognizing and reporting elder abuse and techniques for managing and calming aggressive behavior, something commonly encountered in caring for patients with dementia. The rules also require more frequent activities for residents in special care units at the facilities, which are becoming increasingly popular for elders with dementia. The proposals stopped short of requiring some measures advocates had sought, including minimum staffing levels for all residences. Instead, the proposal stipulates only that it “shall never be considered sufficient to have less than two staff members in a Special Care Residence,” which typically cater to residents with dementia. Some attorneys who specialize in elder abuse cases said they believe insufficient training and staffing are at the heart of most of the abuse cases they see. “Anything is an improvement from what we have, but I don’t think this has teeth,” said David Hoey, a North Reading attorney who specializes in elder abuse law. “At the end of the day, there still needs to be enforcement and oversight,” Hoey said. “There is too much for the [Executive Office of Elder Affairs] to handle. It doesn’t have enough staff, manpower, money, and supplies to police the assisted living industry right now.” Many states regulate assisted living residences as health care facilities, but Massachusetts remains among a handful that still consider the facilities more similar to apartment living. The rules will be presented to an advisory council and will be the subject of a public hearing next month. They could go into effect as soon as January. Elder Affairs has announced a public hearing about its proposed regulations on Dec. 15, from 10 a.m. to noon at 1 Ashburton Place, Fifth Floor, in Boston. The agency is also accepting written comments until 5 p.m. Dec. 17. The proposed regulations are available on the agency’s website, www.mass.gov/elders or by calling 617-222-7562. -See the full Boston Globe article...
Obama’s Executive Action on Immigration President Obama outlined a plan this month to reprioritize immigration enforcement to focus on “felons not families” including provisions to provide temporary administrative relief and work permits to certain undocumented parents of U.S. citizens and legal permanent residents, as well as young immigrants who were brought to the country illegally as children. It is too early to tell how many immigrants will ultimately qualify for the varying forms of relief, but the Migration Policy Institute estimates that roughly 65,000 in Massachusetts will fall into both categories. Boston will probably have a large percentage, according to St. Guillen Alejandra St. Guillen, director of the Mayor’s Office of New Bostonians, which does outreach to immigrants. Benefits Two key programs under the plan are Deferred Action for Parents (DAPA) and an expansion and extension of the previously announced Deferred Action for Childhood Arrivals (DACA) progam. Deferred Action protects from deportation and provides employment authorization. Deferred action does not confer any form of legal status in this country, much less citizenship; it simply means that, for a specified period of time, an individual is permitted to be lawfully present in the United States. Nor can deferred action itself lead to a green card. Those found eligible will be permitted to apply for work authorization, provided they pay a fee. This Deferred Action is expected to last for three years. Please note: those eligible for these programs will NOT be able to purchase health insurance through the Affordable Care Act exchanges or receive federal subsidies. Risks At this point it is unclear what confidentiality protections will be provided, both for the applicant and for others listed in the application. Details also are not yet available about what will happen to those who are denied (e.g., for criminal offenses, or even just arrests, and recent deportation orders), though potentially they may be exposed to removal proceedings. Because DAPA, and DACA, are only a temporary permission to remain, they could be revoked at any time. Applicants are advised to get legal counseling to find out if their criminal or immigration record affects eligibility. Recipients would be protected through the first year of Obama’s successor in 2017. It would be up to the new administration to determine whether to continue the program or eliminate it. Attorney Jeannie Kane with the International Irish Immigrant Center says there's a lot of uncertainty, short and long-term. In an NPR interview Kane said “ this could be taken away by the next administration. We just don't know. But on the other hand, you know, in the past there's been executive action and then that's turned into some kind of permanent status years later. And only the people who registered actually get the status. So it's hard to advise people.” Other cautions include carefully considering what if anything to tell a current employer. Applying for DAPA might be interpreted as admitting that one is not authorized to be employed and could cost one’s job. Eligibility Deferred Action for Parents (DAPA) - under President Obama’s order, DAPA applies to undocumented immigrants who are
Additional Provisions The Executive Action expands Provisional Waivers to Spouses and Children of Lawful Permanent Residents. DHS announced in January 2013 the provisional waiver program for undocumented spouses and children of U.S. citizens. This will be expanded to include the spouses and children of lawful permanent residents (green card holders), as well as the ADULT children of U.S. citizens and lawful permanent residents. At the same time, they will further clarify the “extreme hardship” standard that must be met to obtain the waiver. Under current law certain undocumented individuals in the US who are eligible for immigrant visas, must leave the country and be interviewed at US consulates abroad to obtain those immigrant visas. If these qualifying individuals have been in the United States unlawfully for more than six months, they are barred by law from returning for 3 or 10 years. This waiver allows the U.S. citizen or permanent resident to seek a waiver of the 3-and IO-year bars if they can demonstrate that absence from the United States will result in an "extreme hardship" to a U.S. citizen or lawful permanent spouse or parent AND allows application for this waiver before the immigrant leaves the country. This "provisional" waiver provided eligible individuals with some level of certainty that they would be able to return after a successful consular interview and would not be subject to lengthy overseas waits while the waiver application was adjudicated. Ending “Secure Communities” – “Secure Communities” is a controversial program that requires local law enforcement agencies to detain immigrants who are arrested until they can be screened by federal immigration agents will be replaced with a new program, called the Priority Enforcement Program, in which immigrants who are arrested will still be fingerprinted, but it is up to the local jurisdictions to notify federal agencies if they think that an immigration violation had occurred. Application (and Scam Warnings) While there is understandable interest and excitement, no one can apply for these new/extended programs yet. DAPA- Homeland Security is expected to be able to accept applications 180 days from the date of the announcement (11/20/14). DACA- those wishing to apply for those eligible for expanded eligibility should be able to do so 90 days from the date of the announcement (11/20/14). Caution: Those with any type of criminal record- including charges without convictions - should consult an immigration attorney before applying, as identifying themselves to authorities could lead to removal proceedings. Potential applicants can begin gathering pertinent documents. Learn more. Unresolved Issues It is unclear at this time whether those who receive one of these new/expanded statuses will be able to travel out of the country and expect to be able to return. Another issue to be ironed out is whether immigrants will be able to get state driver’s licenses. After DACA was announced in 2012, Governor Deval Patrick granted recipients licenses and in-state tuition. A Department of Transportation official said recently that the department had not received notice from the federal government about whether beneficiaries of the new order would qualify for driver’s licenses. A spokesman for Governor-elect Charlie Baker said Baker will need more information on the scope of the new order, and the number of people it affects, before he can make a decision on driver’s licenses or in-state tuition. More Information and Advice
Sources and for More Information
The Governor's 9C Cuts Governor Patrick recently announced a series of actions to bring the current year budget into balance.The need for mid-year budget solutions highlights two realities that have shaped Massachusetts budget debates for years: our national economy is still recovering from the worst recession since the Great Depression and we continue to have substantially reduced revenues because the state adopted over $3 billion of income tax cuts during an economic bubble in the late 1990s (learn more), according to a MassBudget.org analysis. These long-term challenges are now compounded by a few short-term ones: a coming automatic reduction in the personal income tax rate, non-tax revenue collections that are below projections, and additional economic development spending commitments that were made with the expectation that there would be more revenue available than is currently projected. The administration estimates that combined these have created a $329 million gap for the rest of FY 2015. To close this gap, the Governor announced $198 million in cuts to executive branch agencies as authorized by Chapter 9C of the General Laws (explained in What are 9C Cuts?). The Governor also proposed additional solutions in areas beyond executive branch agencies -- including to local aid -- that can only be implemented with legislative approval. The $198 million in 9C cuts to programs within the executive branch include:
The Governor has also proposed additional cuts to non-executive branch agencies, which he cannot implement on his own. -From The Governor's 9C Cuts and Context, massbudget.org, November 20, 2014.
Courageous Parents Network supports parents and families of children living with serious illness with the skills, tools and virtual support they need to cope and adapt during their child’s illness journey. Services include:
At the heart of Courageous Parents Network are the parents themselves: parents sharing – through video – their experiences and feelings, speaking frankly about intimate challenges and moments in caring for their sick child including through the end–of–life. May these stories inspire, educate, embolden and provide comfort to other parents. Videos are organized by themes including:
There is also an online support network, blog and of course additional links. -More at: http://courageousparentsnetwork.org/ justice AmeriCorps to Launch in December MIRA Coalition is excited to announce the launch of a justice AmeriCorps program in Massachusetts. This new public service initiative will provide much needed legal services to unaccompanied children in immigration courts across the state. Working in partnership with the Greater Boston Legal Services (GBLS), MIRA is recruiting, training, and placing 12 AmeriCorps attorneys and three AmeriCorps paralegals at legal services organizations across the state. Justice AmeriCorps MA is now recruiting host sites and attorneys to help unaccompanied minors in court. If all goes according to plan, the program will start full-time service at the sites in mid-December. One-Stop Financial Centers Spreading Throughout Eastern Mass. When Federal Reserve chairwoman Janet Yellen visited Boston in October, she stopped at a Chelsea center where low-income residents boost their job skills, take classes on building their savings, and apply for public benefits, such as food stamps — all under one roof. It was a chance to see how nonprofits were pooling their resources to help struggling families pull themselves out of poverty. These one-stop sites, called financial stability centers, are now spreading throughout Eastern Massachusetts as cities and nonprofits look for ways to collaborate, save money on staff and office space, and make it easier for residents to get needed services. Seven centers will open by spring of 2015, including three in Boston. The United Way of Massachusetts Bay and Merrimack Valley has already budgeted $1.5 million in the next two years to support six of these initiatives. “It’s not only cost efficient, it’s convenient for the city residents,” said Trinh Nguyen, the director of Mayor Martin J. Walsh’s Office of Jobs and Community Services. “Instead of sending clients to one site on one day and then another site for another need on another day, once you catch them you can work with them.” The United Way started putting these centers together in 2009 after realizing that people who need one service often have other financial challenges and need long-term support that they can find under one roof. When people come to these centers, many need immediate help paying rent or buying food. But they also face more persistent problems, such as credit card and student loan debt or bad credit that forces them into high-interest loans or disqualifies them from traditional banking services, diminishing their chances to break the cycle of poverty, advocates for the poor said. Those issues can takes months and years to address, said Mike Durkin, the United Way’s president. The centers can provide the mix of programs needed to help low-income families to climb the economic ladder. “This is not a move away from helping families with their basic needs,” he said. “We’re trying to build out the whole path.” The centers offer different services depending on the needs of the communities. In Lawrence, where nearly three-quarters of the residents are Hispanic and many speak Spanish, the financial stability center run by the nonprofit Lawrence Community Works provides English classes, foreclosure prevention counseling, and programs on how to save for college. Eric Rosengren, Federal Reserve Bank of Boston president and a regional United Way director, said the economic crisis set many back. People struggling don’t simply need food or rental assistance, but help with a range of financial challenges, from building job skills to rebuilding bank accounts. “An individual seeking out support, usually needs support in multiple dimensions,” he said. “Nonprofits are starting to work together on a more collaborative method.” -See the full Boton Globe article...
An experiment to improve care for thousands of Massachusetts’ sickest residents (the so-called “dual eligibles” who are eligible for both Medicare and Medicaid) is proving more complex and expensive than health insurers and regulators envisioned, forcing the state and federal governments to shoulder more costs for the first-in-the nation program. Called One Care, the initiative was designed to better coordinate health care services for about 95,000 disabled and low-income adults under age 65 when it launched last October. But the state’s latest count shows fewer than 18,000 enrolled, and officials have repeatedly declined to release detailed information about the program’s finances or the quality of patient care because they say they want to be able to analyze a year’s worth of data first. One of the three insurers managing patients’ care for the program said in an internal memo that the company was losing $1 million a month at one point. And executives at all three companies with contracts to manage patients’ care said even locating patients can prove daunting, often because of errant information from state regulators. The experience with the trial so far opens a window onto the remarkably complicated needs of patients whose conditions include paralysis, severe mental health problems, and addiction. Executives from the three companies said they have been surprised by the extent of patients’ needs. Robert Master, chief executive of Commonwealth Care Alliance, a nonprofit that oversees health care for about half of the patients in the One Care program, listed the challenges his company has confronted in connecting with patients: “The transience is extraordinary, behavioral health issues, homelessness . . . we kind of anticipated that, but we didn’t realize how bad it is.” For years, two massive and often conflicting government programs, federally run Medicare and state-run Medicaid, paid the health bills for this group of patients. But soaring health care costs nationwide, particularly for patients with complex medical needs, prompted federal regulators to announce a new initiative that aims to better coordinate patients’ mental health, medical, dental, and substance-abuse services, hoping to avoid more expensive hospitalizations. States were invited to design their own programs that combine the money from Medicare and Medicaid into one streamlined service that would offer better care for less money. Massachusetts was the first state to sign on, and four other states have launched similar initiatives, with similar complications. The program in Massachusetts scraps the traditional model of paying physicians for every blood test, medical scan, or other health service they provide. Instead, companies in One Care receive a lump sum each year to manage all of a patient’s care, often coordinating and paying for services not typically handled by an insurer, such as transportation, housing, and even food deliveries. Officials have disclosed monthly enrollment figures and preliminary results from a recent survey of 375 patients. That survey indicated 94 percent said they were “completely or somewhat satisfied” with One Care, but fewer than half said they had been connected with a coordinator to manage their services long-term — a feature considered critical to successfully managing their care. -See the full Boston Globe article....
Medicare Final Rules on Paying Physicians for Managing Multiple Chronic Conditions and Improved Colonoscopy Coverage The Centers for Medicare & Medicaid Services (CMS) recently announced a new rule to make changes to the payment policies and rates under the Medicare Physician Fee Schedule for services received on or after January 1, 2015. This latest rule includes policies designed to enhance beneficiary access to primary care services, particularly for those with multiple chronic conditions. While Medicare mostly pays physicians for services provided during face-to-face visits, last year, CMS created a separate payment for managing care for people with Medicare who have two or more chronic conditions without a face-to-face visit. The final rule includes additional details on the implementation of this policy, which begins in 2015, as well as payment rates. In addition, CMS adopted a new policy intended to facilitate greater access to low-cost colonoscopies. Specifically, CMS redefined a colonoscopy to include anesthesia—as it is increasingly common to receive anesthesia with this screening procedure. This redefinition is important because it will allow beneficiaries to pay no cost sharing for a colonoscopy with anesthesia moving forward. Previously, Medicare beneficiaries benefited from having no cost sharing on the colonoscopy itself, but were required to pay cost sharing for the anesthesia. - From Medicare Watch, Medicare Rights Center, November 6, 2014. Medicare Will Continue to Allow Coverage for Upgradable ALS Devices
The Centers for Medicare & Medicaid Services (CMS) reversed course this month and decided to allow continued Medicare coverage of upgradable speech generating devices used by people with ALS. Patients with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, often lose their ability to speak and need to use a wheelchair. -From Medicare Watch, Volume 5, Issue 44, Medicare Rights Center, November 13, 2014. Report Compares Quality of Medicare Advantage with Traditional Medicare The Kaiser Family Foundation (KFF) has released a comprehensive review of research literature comparing health care access and quality in Medicare Advantage with the traditional Medicare program. Today, 30 percent of all people with Medicare are currently enrolled in a Medicare Advantage (MA) plan, private plans that contract with the federal government to provide Medicare benefits. The literature review analyzes 45 studies that compare MA and traditional Medicare, published between 2000 and 2014. The report reviews studies that examine a variety of topics, including beneficiary reports on quality and access, potentially avoidable hospital admissions, readmission rates, health outcomes, resource utilization and more. While highlighting some methodological criticisms of the studies, the report finds that the cumulative evidence shows that MA plans tend to perform better than traditional Medicare in providing preventive services and conserving their resources, at least through 2009. At the same time, according to the report, people with Medicare consistently rate traditional Medicare as being better than MA in terms of quality and access, though one study suggests that this gap may be closing for some groups of beneficiaries. Across studies, sicker beneficiaries overwhelmingly favor traditional Medicare. Ultimately, the report expresses disappointment in the lack of information comparing MA with traditional Medicare. KFF calls for more study of the differences between MA and the traditional Medicare program, particularly in light of increasing MA enrollment. -From Medicare Watch, Volume 5, Issue 44, Medicare Rights Center, November 13, 2014. Advocacy Tip: Premium Assistance from MassHealth for Private Health Insurance It seems that very few parents of intellectually disabled adult children aged 18-26 know about the MassHealth Standard/CommonHealth Premium Assistance Program, which can provide meaningful financial assistance to those who qualify. If your child is disabled and on MassHealth (which happens automatically if she receives SSI benefits), and you are continuing to cover her on your health insurance plan at work, you may be able to receive reimbursement for the health insurance premiums that you pay -- not just for your child, but for your entire family. In order to be eligible for Premium Assistance, you must:
There are other restrictions, so the best way to find out if you qualify is to apply. (Note that family income is not taken into account.) The size of the reimbursement is based on many variables, but it can be up to $66 0a month. You will either get a monthly check sent to you, or your employer will reduce your payroll deduction for health insurance. Your child will receive whatever health care benefits your private health insurance offers. In order to apply, call MassHealth at 1-800-862-4840. (MassHealth does not post the application on the web; you have to call them. Or Mass General patients can contact Patient Financial Services.) Explain that you are calling about the MassHealth Standard/CommonHealth Premium Assistance Program for a family member with a disability. Good luck. This is not retroactive, so get going! Don't leave up to $7,920 on the table. -From Premium Assistance from MassHealth for Private Health Insurance, Margolis & Bloom, LLP, November 25, 2014. New Mass. Health Connector Website Works, But Some Have Problems In the Connector website’s first seven days, 51,967 signed on and learned what kind of health coverage they are eligible for — the key function that software was unable to perform last year, after it was retooled to comply with the federal Affordable Care Act. That number represents roughly a quarter of the 175,000 to 225,000 people expected to use the Connector during the three-month open enrollment period. “To reach that milestone in seven days gives us really good hope,” said Maydad Cohen, the state official overseeing the website’s reconstruction. He said the website continues to operate without lags; the average wait time at the call centers during the first seven days was just over four minutes. Of those who determined their eligibility, 23,792 qualified for Medicaid and were immediately enrolled. The rest were found eligible for private insurance, and half of those people selected a plan. A total of 753 have already paid their first month’s premium, which is due Dec. 23 for coverage starting January 1, 2015. While thousands made it through the process, 4,998 people came to a dead stop when they could not verify their identities online. Connector officials said this rate of roughly 10 percent is similar to that of the federal marketplace. Spokeswomen for the health insurance exchanges in Connecticut and Rhode Island, both among the nation’s best-functioning, reported similar estimates for identity-verification problems: 10 percent in Connecticut, 10 to 15 percent in Rhode Island. Software glitches are not to blame, said Cohen. Instead, requests for more documentation to verify identities are evidence of a necessarily rigorous process, he said. “The system is operating exactly as it was built to,” Cohen said, by trying to ascertain “that you are who you say you are when you’re applying.” To continue with their application, people need to provide backup documentation, such as copies of a driver’s license or passport, by mail or fax. As of Monday morning, 899 people had sent in documents and 739 accounts had been unlocked, according to Connector spokesman Jason Lefferts. The Connector is using Experian, a credit-rating service, to check identities against information the service has in its database. Young people and new immigrants who do not have long credit histories, people who have been victims of identity theft or have had their credit history frozen, and those who have recently moved can run into this problem. But any number of quirks can cause it. Eric Linzer, spokesman for the Massachusetts Association of Health Plans, said health insurers are starting to receive enrollment files from the Connector. It is too soon to tell, he said, whether the next crucial steps — getting people enrolled so they can get their insurance cards — will go smoothly. -See the full Boston Globe article...
Homeless Population in Mass. Rising Faster than Any Other State; Baker Outlines Plan The homeless population in Massachusetts increased faster than in any other state in the nation, rising 40 percent since 2007 even as overall homelessness in the country declined, according to a report issued this month by the US Department of Housing and Urban Development. Agencies around Massachusetts reported 21,237 people in shelters, in transitional housing, or on the streets, an increase of more than 2,200, or 12 percent, from last year. Nationwide, the numbers fell more than 2 percent over the year. State officials and some advocates for the homeless dispute the findings, noting that Massachusetts’ strong reporting system may skew the rankings. But less than 4 percent of the homeless in Massachusetts live on the streets — one of the lowest rates in the country. Massachusetts is the only state in the country with a “right to shelter” law that entitles every family with children to a roof over their heads the day they qualify for emergency housing. As a result, the vast majority of the state’s homeless population are in shelters or transitional housing. Across the country, there are about 578,424 homeless people — half of them concentrated in just five states: California, New York, Florida, Texas, and Massachusetts, which accounts for 4 percent of the nation’s homeless. Since 2007, the number of homeless in the United States has declined 11 percent. The overall drop in recent years is due in part to an increased effort to house homeless veterans, according to the Department of Housing and Urban Development. Homelessness among veterans has decreased by 33 percent nationwide since 2010 as federal programs have provided more housing subsidies to them. Causes Housing advocates cited several reasons why homelessness has increased in Massachusetts, against national trends, including housing costs that are rising faster than wages. Many low-wage workers have seen their pay stagnate or decrease in recent years, said Michael Durkin, president of United Way of Massachusetts Bay and Merrimack Valley, and those without savings or other safety nets can easily falter. A serious illness or other setback that forces them to miss work can lead to unpaid rent, eviction, and homelessness. “I think the recession has had a long tail for families on the margins,” he said. The annual median income for a renter in Boston is around $35,000, or about $3,000 a month, according to Michael E. Stone, professor emeritus of community planning at the University of Massachusetts Boston. The average rent for a one-bedroom apartment in the city is almost $2,000 a month. Boston and much of the rest of Massachusetts are in the midst of an affordable housing shortage that shows few signs of abating. The rate of new housing production in Massachusetts is among the lowest in the country, with luxury units in the booming downtown and beyond expected to make up the vast majority of new apartments built in Boston in the next three years. One in four renters in the state spend at least half their household income on rent — considerably higher than the one-third recommended by financial specialists. When a local nonprofit announced a lottery for a new batch of rental subsidy vouchers this month, applicants jammed the lobby. In the end, more than 10,000 people applied for just 73 slots. The state has 6,600 rental vouchers to help low-income families pay for apartments, a third of what it had in the early 1990s, due to budget cuts, according to Massachusetts housing officials. The number of vouchers has risen modestly over the last few years, but not nearly enough to keep up with demand. The average annual income of families who currently have vouchers: $13,000. State funding for shelters housing individuals, such as the Pine Street Inn in Boston, also remained flat for more than a decade, preventing case managers from helping more people get into subsidized housing. “The situation continues to worsen for families at the lowest income levels,” said Chris Norris, executive director of the Metropolitan Boston Housing Partnership. “Our fear is that if we don’t get more resources, the state rental voucher wait list will look like our Section 8 wait list, which is 11 years long.” Last year, budget cuts eliminated more than 1,400 of the state’s Section 8 vouchers, making the shortage more acute. Federal funds for building affordable housing in the state were also sliced in half last year. The Boston Housing Authority has a wait list of 40,000 households for 15,000 subsidized units. Policy Efforts In Boston, Mayor Martin J. Walsh has announced several recent initiatives to assist low-income people in the city, including a commitment to creating 6,500 new units by 2030 aimed at families making less than 60 percent of the median income — with a quarter of those designated for even lower-income households. The mayor also has announced he will be launching an office of financial empowerment to help residents with job searches, career development, and financial coaching. Governor-elect Charlie Baker, a Republican, has made tackling family homelessness a top priority for his first few months in office — combining empathy with the sort of cost-efficient policy fixes that were the central promise of his campaign. Baker said his immediate priority will be getting families out of those hotels and motels, which are expensive for the state and take many homeless children miles from their schools. “Our first objective has to be to reduce that number down to zero, and then keep it there,” he said. Ultimately, the governor-elect said, he wants to shift families into permanent housing. Baker’s approach is multipronged. He wants to send assessment teams into motels to develop tailored economic stabilization plans for each family; he is looking to provide aid for parents and kids who want to stay with extended family instead of in hotels; and he wants to empower local officials to develop regional approaches to the problem. But if his approach is winning praise in some corners, it is also facing skepticism from some advocates who say management improvements will only go so far in an era of skyrocketing rents and growing economic inequality. “It’s poverty,” said Robyn Frost, executive director of the Massachusetts Coalition for the Homeless, arguing that a large-scale investment in affordable housing is required. “It’s driven by sheer, unadulterated, horrific poverty.” Baker, who worked in the administrations of Republican governors William Weld and Paul Cellucci in the 1990s, said he’s had success in this area before: noting that the Weld administration shrunk the homeless hotel and motel population to zero at one point. But advocates and analysts say the landscape has shifted dramatically since then. Rents have soared. And the recession has done long-term damage to low-income workers, they say, leaving them in part-time jobs with fewer state services to keep families afloat. Donna Haig Friedman, director of the Center for Social Policy at the University of Massachusetts Boston’s McCormick Graduate School of Policy and Global Studies said that if the governor-elect wants to keep people out of homelessness, he will have to reverse deep cuts in cash assistance, food assistance, and job training. Baker will also have to ameliorate the “cliff effect” that kicks in when a promotion or a better job cuts off a low-income mother or father from state supports, Friedman said. She said Baker’s call for an expanded, state-level earned income tax credit — a direct payment to low-income, working people — is a good start. But the governor-elect, who has pledged to keep taxes low, does not seem primed to make broad new investments in the social supports that antipoverty activists advocate. Sources and For More Information See the full The Boston Globe articles:
New Campaign to Strengthen EAEDC Assistance The Massachusetts Coalition for the Homeless has now officially launched its Campaign to Strengthen EAEDC Assistance. They argue that when the state does not assess the effectiveness nor updates a program that began in 1988 that provides monthly cash assistance to individuals who are extremely low income and unable to work, it is bound to take a human toll in unmet needs for people who are struggling to survive. Such is the case for the state's Emergency Aid to the Elderly, Disabled and Children (EAEDC) program, a program funded through the Department of Transitional Assistance that serves approximately 23,800 participants. There never has been a cost of living adjustment or increase in the program's 26 years! The monthly cash benefit depends on one's living arrangement: $304.80/month if one has their own housing. This amount is $668.80 short of the 2014 federal poverty level guidelines for one person. If the individual becomes homeless and resides in emergency shelter, he/she is required to inform the Department of Transitional Assistance, which then reduces the benefit to $91.60/month. If the individual resides in a residential care facility one receives $72 (personal needs allowance).
The Coalition is seeking a minimum of 25 organizational endorsers if not more. Please consider filling out the online endorsement form, especially if you work with EAEDC participants. If you need further information on this Campaign, and have EAEDC recipients who would like to be an "Enduring Voice" in this campaign and would like to be interviewed, please contact Sister Linda Bessom SND at linda@mahomeless.org, 781-595-7570 x18 or Kelly Turley at kelly@mahomeless.org, 781-595-7570 x17. -From e-mail from Massachusetts Coalition for the Homeless, November 04, 2014. Bullying Is Ageless- Study Finds Conflict and Violence Widespread in Nursing Homes New research shows that aggression among residents in nursing homes is widespread and “extremely high rates of conflict and violence” are common, according to study author Karl Pillemer, professor of gerontology in medicine at Weill Cornell College of Medicine in New York. His stark findings, presented at the annual meeting of the Gerontological Society of America: One in five people living in the nursing facilities studied was involved in at least one “negative and aggressive encounter” with another resident during a four-week period. “In most environments — say my work environment at a university — someone yelling at me angrily is so unusual that it would keep me up all night worrying about it,” Pillemer says. Yet such conflict in nursing homes appears to be routine. Abuse and Mistreatment As part of the study, researchers examined patient records at ten nursing homes in New York state, interviewed staff and residents, and recorded incidents through direct observation. In a sample of more than 2,000 residents, 16 percent were involved in incidents of cursing, screaming, or yelling; about 6 percent in physical violence such as hitting, kicking, or biting; one percent in “sexual incidents, such as exposing one’s genitals, touching other residents, or attempting to gain sexual favors”; and 10.5 percent in events researchers labeled “other” — residents entering rooms uninvited, for example, or rummaging through others’ belongings. Abuse and mistreatment of the elderly in general — in their homes and in nursing facilities — is a serious and growing problem. The elder population is burgeoning; the number of vulnerable elderly is increasing; more and more people need care—and nursing homes are often understaffed. Because abuse is usually hidden, data on abuse is difficult to gather. The problem is very likely vastly underreported, according to the National Center on Elder Abuse. Surveys tend to miss elders who don’t have a phone, who are too frail to answer it, or who can’t respond truthfully about their situations because their abusers are present. Abuse of elders by staff in nursing homes is also pervasive. One survey of certified nursing assistants found that 17 percent of CNAs had physically abused residents, 51 percent had yelled at them, and 23 percent had insulted or sworn at them. Crowded Conditions and Understaffing Resident-on-resident aggression has received less study and publicity — but “it happens all the time,” says Diane Menio, executive director of the Center for Advocacy for the Rights and Interests of the Elderly in Philadelphia. Pillemer’s study found that the residents involved tend to be among the more active and cognitively intact in a nursing home — they’re the ones who are more engaged. Mild to moderate dementia is clearly a factor in much of the aggression, however, because it causes disinhibited behavior. Other factors, Pillemer says, include:
The prevalence of such aggression raises questions about how well U.S. nursing homes are meeting the great and growing need for compassionate, skillful long-term care. In many ways, aggression among nursing home residents is more complicated than other forms of elder abuse. When a family member or nursing-home worker abuses a vulnerable elder, the perpetrator is clear. But resident-on-resident aggression is more systemic and much less clear cut. It needs to be addressed, many experts believe, not by thinking in terms of perpetrator, victim, and punishment, but by looking at causes and prevention — by improving care. Laura Mosqueda, a practicing geriatrician and director of the National Center on Elder Abuse, believes that nursing homes should be seen as responsible for easing aggression. “Let’s not forget that the people [in this study] … are some of the most vulnerable members of our society. Even if they’re the ones who are ‘perpetrating’ some of this, they’re not the ones who should be held accountable,” Mosqueda says. If, for example, inadequate staffing is linked to the problem, as the study found, then facilities should hire more staff, she says. Mosqueda, Pillemer, and others say that staff need to better understand the root of the problems. For instance, Pillemer asks, “Is someone being aggressive because they’re in pain? Are they being aggressive because they’re hungry or bored? Personalizing the care for residents, understanding why they [become aggressive], and looking for individual solutions are very important.” -See the full CommonHealth blog post... Debt and Resulting Poor Credit Barriers to Rising from Poverty Roberta Brown, a 37-year-old single mother, lives in a homeless shelter, desperately trying to find the job that will help her gain a new home and better life. She recently earned a certificate as medical assistant, hopeful it would lead to a job in the state’s burgeoning health care industry. But that has not been not enough to surmount what Brown believes are the greatest barriers to her employment: the $20,000 in credit card debt she ran up while out of work several years ago and her damaged credit report. Each time she applies at a hospital, she’s asked to sign an agreement allowing the employer to check her credit. “It’s really hard,” she said, “when you feel like they’re just looking at your credit.” Brown’s experience is just one example of how debt makes it even harder for low-income families and individuals to break the cycle of poverty — even as they take steps, such as gaining new skills and higher levels of education, that are supposed to help, according to a new study by Crittenton Women’s Union, a Boston nonprofit that helps people find ways out of poverty. The study, based on a survey of more than 100 low-income individuals, found that most of the debts resulted from stretches of unemployment, medical costs, and student loans. The study also found that poor people are often overwhelmed by high interest rates that make it nearly impossible to pay down debts, then penalized again when prospective employers or landlords conduct credit checks before hiring or renting to them. “It’s so discouraging,” Ruthie Liberman, vice president of public policy at Crittenton. “We brought their education level up and brought their income up, and they’re still trapped.” The report said a growing number of employers use credit reports to help vet a potential employee, and cited research that nearly 50 percent of Massachusetts residents have subprime credit scores. It’s impossible to know for sure if companies disqualify candidates based on credit scores, since most people aren’t told the reasons they done get a job, said Liberman. But the concerns are great enough that state Senator Jamie Eldridge, Democrat of Acton, said he is drafting a legislation that would limit the use of credit scores in hiring. As co-chairman of the Senate’s Asset Development Commission, he said he heard many people testify that they borrowed money for college or a trade certificate, but could not find work. When their student loans came due and they were unable to pay, their credit rating suffered -- and so have their job prospects. The debt “left many, often single mothers, in a worse position than when they started,” he said. -See the full Boston Globe article... Kinship Foster Care Helps Kids Thrive When children need to be removed from their families due to concerns of abuse or neglect, they have a greater opportunity to succeed and thrive if they are placed with members of their extended family, rather than with people they don't know. Children who are placed with members of their extended family (their "kin") experience less disruption and trauma upon removal from their parents, and benefit from continued connections with their family, their cultural and linguistic heritage and their community. They also benefit from greater stability as those placed with kin are more likely to remain in one foster care placement, and they have a greater chance of finding a permanent home. MassBudget's new Kids Count analysis, "Family Ties: Exploring Massachusetts' use of Kinship Forster Care for Children in the Child Welfare System," is a companion to the Mass Law Reform Institute's (MLRI) release of a new Kids Count report. MassBudget finds that the state has made real progress over the past seven years, increasing kinship foster care rates from 20 percent to 28 percent for kids removed from their homes. But Massachusetts lags behind other states that have been able to place greater number of children, particularly children of color, with members of their extended families. MLRI's new KIDS COUNT report, "The Ties That Bind: Strengthening, and Reducing Racial Disparities in, Kinship Foster Care in Massachusetts" describes the evidence on the value of kin placements and examines the policies the state has been using to increase the number of kids placed with kin. It concludes by providing a detailed set of commonsense solutions to help the Department of Children and Families increase kinship care overall and make sure that that all children, regardless of their race or ethnicity, have the same chance to overcome trauma and thrive. The report also incorporates data from MassBudget's analysis that describes the trends in kinship placements overall and for children from different racial and ethnic backgrounds. The Ties that Bind makes the following recommendations for DCF:
The report also recognizes that DCF must collect and use data about the outcomes of these and other practice and policy changes. This is important to ensure that policies and practices are having their intended effect of increasing kinship care and promoting placement stability and permanent homes for children. As with any public investments, it will be important for DCF to demonstrate the effectiveness of efforts on this issue. That will require data demonstrating how many children are helped and how those children life prospects are improved. -From Two New Reports on Kinship Foster Care, MassBudget.org, November 06, 2014.
|