Direct Services Slashed Again In County AIDS Program
By Karen Nakamura
The Coastal Post visited
the Marin AIDS community in our August, 2002 issue. Budget cuts for fiscal year
2002-03 were decimating programs. While cuts trickled down via Ryan White funds,
etc., it was the perceived inequitable distribution by Marin County's
Department of Health and Human Services (HHS) that caused the most pain. To
many on the Marin AIDS Commission, the 2002-03 distribution of cuts was aimed
at direct client services with administrative costs left relatively intact.
Providers and clients also argued certain case managers provided duplicate
By the end of 2002, the outlook was hopeful. While little could be done about the 2002-03 budget, meetings between the community and Marin County officials were held to set priorities for expected cuts in FY 2003-04 beginning July 1. The CP returned to examine the final product. Disappointingly, from what we could discover, it was the same old same old.
In February, a Marin AIDS Commission "priorities" poll was handed into the Marin HHS. It set forth MAC's consensus on where cuts would do the least harm. Number one on the list of importance was primary medical services. Next came case management, client advocacy groups, substance abuse treatment and direct emergency assistance. These were followed by attendant care, food services, vitamin/herb vouchers/acupuncture, volunteer services and workshops/peer mentioning. Important was the stated desire of the Commission to not slash the bottom half of the list while the upper half remained the same.
Cuts for 2003-04 were finally announced in a May 28 memo from Dr. Larry Meridith, HHS director. Service providers had one month to make necessary adjustments. For example, the Food Pantry, vital to many clients, took a staggering $41,000, 30% cut from the previous year's budget. It meant cutting 25 clients from a total of 75. In 02-03 Food Pantry funds were $147,969. The 03-04 budget is $106,746. In contrast, the eight case managers that handle approximately 300 clients total, received a $11,000 cut from $282,855 in 02-03 to $271,773 in 03-04.
Three service providers requested a meeting with the County. On June 10th, MAC Commissioner Gregory Giorgi, past chairman and nine year member, Gail Pheller, Director of Community Action Marin, the largest community-based agency in Marin, and Barney Pia, Director of the Positive Center, which runs peer mentioning workshops for people with HIV/AIDS and other life-threatening illnesses. Among the 10-12 community members attending were Rev. Dave Martin from the AIDS Interfaith Network, which facilitates the acupuncture and vitamin voucher programs, and Joseph Odom, the lead acupuncturist. Representing the County was Health and Human Services Director Meridith, Frema Stewart, deputy director who oversees the department's HIV/AIDS programs, and her assistant Sparky Spaeth.
The upshot of the meeting was case management was still top heavy and direct services were getting the ax, especially alternative programs at the bottom of the list, almost exactly what the Commission had requested not happen. There was little change from 2002-03.
When attendants asked why more community input wasn't included, Sparky Spaeth explained she didn't have time to collate the poll and an independent report ordered by the Department. She received the poll's data in February. The community was up in arms.
Commissioner Giorgi was quick to point out. "They didn't listen. Since October there has been a total about-face at the County level. Our input has been completely disregarded. What was the reason for the meetings and the poll if our input had no chance of being considered? What's even worse is if we eliminate two case managers, it would make up most of the cuts in other programs." Georgio continued, "There wasn't a case management review even though it's been a point of contention for several years."
Excluding the two Hospice nurse case managers, who it's agreed are solidly on the front line, there appears to be numerous overlaps in case management services. A frequently heard complaint is that, except for the nurses, clients rarely if ever see their managers. One client, preferring to remain anonymous, said. "I have one manager who sends me a newsletter couple times a year. That's it. In the meantime, "I'm considered an active client."
Another complaint is the redundancy of case managers at each service requiring the same information. Perhaps a simple computer "network neighborhood" program might reduce funding burdens by allowing clients to make out one application for all programs.
There was also a move by HHS to separate the Food Pantry and Acupuncture programs out of the primary care category. That move was squashed when Joseph Odom, San Anselmo acupuncturist, sent a letter to the County Counsel, pointing out the HHS staff's separation efforts were taking on an illegal legislative function and were in violation of California law. Odom also pointed out that acupuncture services are accepted California medical practice. Workman's compensation and state primary medical care procedures recognize the therapy.
Dr. Meridith did take these complaints under consideration and agreed to make his decision the next week. At the June 17 meeting, the Food Pantry was restored to its primary care position. At the June 18 meeting, Meridith acknowledged that acupuncture is part of primary care. However, funding cuts remained in place.
The Wellness Center, run by the Marin AIDS Interfaith Network and Rev. Martin, is taking drastic cuts yet has a waiting list for its acupuncture and vitamin vouchers. Also, some clients have chosen alternative medicine as their primary care. Most can't tolerate the toxic side effects of pharmaceutical treatments, so it's is a serious matter. Gregory Giorgi is included in this group.
In 02-03, the vitamin/acupuncture program received a total of $77,450 plus another award to make $93,000. They still had to cut 50 people. This year the grant was lowered to $46,973 to run the same program. Plus, where there had been funds for part-time staff and office supplies, that money now has to come from the same $46, 973. Rev. Martin agreed it's like making Sophie's Choice.
Staff Go The Extra Mile
Linda Kinnear and Lisa Becker are RN case managers with Hospice of Marin and work primarily with AIDS patients. For years, these two women have been viewed by their clients as always being on the front line. Every day they deal first hand with the ravages of this disastrous disease.
Richard Germann, one of Linda Kinnear's clients, says this of her, and it really applies to them both. "Linda's on the circuit. You actually see her. She gets the job done and does what it takes. She doesn't do just Hospice work, she delivers from the Food Pantry if you can't get there. If your tooth hurts, she knows where to get it fixed. She can access the eye doctor and knows how to keep you from falling apart. She helps me more than my doctor. In fact, she often has to explain what he means."
When asked about her nursing job, Kinnear answered, "I thoroughly enjoy these guys. This isn't a 9-5 job. Sometimes I call a client in the evening to let them know I care, or take them what they need when they need it. There's nothing I wouldn't do for them. I get as much from them as I give."
These two nurses epitomize what their profession stands for and deserve recognition for their unsung work. The AIDS community thanks them both for a job help well done.
AIDS Flea Markets Coming UP
A Flea Market will be held once a month on Saturday during the summer to benefit the Marin Emergency AIDS Fund, an independent fund to off-set County funding cuts. The dates are: July 5, August 9 and September 6. Hours are 8 a.m. to 3 p.m. at 29 Mary Street in San Rafael. Spaces are available for $25, The Flea Market could also use volunteers and donated goods. Donations can be dropped off M-F, 9-4. Any salable goods will be accepted but please, no heavy furniture like refrigerators, etc. All profits go to the Marin Emergency AIDS Fund and donations are tax deductible.