A pilot program that reduced the hours some home care aides spend with elderly and disabled clients in Fairfax County has drawn complaints that the affluent community is cutting costs at the expense of its needy residents.
Fairfax officials said the county remains committed to helping those in need and is simply trying to deliver services more efficiently. County officials said they could not discuss individual cases but stressed that the new system is based on thorough assessments of clients' needs.
Candi Chase, afflicted with multiple sclerosis and scraping by on a small government pension, relies on a home care aide provided by Fairfax County to help her manage living alone in an apartment complex for the elderly and disabled. Under the new program, the aide's time with her has been cut nearly in half, from about 12 hours a week.
"It's very unfair," said Chase, 46, who once worked for NASA and the Securities and Exchange Commission but whose disability pay now leaves her well below the poverty level. "They did this to save money . . . but the victims are the elderly, the poor and the handicapped."
In August, the county contracted with a private company, Capital Home Health Care Inc., to be the sole provider of home aides in a new "cluster-care" project at six sites in the Falls Church area. The pilot program, serving about 80 people, is aimed at using the aides more effectively by assigning them to perform certain tasks for elderly and disabled people who live close to each other in apartment blocks, rather than stay with individual clients for set periods of time. The aides do housekeeping, cooking, shopping and other tasks.
Capital's contract runs through June, with two one-year renewal options. The in-home services, which the company began providing in September, are expected to cost roughly $130,000 a year. A team from George Mason University will evaluate the program.
"We're changing how we provide in-home services . . . from a traditional hourly model to a task-based, cluster-care model," said Barbara Antley, who manages programs for the elderly in Fairfax County's Department of Family Services. "We have a growing population of elderly people who need assistance with the activities of daily living. We're looking at more efficient ways to provide in-home services."
Elizabeth Shirley, head of the department's long-term-care unit, said the county now is paying by the task: "We're not keeping track of the time; we're keeping track of the task and how the task is being done."
Throughout Fairfax, the Department of Family Services uses home care workers from 17 private agencies, plus some who are self-employed, to help an average of 630 clients a month. The cost this fiscal year: nearly $4.4 million.
"There were some difficulties" during the start-up as people adjusted, but "now things are going well," Antley said. "I'm not hearing complaints."
According to Chase, though, there is considerable dissatisfaction with the changes, with some beneficiaries also concerned about a recent bankruptcy filing by Capital. Saddled by debts of as much as $1 million, the company filed for Chapter 11 reorganization in October. Lorraine Fox, the firm's president, said that the difficulties stemmed from Medicare cutbacks as a result of the Balanced Budget Act of 1997 and that the company is now on a much stronger financial footing.
"We're in no way going out of business," she said. "Revenues are growing, and we're recruiting staff like crazy." The reorganization has had "absolutely zero impact on the provision of services under this contract," Fox said. "We're 100 percent staffed and we're meeting all of our contractual obligations."
Chase, who worked for the government for seven years before retiring in 1986 on medical disability, complained that her aide's hours have been cut, leaving her too little time to complete her duties.
Chase also said the aide had been with her for 10 years but "had to go get hired by Capital" in order to continue once the new contract took effect.
Sitting in her cluttered one-bedroom apartment recently, Chase said she is barely getting by on the $538 a month from her federal disability annuity, out of which she must pay $136 rent for her subsidized housing. Chase, who has trouble with her balance that affects her ability to walk and do other things, said she depends on her home aide for a number of chores that the aide no longer has time to do.
"Cluster care is not working," said Chase, who has asked the county for more hours.
Another resident of her building, Julie Leonard-Alva, 40, lost her home aide when Capital became the sole provider. Leonard-Alva, who has polio, resented the switch and refused to accept a new aide from the company. "I feel like a guinea pig," she said.
August Anton, a Korean War veteran battling prostate cancer and other ailments, charged that the pilot project area is being "monopolized" by one company and that the agency that used to provide his aide "never received a proposal for a bid, which I think is very unfair." Anton said he lost four hours of assistance a week.
Capital's president said the county, not the company, determines how much time aides spend with clients. "We only provide the service," Fox said.
"Our cluster-care people are totally happy and totally satisfied," she asserted. "Under the old model, there were periods of time when the home care worker just sat there and did nothing, maybe just provided companionship. It's true the new model does eliminate that. [But] in this day and age, when money's so tight, you have to ask yourself as a taxpayer if we should be paying for someone to have companionship."
CAPTION: Chase, who has multiple sclerosis and has trouble walking, said she needs some help to keep living on her own.
CAPTION: Candi Chase said she and others whose service has changed under a pilot project of the Fairfax County home care program are dissatisfied.