In 1981, when Congress cut social services grants to states from $3 billion a year to $2.4 billion at President Reagan's request, the city of Richmond had to cut off "companion-housekeeper" services to Daisy Trower.
Trower, then 71, an amputee who lived alone, with "no relatives, no close folks" nearby to take care of her, is a member of what Richmond social worker James Taylor calls "the invisible population" receiving help from social services around the country.
That population is made up not of America's 3.5 million young and able-bodied welfare mothers, but of the impoverished elderly, disabled, mentally retarded, blind, isolated and shut-in, who benefit from programs tailored to make the difference between independence and institutionalization. These are people who depend on the social programs Reagan has called a "safety net" to protect the nation's neediest citizens.
A recent study by the Urban Institute disputed Reagan's assertions -- often repeated in the past five years -- that budget cuts during his presidency have not damaged that safety net, and not hurt the "truly needy."
The study scrutinized four cities, including Richmond, and found that "needy people . . . suffered as a result of federal changes and local response."
The Washington Post went to Richmond to examine the issue in the microcosm offered by one small program.
Richmond's chore-and-companion services program, funded since the mid-1970's primarily by federal social services grants, has paid for visits to clients, all well below the poverty line, from workers who attend to the small but essential chores of living: preparing meals, minimal cleaning, shopping, bathing and hygiene. This program, tiny by standards of billion-dollar budgeting, is a single strand of the safety net.
In mid-1981, Richmond's monthly caseload for chore-and-companion services was chopped from between 350 and 400 people a month to 65 people.
Months earlier, Reagan had sent his first budget proposal to Congress, saying, " . . . [T]he government will not continue to subsidize individuals or business interests where real need cannot be demonstrated."
But he promised, "Those who through no fault of their own must depend on the rest of us, the poverty-stricken, the disabled, the elderly, all those with true need, can rest assured that the social safety net of programs they depend on are exempt from any cuts."
The documents he sent to Congress requested that for fiscal 1982, federal social services grants and a dozen related programs be melded into a huge block grant, with funding cut by 25 percent from the combined total. Congress did not create the "megablock," but it did end up cutting social services grants $600 million, or 20 percent.Richmond residents have been eligible for in-home assistance for decades. At one time, a small cash payment to cover it was given directly to the welfare recipient as part of his basic support payment. But after Congress united the basic cash support payments to the aged, blind and disabled into the federally funded Supplemental Security Income program, the Richmond Bureau of Social Services in the mid-1970s started paying separately for in-home services, with funding coming from the Title XX social services grant.
The 1981 federal cuts, according to Richmond officials and people who had been receiving services, were a devastating blow to the chore-and-companion services, forcing drastic reductions in the program.
In 1981, Daisy Trower's income was about $300 a month from Social Security and federal Supplemental Security Income welfare payments. Up to that year, the city of Richmond had been paying a woman to come in and cook, clean and otherwise assist Trower for 12 hours a week, leaving a number of prepared meals each time to carry over to her next visit. Trower's leg had been amputated at the knee the year before.
"I can't get around my apartment well," Trower said in a recent interview. "The only thing I can do is fix my own breakfast.
"If I have nobody, I can't stay here, I can't take care of myself." Without companion services, she said, she faced transfer to a state-paid nursing home. She desperately wanted to stay in her own apartment with as much of a normal life as she could retain.
For more than a year, she scraped together about $30 a month to pay for her companion-housekeeper to continue coming -- for only two hours a week. It meant she had less money for other essentials and that far fewer hot meals could be prepared each week; there was less cleaning, less aid with baths, less having someone around in case of emergency, but it was the best she could do. When the bureau got more money for companion services, Trower was restored to the rolls of the program.
Another person who lost companion services in 1981 was Bonnie Nagy, a former schoolteacher, then 44, a victim of glaucoma and multiple sclerosis. Nagy has only partial use of her hands and large swellings in her legs, and can only move about "in a little electric wheelchair." Divorced, Nagy lives with an unmarried younger brother, an auto salesman whose job keeps him away all day and part of the evening, in a house in Richmond's west end.
Bonnie Nagy's only income is $224 a month from the federal Supplememtal Security Income welfare program.
"I use my right hand fairly well but the left is useless," she said in a recent interview. "I had someone coming in for seven years. All of a sudden they cut me off. I was here myself. I couldn't get anything to eat. I went months without showers. I was sitting in a chair eating from packages. My brother fixed something for me at night."
Once she fell trying to go to the bathroom and lay for two hours, unable to move or call for help until her brother came home.
Bonnie Nagy was off the rolls for more than 3 years.
Another person dropped from the rolls in 1981 was Michael Langhorne, then 23, and severely mentally retarded since birth. The supplemental income program was paying for Michael's direct support (the payment is now $336 a month), and the city was paying for 22 hours a week of companion services. Langhorne lives with his father, Joseph, and mother, Sophia, in a small house in the east end of town. Joseph was working then, but now is disabled with leg injuries and a heart problem.
Michael Langhorne requires 24-hour care. During an interview, Michael sat smiling next to his mother or prowled restlessly onto the front stoop and then came back and sat next to her. He gave no indication that he understood what was being said. His father said, "This boy was born this way. He is a not capable of doing anything. He can't talk. We have to take him to the bathroom. We have to feed him."
Michael is a special case. On the theory that his mother would give him the best care and that it would cost far more to institutionalize him, the program designated Sophia Langhorne as his companion, and paid her for 22 hours of companion services. When the money was cut off, Michael experienced no decline in services, but there was enormous pressure for his mother to institutionalize Michael -- at much greater cost to the city -- and seek a job.
Michael was able to stay at home only because he was reinstated after a little more than a year.
To decide which people would be removed from the rolls, officials rated them according to severity of impairment. Could they walk? Go to the bathroom without help? Eat without help? Reach the phone? By these measures Daisy Trower, Bonnie Nagy and Michael Langhorne were all obviously and severely impaired. But when the money ran out, they -- and hundreds of others like them -- were cut from the rolls anyway.
John Twisdale, who administers the programs, said that a survey of 622 people receiving companion services from his agency at the end of 1979 showed that by June 1982, 193 were simply unaccounted for; 119 were receiving companion services (some after being cut off and reinstated), in many cases funded by nonfederal public sources; 104 were receiving care the bureau considered adequate from relatives or friends or from aides whom they paid themselves; 57 had gone into nursing homes, special housing for older people with limited capacities or other outside-the-home arrangements for care; 48 no longer neeeded care -- either because they had died or because their condition had improved so they no longer needed services; 22 were being cared for by relatives or friends but the care was considered inadequate; and 79 were receiving no services but still needed them.
Trower, Nagy and Langhorne were, in the end, lucky. All were restored to the companion service rolls or to a special similar program engineered by Reps. Henry A. Waxman (D-Calif.) and Claude Pepper (D-Fla.) that allows a state to use Medicaid funds for home care if that will avert much more expensive institutionalization in a nursing home.
But as Twisdale's figures show, hundreds of others never got back on the rolls. Five years later, these people are harder to find. The Washington Post's interviews, arranged through Richmond's Bureau of Social Services, were all with people who had been restored to the rolls eventually or had been admitted to a related Medicaid program. The bureau was unable to locate people who had not been restored to the rolls and were willing to be interviewed by a reporter.
Lory Osorio, an occupational therapist and gerontologist who is director of the Stuart Circle Center, a nonprofit "adult day care" center sponsored by five Richmond churches, said she knew one woman whose death, she believes, resulted almost directly from the loss of the companion services.
The woman, whom Osorio identified only as "Mrs. T," had diabetes and heart problems and was receiving companion services at home as well as adult day care at Osorio's center.
But when the city cut off her financing for both services, Mrs. T became despondent. In a nursing home, depressed, she refused to eat. She died within a year. According to reports by a member of Osorio's staff and from nursing home personnel, her depression was a major factor in her death.
Thomas Hogan, Richmond's director of social services, said in an interview that at least in his city, "The cuts have hurt people who need help. I don't think there's any question about that. We've made deep and significant cuts . . . . "
And while the city made efforts to compensate for federal cuts and state reallocations of funds, he said, it couldn't recover them all. Since certain services to children were mandated by state law, "initially we cut services that the state considered optional," including many services for the elderly and the supplemental income population.
"Looking back at the files," said Twisdale, "it's depressing, how hard we worked to save the programs." Officials went to various charitable institutions, to the agency administering federal Community Development Block Grants, to the Capitol Area Agency on the Aging to ask for money. They recruited volunteers and obtained the use of federal public service job workers (a program later eliminated by the Reagan administration). While all these things helped, Twisdale said, the program has never been restored to the level it enjoyed in the late 1970s.
"You'd be amazed at how many of these companions kept dropping in and providing services even after the funding was cut," he added. The current city pay rate is $2.90 an hour.
As for those cut from the rolls, said Twisdale, "some just didn't manage as well. Their houses got dirty. Some I felt were endangered. We had isolated comments from workers -- 'Mr. Jones died walking to the front door.' It's not clear if it's true . . . . "
For the living, though -- even for those who went without services for no more than a year or two -- Twisdale is certain that the quality of life declined sharply.
"They suffered in terms of household cleanliness, and nobody to pay that bill, fix that breakfast . . . we know some went without some meals. Their fears [were] greater, they had less pleasure, more privation. In Richmond, 104 more people were in nursing homes in 1982 than 1981; most came from people cut off from the chore-companion and adult day-care programs or who had not been on these programs but would have been able to stay home if they had been able to get adult day-care or companion services."
Social worker James Taylor says of this "invisible population," that "only social workers and others like myself," who go into their homes to help the invisible population, are aware of their suffering. "No one sees these folks," he said.
In Washington, Congress and the Reagan administration remain focused on ways to cut the federal budget. In his budget message last January, Reagan reiterated his view that "eliminating the deficit is possible without . . . cutting into legitimate programs for the poor and elderly."