Benefits finally approved just as man dies

By Timothy Pratt

Thursday, Oct. 2, 2003 | 11:10 a.m.

He was known as Smokey; Kools were his favorite. The last president he had any knowledge of was Nixon.

After 24 years on the streets of Las Vegas, James D. "Smokey" Casteel died at the age of 54 on Saturday, only a week after his first Social Security disability check arrived in the mail. His Medicaid application is still pending.

The $2,500 check will now be used to pay for his funeral.

"The very thing that might have helped him in life is being used to bury him," said Linda Lera-Randle El, who handled Casteel's case as director of Straight From the Streets, a nonprofit organization that works with the homeless. "They didn't need to drag it on and he shouldn't have been denied in the first place."

Casteel's search for a safety net included a denial, appeal and eventual approval from Social Security that stretched over nine months as he got sicker with high blood pressure, dementia and partial blindness, capped off by a stroke shortly before his death.

His case illustrates what a dysfunctional system does for those who are on the streets and running out of time because of serious illnesses, say those who tried to help him in the last months of his life.

"This is not uncommon ... (and) it can often take longer than a year before people can get approved ... even when they have such serious conditions that they don't have time to be waiting for appeals," said Barbara Buckley, director for Clark County Legal Services, a nonprofit group that helps people who appeal Social Security denials of disability benefits.

"Homeless people have it worse and can have their cases take even longer," said Buckley, an assemblywoman whose agency did not work with Casteel.

But Nancy Brown, district manager for the North Las Vegas Social Security office that received Casteel's initial application, said there's not much more her agency can do to help a population that is often difficult to work with, for reasons ranging from a lack of an address to a lack of compliance with doctor's orders.

"With the homeless there's so many obstacles -- if they're unable to help in the process, they become the obstacle," Brown said.

Lera-Randle El first ran into Casteel at Bonanza Road and D Street about a year and a half ago.

"I remember he used to chain-smoke Kools because his fingers were too feeble to roll his own," she said.

His sketchy biography included a wife who left him and a daughter he hadn't seen in decades. He couldn't read or write, see or hear very well. He had been hit by a car and was left hobbling. Still, he snared landscaping and other odd jobs near where Lera-Randle El first came across him.

"One day I asked him, 'Do you want to be here?' " the homeless advocate said.

Smokey said no. Late last year Lera-Randle El took him into her Ford Explorer and helped him begin scaling the rungs of life's ladder that most people take for granted -- getting his birth certificate, a Social Security card and a state identification card.

"He thought I had to ask his mom and dad for his birth certificate and that Nixon was still president," Lera-Randle El said. "I had to tell him both his parents were dead."

She began the process of applying for disability benefits from Social Security in January, a prior step to applying for Medicaid benefits. This includes building up evidence of medical conditions that would make it impossible for Casteel to work. She also took him to Clark County Social Service for interim help with medical care.

But she had to get Casteel off the streets "to get him out of harm's way."

Who will take a homeless man with no money and no benefits who is spiraling into sickness?

Normally, no one. Randle-El worked out a deal with a shelter run by Catholic Charities, cobbling together a plan involving a nearby clinic for the homeless and other agencies.

In March Social Security denied Casteel's application.

"I was stunned," Lera-Randle El said.

Buckley has seen people display the same reaction at her agency. "A lot of people can't believe (the denial of benefits) is happening to them," she said.

" 'Look at me -- anybody can see I'm going to die,' they say."

Brown, of Social Security, said she couldn't discuss the details of Casteel's case but said that homeless people are often denied benefits in part because they don't follow doctor's orders when it comes to their care.

Lera-Randle El said the letter from the agency denying Casteel's application indicated he had failed to take medication for high blood pressure, diagnosed in one of several emergency room visits.

"But he was in no condition to take medication by himself and would often forget," she said.

Lera-Randle El appealed the decision, embarking on several more months of back and forth centered on paperwork from various doctors indicating the various ways Casteel was sick, mentally and physically.

"The battle between me and the agency kept raging, but I could tell he was dying," she said.

Finally, Catholic Charities was no longer appropriate for Casteel. With Social Security and Medicare unresolved, Lera-Randle El went back to Clark County to seek what is known as group care. The answer was no, but a skilled nursing home was recommended.

So began four months at the Manor Health Care Center, a home with about 160 patients at Del Webb Drive and Rampart Boulevard.

Casteel had a stroke in late July. Around the same time, Pat Gutierrez, social worker for Manor Health Care, called Social Security to ask about Casteel's claim.

"I told them I can't ship him out to any more medical appointments," she said.

"He already had three documents saying he couldn't go to work."

Gutierrez said she heard nothing from the agency until September, when she got word that Casteel's application had been approved.

Casteel died Sept. 27, about a week after the check for $2,500 arrived.

Ironically, Gutierrez said, the $2,500 -- a sum covering the monthly payments accrued during the time it took to resolve Casteel's case -- is higher than the maximum amount of money allowed to a person applying for Medicaid.

And the Medicaid benefits still pending are what she hopes will pay for Casteel's stay at the Manor Health Care Center, or $140 a day during five months.

The $2,500 will now be spent on Casteel's burial. He will be buried Friday.

Meanwhile Gutierrez said she has seen many homeless people with applications for benefits pending in nursing homes across the valley.

"I just don't think (Casteel) was the only one out there," she said.

"It's a sign that the system is not working the way it's supposed to -- especially for the homeless."