Home assistance for disabled among services on budget chopping block

By David McGrath Schwartz

Thursday, Oct. 21, 2010 | 2 a.m.

Rory Reid

Brian Sandoval

Both candidates for governor have pledged not to raise taxes. Whoever wins — Democrat Rory Reid or Republican Brian Sandoval — will eventually have to come to terms with the reality of what that means.

Take the reality of Michael Hawley, 43, living in a Las Vegas condo with the assistance of a part-time, state-funded care attendant.

For two hours in the morning, the attendant comes to his home, brushes his teeth, changes his diaper and gets him dressed and into his wheelchair. She cooks him breakfast and helps clean.

At night, an attendant is there another two hours to cook dinner, change him again and help him into bed.

The 10 percent budget cuts that state agencies have prepared at the request of Gov. Jim Gibbons would eliminate the personal-care attendant for Hawley and 6,500 disabled Nevadans. Agencies spent months evaluating the least painful ways to reduce spending by 10 percent to help address the state’s projected $3 billion deficit.

Under the 10 percent proposals, four of the state’s seven museums will close, a prison will close, 17,000 seniors will lose property tax or rental assistance, the elderly will lose hearing aids and dentures, and mental health courts in Las Vegas will cease.

The scenarios go to the heart of what some say is the disconnect between being a candidate for office and actually being the state’s CEO. Saying you will hold the line on taxes and spending is easy. It gets more difficult when you get into the details of making spending and revenue balance.

The specifics are laid out in the 455 pages submitted by agency directors to the state’s budget office Friday. The recommended cuts will go to Gibbons’ staff, who will then pass off a draft budget to the next governor. That governor will then submit a budget to the Legislature, which will have final say over what stays and goes.

Explaining why a program providing personal-care attendants to help disabled Nevadans remain in their homes would be targeted, officials said under federal Medicaid guidelines, it is one of the few “optional” programs the state provides. The program has been around for just 10 years, and eliminating it would save the state about $55 million over two years.

Both campaigns said they had not reviewed the 10 percent reductions.

Reid and Sandoval have both promised to balance the budget without new taxes. Sandoval hasn’t released a plan on how he would accomplish that. Reid’s plan includes 10 percent reductions in agency spending.

Early voting started Saturday. Election Day is Nov. 2.

Sandoval talks about a shared sacrifice because businesses can’t afford in this economy to pay more in taxes. Reid says there are efficiencies to be found, although he hasn’t gotten more specific.

Meanwhile, Hawley, who is paralyzed from the chest down since a 2008 motorcycle accident, is clear about what the loss of his personal-care attendant would mean for him — a nursing home.

He prizes his independence and time he spends on the Internet connected to the outside world, his nightly dinner of rice, beans and exactly 20 bits of meat he portions out from a roast to make it on his budget of food stamps and Social Security. Hawley is excited that his shower was refurbished recently to accommodate a special wheelchair so he no longer has to have his baths in bed, given by his personal-care attendant.

If he ends up in a nursing home, that will cost taxpayers more than twice what it costs now for his attendant, Social Security and food stamps combined. (He pays half his mortgage on the condo he bought with a friend, who pays into it as an investment.)

Advocates acknowledged this policy doesn’t make much sense in the long run because many of the 6,500 people will end up in hospitals or nursing homes, where care is more expensive. But the state demanded $200 million in spending cuts, forcing a look at major programs, advocates said.

“We needed to cut spending. The only way to do that is reducing programs,” said Ben Kieckhefer, spokesman for the Health and Human Services Department. “If it was not this one, it would be something else.”

State officials are willing to make that decision because the budget has to balance on paper for each year, eventual consequences be damned.

(Advocates say another large optional program discussed for cutting was prescription drug coverage for Medicare recipients.)

Kieckhefer noted that children’s mental health and child welfare programs remained largely untouched.

But recipients of personal-care attendant services are scared.

Shane Miksell, 45, of Las Vegas lives with his aunt, Sharan England, 70, who also serves as his personal-care attendant.

She gets paid by the state $129 a week to care for her nephew, including changing his diapers, dressing him, cooking and cutting his food, bathing him.

The hours she gets paid by the state have been cut from 24, then to 19, then to 12 hours a week as a result of the state’s ongoing budget crisis.

England said without the money from the state, she’d have to get a part-time job — there’s a Walmart across the street, she said — and she’s not sure what Miksell would do when she was out.

“He can lean forward, but he can’t lean back,” she said.

Paul Gowins, 57, of Reno is chairman of the Nevada Services for Persons With Disabilities Commission. He’s been a quadriplegic since an auto accident when he was 25.

He needs four hours of help a day to get him out of bed and shower him. “I’m pretty dangerous after that,” he said.

Ending the personal-care attendant program would mean more people applying for a limited number of nursing home spots, or ending up in hospitals, he said.

In 2000, he was part of a group that advocated for the state to stop building nursing home beds and shift toward community-based services — keeping people in their homes is less than half the cost of placing them in care facilities.

He’s seen the budget process before. He knows for all the Legislature’s tough talk, lawmakers rarely do more than tweak a governor’s recommended budget by 3 or 4 percent.

He worries that various groups dependent on state help will be pitted against each other.

“Guys who need (personal-care assistance) against mental health against children against guys who need diapers and glasses,” he said. “It’s like pit bulls, fighting over scraps.”

He doesn’t see a way out without additional revenue. If there are inefficiencies and waste, he challenged candidates to prove it.

Has he seen leadership from the candidates for governor?

“No. Not until Nov. 2. Maybe we’ll get straight answers at that point.”