The 10 percent cut to the state health department’s budget, part of an attempt to bring Montana’s overall state budget back into the black, is starting to sound less abstract.
Just before Christmas, the department announced it was cutting ties with four non-profit companies that help people with developmental disabilities.
"Nobody really understands what we do," says Pat Grant, the lead case manager for the Kalispell office of Missoula-based Opportunity Resource Inc. It’s one of two non-profit companies in the Flathead Valley the state contracts for targeted case management. Its seven employees here serve about 280 clients.
"It's a very small population that we serve. They will go on. They will be ok," Grant says. "There will be several that suffer. There will be people that suffer greatly."
Statewide, about 70 people will lose their jobs. 2,700 people with developmental disabilities will lose their case managers when the cuts hit in April. Two months ago Anaconda-based AWARE Inc. let go of its two dozen staff in the Flathead, when it became clear that cuts were likely. Grant expects to hold onto her job until Opportunity’s state contract expires in April.
Grant’s day-to-day work is varied. She works with people who have autism, down syndrome and an array of other developmental disabilities. Some of her clients are non-verbal, some live independently.
"Every day is new." she says.
Sometimes she’s there to give a little boost, like helping a client understand a parking ticket and move their car, or sorting through mail to figure out what’s important.
"This client drops in probably once or twice a week," she says, "he has a lot of anxiety, so he sits and talks and we make him a cup of tea, and by the time he leaves he's a happy camper and he lasts a week or two."
More often, she’s handling her clients’ complicated paperwork for things like food stamps, housing and Medicaid, paperwork that means shelter, safety, food. Grant says one of her clients came to her after receiving a letter, saying that the house she rented was going to be sold.
"And so, because she couldn't read and couldn't figure it out she brought it down to me and we had three months to figure out how to find a new place," Grant said.
Between the low-income housing shortage in the Valley, and her client owning a dog, it took them the whole three months to find a rental.
"So we looked, I looked, because she can't do it for herself. She can't figure it out in the newspaper. She can't go to the different rental agencies to find housing for herself. I did it all, with her assistance, and her permission and her by my side, but she couldn’t navigate all of that," Grant said.
They finally did find a new place, just three days before their deadline.
"And because she has no people, no relatives, no nothing, she and her dog and I moved her stuff and helped her do all the paperwork, and hours of working with Section 8 [an affordable housing voucher program], and getting her food stamps transferred, and her electricity transferred, and her Medicaid transferred to this new address. She literally would have been homeless without case management. Literally, on the street with her dog, homeless without our assistance," Grant said. "That’s what we do every day."
Grant says often, she plays the role of first responder. She keeps her clients out of homeless shelters, out of the emergency room, out of a jail cell, because they call her before they make an unnecessary 911 call. Once she’s laid off, she says she expects to see a sharp rise in the number of police and hospital visits her clients make, as well as an increase in calls to Adult Protective Services.
"We're kind of a frontline for helping all of that, so the existing emergency services are going to get the overflow of the need," she says.
For the most part, she says her clients will be ok - many of them have family nearby, and they’ll have a new case manager from the state. But Grant says it’s unreasonable to expect any one office to be able to absorb the few hundred clients about to need a new case manager.
"Our caseloads are 35 clients. the new caseloads will be 60 or above," she says. "That is almost humanly impossible."
The day I caught her on the phone, Grant was about to meet with a few of her clients, to tell them about the changes coming up. She wanted them to hear about it from her, instead of finding out on the news, unexpectedly, as she and her colleagues did.
I asked her if she had thought about how she was going to say it to them.
"I'm just going to say it, and, I'm going to assure them that they will have case managers," she said. The model will be different, but they will have case management."
She plans to keep serving some of her clients, who she’s worked with for years and years, even after her position is terminated.
"I will work personally on my own time as their friend and mentor, with whatever they need," Grant says.