Tag Archives: welfare

The Women of Can’t Catch a Break: Summer 2016 Update

rp_9780520282780_Sered-200x300.jpgThe past six months have been eventful: a birth, a death (see Eulogy for Nicole), a job gain and a job loss, family ties strengthened and family ties torn asunder. Eight years after first meeting the women of Can’t Catch a Break I still struggle to identify indicators or interventions that predict happy or sad outcomes. Secure and stable housing ups the odds that life will be on an even keel, and women who use drugs heavily are less likely to obtain or hold onto housing. But I cannot identify specific personal attributes or past histories consistently associated with continued heavy drug use, moderate use, or refraining from using. Nor can I figure out who makes it to the top of a housing list and who waits for a decade or more for housing. Strong family relationships do seem essential to women’s well-being; that is certainly the case for Daisy and Ashley. But as Vanessa’s and Joy’s stories show, family relationships alone are not sufficient to keep women off the streets or out of jail.  The good fortune to remain healthy should be relevant, and serious health problems can set off a cascade of other disasters. Yet for some of the women, including Andrea and Junie, deteriorating health has led to better access to a range of support services.

The sole pattern I feel confident pointing out is this. The women who seem happiest, most settled and most able to ride the ups and downs that are part of life are the women who have a sense of purpose, a sense that their lives are worth something, that they have something to offer others and — equally important — that others value what they have to offer. While some may argue that having a sense of purpose is a psychological or character trait, my observations suggest that opportunity may play a far bigger role.  In this update we hear from several women who landed a meaningful paid (Mary) or volunteer job (Tonya and Kahtia) or who have been landed with grandchildren to raise (Francesca). These women now feel that their unique contributions make a real difference in the lives of others; that they are good at what they do; that they are respected; and that they have better things to do with their time than chase after drugs or cater to abusive or controlling men.

Andrea (now in her mid-fifties) recently called me, somewhat out of the blue, to tell me that she is in the hospital. In fact, she’d been in and out of the hospital frequently since the early Spring. She said she hadn’t called before “because people are too busy.” Indeed, she seldom has visitors. Her son hasn’t been to see her because he “doesn’t like hospitals.” Her boyfriend rarely comes. And her best friend wants to come but can’t always manage the public transportation system.

The hospital, she told me when I went to visit, “is my home away from home.” Though she is not quite clear about the cause or trajectory of her medical condition (Andrea struggles with reading and with comprehension of complex words and concepts), she likes the hospital and feels that the nurses are “nice to me.” As an example, “The nurse even said that if I’m bored I can come sit by the nurses’ station.” She especially loves the food because “I can ask for whatever I want in my salad.”

When she is not in the hospital, Andrea’s life seems to have settled into a stable routine. She is still living in a studio apartment in a low-income housing complex. She still finds it too small – especially because her boyfriend, who does not have a place of his own, stays with her nearly all the time. She told me that everyone in her building received notice that they are going to receive Section VIII vouchers so, in principle, she can look for a “real” (her word) apartment, but suspects that with her health problems that may not be realistic.

Despite the illness and hospital stay, Andrea (as always) looked nicely groomed. She was delighted when I commented on how beautiful her teeth are: “The woman in the next bed told me that when I smile it lights up the whole floor!”

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Carly (see “A New Home for Carly“) gave birth to beautiful and beautifully calm baby. For a couple of months all was going well. Carly had moved into her nice new apartment right before the baby was born and, with the help of a “pregnancy choice” organization, she set it up with a crib, changing table, baby swing and all of the other requisite baby paraphernalia. I had the good fortune to babysit a few times and even had the great pleasure of giving Baby her bottle and rocking her in my arms.

Then, everything fell apart. Carly became convinced that the baby’s father was trying to get the baby from her, through violence if necessary. A few weeks later, DCF removed the baby from Carly’s custody. Since then, Carly has been extremely distraught and distrustful. The situation is unlikely to improve before her September court hearing.

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Daisy (see “Outcast Island“), now nearing sixty years old, is still stably situated in a room that her adult children found and rented for her. She attends a daily program for people with mental health challenges. Though the program does not offer much in the way of services, Daisy likes it very much. She is a social person and enjoys the opportunity to be with other people. Weekends, which last for three days (the program is only open four days a week), are long and lonely, and the time she is most likely to find herself getting into trouble.

Whenever we speak Daisy updates me on her children, both of whom have solid careers and relationships with significant others. My sense is that her kids have set very sensible and mature boundaries that ensure their mother’s safety while also making sure that her problems do not take over their lives. Daisy is proud of her children, proud of how she raised them, and happy that they call her on a regular basis.

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Francesca‘s (see “The Bitch at the Welfare Office“) life has changed dramatically since the last update.

Both of Francesca’s sons have children. Though the children lived (until recently) with their respective mothers, Francesca has always made a point of encouraging her sons to be good fathers: to see their kids as often as they possibly can and to bring the kids to her so that they can have a relationship with their grandmother as well.

A number of months ago one of her sons received custody of his child. He realized that he would need help, especially during the hours that he is at work. The solution they came up with was for Francesca and her son to get an apartment and raise the child together. They found an affordable apartment in a semi-rural town (this has a serious downside since Francesca does not have a car, leaving her dependent upon her son to drive her everywhere) and quickly turned it into a warm home for the child. Francesca has embraced raising her grandchild. She has taught the child to read, tie her shoes and ride a bike. They adopted a dog and put up a swing set in the yard. Francesca also looks after a few other children in the neighborhood and takes them on “field trips” to the fire station and playgrounds. In a very short time she has created an extraordinary community of families who help one another out and whose children are growing up fast friends.

On some levels, Francesca is living out the fantasy she told me about when we first me: a house with a picket fence, a dog, and her kids with her. She has reconciled with siblings she hadn’t spoken with in years, and loved bringing her sons and grandchildren to a big Easter dinner with the extended family. She is not dependent on a boyfriend for a place to stay or for a sense of belonging, and for the first time since I’ve known her she is involved with a man who is stable, supportive, trusting and respectful.

But on other levels the demons that have haunted her never quite disappear. She still has serious health problems that have landed her in the hospital more than once. During her last hospital stay she re-developed a physical dependence on painkillers. Afraid to tell the staff about her drug history (she, rightfully in my opinion, suspected that if they knew her drug history the would focus on that rather than on her kidneys and liver), she went through withdrawal on her own after she left the hospital. But the more daunting demon is external rather than internal. She has no money, no job, little chance of employment (especially without a car), and a living situation totally dependent upon DCF keeping her grandchild in the custody of her son. Francesca knows all too well that this is a fragile house of cards. But in the meantime, she savors every moment of this “second chance at having a real family.”

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Ginger (seeThe New Price of Freedom“) has not been in touch with me since the winter. I’ve heard from people who have seen her hanging around downtown. I miss her!

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Isabella (see “Failure by Design: Isabella’s Experiences with Social Services“) continues to have a hard time. She is still grieving her husband’s sudden death. She still is on methadone and spends a great deal of time at appointments and meetings at the methadone clinic. She has not been able to hold onto a job and she cannot afford an apartment. As a consequence, she has stayed with a succession of friends. She contributes to paying the bills and pitches in on housework and childcare, but does not have the security of a place that is hers. Several times over the past few months she has been surprisingly upbeat, feeling that good job or housing opportunity is right around the corner. But more often she feels overwhelmed and paralyzed by the sorrow of her husband’s death.

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Joy, now forty years old, truly cannot catch a break. In January she was excited to report that, “I’ve been clean for five months.” She checked into a detox (for perhaps the hundredth time), but “this time I decided that enough is enough and that I’ve had enough.” She was put on Suboxone (similar to methadone) and reconciled with her mother. She was allowed to see her daughter often (her daughter lives with Joy’s father) and even had sleepovers with her. “I am happy that I have my family back.” She remembered that I had told her years ago that many people age out of drug use. “I didn’t believe it at the time but that is what has happened with me. I just don’t want to do it anymore.” While things in her life were not perfect, she was happy to live with her fiance in an apartment down the street from her mother. The day we spoke she had two job interviews: one at a retail store and one at McDonald’s. “I need to put myself number 1,” Joy exclaimed.

By July everything had fallen apart. Crying, she told me, “I do so good and stay sober but still have a shitty life. I don’t understand.”

On a hot summer day I picked her up outside a homeless shelter where she, together with other residents, hang around during the day waiting for the shelter to re-open. Over lunch she caught me up on the past few months. “My fiance beat me up — three times.” The first two she didn’t go to the hospital, but the third time was severe: broken ribs and facial bones. She didn’t press charges because she was afraid his family would come after her, but, she said, these days the state can go ahead and press charges without the woman because they know that women may be afraid. She is relieved he is in jail but nostalgic for her time living with him (she couldn’t stay in the apartment after he went to jail because the apartment and Section VIII eligibility were in his name). “I liked keeping house, cleaning, cooking. I wanted to marry him.” She still has the engagement ring he gave her.

For about eight months the Suboxone worked well, but then she started to have cravings for heroin and asked her doctor to increase her prescription. The doctor refused, “So I quit. I was okay for a while but then I relapsed.” In short, without an apartment, job or boyfriend (none of the job interviews panned out “because of my “record”), “I just decided to go and buy some heroin.” She shot up twice and each time she overdosed and had to be brought back to life with Narcan. (Many drug users now carry Narcan because overdoses have become increasingly common as Fentanyl is flooding the streets.) She OD’d a third time when someone stabbed her with a needle and stole her wallet right after she took out money from an ATM. She has not used since.

I asked her whether she has any leads for housing. Joy explained that she’s been “on the list” for eleven years but has not followed-up or made inquiries. She recently received a call from a town outside of Boston saying her name came up for housing because she had been a victim of domestic violence. She thought they were referring to her fiance’s beating her up but it turned out that they were talking about violence that was done to her twelve years ago. In the end they said she didn’t have enough evidence so she’s not eligible for housing.

When I dropped her off, she didn’t want to get out of the car outside the shelter. There was someone there she didn’t want to see so she had me drop her off on a side street. I had to make some phone calls so I sat in the car for a while. When I drove off I saw her walking down that street, phone in her hand. I wondered if that would be the last time I’d see her.

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Kahtia (See “Prostitution, Decriminalization and the Problem of Consent“) is still working hard towards getting her children back (see New Years 2016 update.) She has participated in, and graduated from, a succession of treatment programs. The certifications of completion will be useful when she finally has her day in court – a year after her children were taken away.

In addition to going to multiple twelve step meetings each week, Kahtia volunteers at a soup kitchen preparing ‘meals on wheels’ and serving lunch to anyone who needs a meal. She loves her work! Here’s an example of an email she sent me: “On my way to do my service work to give back to the public freely as was given to me love waking up and have a purpose today … feeling awesome and positive I thank my god for waking me up 👆 and pray for those who didn’t.”

At this point Kahtia is excited but nervous. She believes she will get her children back because DCF did not have a real case against her to begin with. But the kids have been in three foster homes and three different schools since they were taken. Kahtia knows that they will all have a lot of issues to struggle through when the are reunited.

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Mary, now in her late fifties, is doing fabulously well. She had been one of the fortunate few to receive an apartment in a mixed elderly/disabled public housing complex and has thrived for the nearly seven years she has lived there. Before getting that apartment she had been homeless for decades.

Mary’s big news is that she has a job as a PCA (patient care assistant) for a disabled younger woman in her building. Mary reminded me that she used to work as a nurses aid until, in her early thirties she realized that she wasn’t making a decent living and could earn more selling crack. At about the same time, her mother died and she had to move out of her mother’s apartment. She married a man who “wouldn’t let me out of the house. I cut my wrist so that I could get out [in an ambulance]. That is how I ended up in a battered women’s shelter for a few years. … I didn’t know how to go about getting my own apartment.”

Unable to read, Mary had struggled for years finding a job that does not demand at least some literacy (even just use of a computer to sign into work). Her new job as a PCA feels to her to be a great privilege. Though she only is paid for two hours of assisting daily, she volunteers many more hours because “I love it. I love taking care of people, taking care of someone. I’m a people person!”

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Melanie‘s doctors have not yet figured out a diagnosis to explain her enlarged spleen, liver pathology and diffuse pain. They are running multiple tests which seem to be scheduled weeks or months apart. Between the medical appointments and the pain, she has not been able to return to the work she loves at a homeless shelter. Much to her distress, she has been put on long-term Disability.

Melanie told me that her boss told her that the main reason she can’t come back to work is her mental health. Apparently she “snapped” at people at work a few times (this is very unlike the mild-mannered Melanie I’ve known for eight years). She clarified to me that the people she snapped out were not shelter clients but rather her boss and co-workers who “don’t treat me as an equal.”

On some level Melanie has bought into the idea that her main problems are mental health: depression and anxiety. She was told that all of the things she’s gone through in her life (rape, losing custody of her children because of a drug addiction she acquired after becoming hooked on pain medication in the wake of a botched c-section) have caught up with her. The theory is that the pedophiles she saw as work “triggered” her anxiety and depression.

But on another level Melanie does not agree with this analysis. She tells me that she has not repressed the memories of the awful things that have happened to her and that she has worked at homeless shelters and social service agencies with similar populations for eight years without any problems. The “trigger,” in this analysis, is physical health problems and the fear that she won’t be able to go back to work.

While she continues to express hope that her situation is temporary, she seems to be settling into a daily routine of going shopping and watching television with her disabled mother.

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Tonya (see “Knowledge is Power“), now forty years old, is living in the same apartment. She finally got the management company to take out the (horrid, uncleanable) carpet and put in flooring, so the place looks quite good. She also looks — and sounds — good. She still scrapes by on the welfare checks she gets. Though her son is now almost five years old, she received an extension on welfare (according to law, welfare ends two years after the child is born) because she has applied for SSI (Disability). The SSI was denied and she applied again, and her caseworkers at welfare keep changing, but somehow they’ve allowed her to stay on welfare as long as she does volunteer work.

She loves her volunteer work! Most days she volunteers at her son’s daycare, in part because she can’t afford to take the bus there and back twice so she just stays all day. But more important, “the staff ask me to stay. I gravitate to the arts and crafts table and I like that I can help.”

Her son is the center of her life and she sees him as her primary responsibility. She puts great effort into providing him with appropriate toys and food, and planning his education.

Like many poor and many African American women, her home — which she was eligible to receive because she is a mother — serves as the landing space for her relatives. The brother who had been staying with her last year finally moved out but then her other brother moved in. This brother has always worked and was married with a child but the marriage broke up. He’d never been homeless before so she took him in.

While all of this was going on, she and and her son’s father were fighting constantly. The key issue to Tonya is that he was working and earning a decent salary but was barely contributing to the household. She finally told him to get out. He now is staying with a family across the street and apparently has a new girlfriend somewhere. “I’m tired of it,” she said, “the men who don’t help but just pass babies around from woman to woman, expecting women to make ends meet. I’m fed up with my family too, but they’re my family and I’ll defend them against anyone else.”

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Vanessa, about to turn fifty, has not, according to her mother, settled down. When we first met Vanessa told me that she only had been an addict since she was thirty-seven years old. ““I’m late!” she said, with drugs as with most things. “Why did you start using?” I asked. “I was trying to follow everyone else, be like everyone else.” As she explained once I knew her better, she had lead poisoning as a child and as a consequence is “slow” (her word.) She continued living with her mother until age thirty-eight, when her mother kicked her out because of using drugs. “I wish I was still there,” Vanessa told me more than once. “My mother is a beautiful person. She is my Higher Power.”

By the summer of 2016, Vanessa’s mother had become exasperated. “I’m happy to talk to her if she makes sense but not when she’s not. She’s staying in different places. With a friend and then a homeless shelter…I can’t help her anymore. She’ll do good for a couple of days and then don’t do good. She’s grown. You can’t tell a grown up person what to do. I can’t be aggravated to death. I have my own health to deal with. I raised my mother’s children – she had nine and I was the oldest, and my cousin’s eight children, and my girlfriends’ kids and my own and Vanessa’s kids. I’ve done enough.”

Both of Vanessa’s kids (now in their twenties) are living with their grandmother. Neither is working at this time, though one had a fairly good job until recently. “They apply for jobs but it’s hard to get a job now,” Vanessa’s mother tells me.

 

To read previous updates click on:  New Years 2016   Summer 2015   Christmas 2014 / 2015    Fall 2014 

For more on volunteering see: Concrete Suggestions for Positive Change

Penny and Pound Foolish: Governor Baker’s MassHealth Savings Plan

After running on a campaign of new and smart ways to reduce government spending, Massachusetts Governor Charlie Baker (R) has proposed budget cuts for fiscal year 2016 that are neither new nor smart — going after the low-hanging fruit of government funded Medicaid (MassHealth) for the Commonwealth’s poorest, sickest and most vulnerable residents. Most of the proposed savings to MassHealth in Gov. Baker’s plan are merely a matter of bookkeeping – shifting costs from fiscal year 2016 to fiscal 2017. But the Administration also aims to reduce spending by requiring over one million residents enrolled in MassHealth to prove that they are still eligible. Though the Administration has not provided an estimate of how many ineligible people are enrolled, Baker’s budget team estimates that this move will save the Commonwealth $210 million.

The immediate plan is for the Commonwealth to contact 1.2 million people who were automatically re-enrolled in MassHealth when the Health Connector (‘Exchange’) website experienced technical failures in 2013. Each of these people will receive two letters asking them to reconfirm their eligibility. After 60 days those who do not respond will lose coverage. That may not sound unreasonable, but as a sociologist who works with low income women, I suspect this plan presents disproportionate hardships for residents who do not have permanent addresses or who struggle with understanding government forms and with gathering the required documentation; that is, the people who most need consistent healthcare coverage. Individuals who lose eligibility will be allowed to re-certify in the future, but the immediate effect will be disrupted care and an uptick in expensive emergency department usage.

The scanty information released by Governor Baker’s office indicates three categories of potentially ineligible people who would be eliminated from the MassHealth rolls. The most straightforward are people who still are on MassHealth plans but have moved out of state and receive coverage elsewhere. These people, however, would not seem to account for much spending given that they have other insurance where they actually live so are unlikely to use MassHealth benefits. The second category is people who have had a change in income sufficient to place them over the eligibility threshold. Given the absence of a meaningful economic recovery for low wage workers in Massachusetts, this category likely consists of individuals and families whose current earnings push them marginally over the eligibility line. Switching these people from MassHealth to the heavily subsidized insurance policies that they are eligible for through the Health Connector is unlikely to make much of a difference in the budget.

A third category – people who are purposely cheating or “working the system” — has not been explicitly singled out in statements from the Governor’s office. But given 2010 gubernatorial candidate Charlie Baker’s fake electronic benefit cards that said: “Deval Patrick’s Massachusetts EBT Welfare Card. Swipe me for booze, cash, cigarettes, and/or lottery tickets at taxpayers’ expense,” weeding out Medicaid cheaters certainly lurks behind the call for re-certification. Again, we have no information regarding numbers, but we do know that hunts for fraudulent welfare claims consistently turn up very little cheating and thus very little cost-saving. Last year, for example, Maine Gov. Paul LePage (R) released data intending to prove widespread welfare abuse but in fact showed that 99% of all welfare benefit transactions were legitimate and legal.

The re-certification process in and of itself will be costly. If we calculate (modestly) 15 minutes for a government worker to process a straightforward re-certification, the 1.2 million re-certifications will take approximately 300,000 hours. And if we assume (modestly) a salary of $15 / hour for the workers who process re-certifications, the bureaucratic cost will come to 4.5 million dollars – a substantial chunk of what the Administration is looking to cut from the MassHealth budget and money that surely could be spent in a manner more conducive to protecting the health of Massachusetts’ residents.

These numbers are just an estimate, and I assume the Governor’s staff has more accurate numbers. But even if I’m off by 50%, we’re still looking at a cost cutting plan that is likely to cost the Commonwealth a great deal both in terms of salaries and in terms of health.

For more on the larger picture of  health care coverage click:  Health Insurance Roulette: The House Always Wins

The “Bitch” at the Welfare Office — Or Why Responsibility Without Authority Makes Us Sick

feature image via thebluedolphins.blogspot.com

A few days ago I listened while Francesca, a woman I’ve come to know during a decade of working with criminalized women, ranted about “the bitch” over at the welfare office who refused to give her food stamps. According to Francesca, “the bitch” didn’t believe that Francesca had not received the letter telling her that she needed to re-certify her eligibility. This, I thought, is a systematic problem: Access to vital services typically is tied to having a permanent address. As a consequence, the ability to receive services is linked to a level of financial stability that the people who most need these services are unlikely to have. Since Francesca had not had a secure place to live for over a decade, it’s no surprise that the letter didn’t reach her. But for Francesca, at least at that moment, the systemic problem was not on her mind. Rather, she focused her attention on “the bitch” who, so it seemed to her, wanted Francesca and her children to starve. Never one to hold back, Francesca had “let the bitch know what I thought about her” before she stormed out of the office.

Francesca is a fabulous raconteur and as I listened to her retelling of the food stamp office story I shared her outrage, and probably would have joined her had she proposed a return trip to yell at “the bitch”. But when I had the luxury of some time to think over what she’d told me I realized of course, that the welfare worker had no authority in this matter: However much she liked or disliked, sympathized with or looked down on women like Francesca, she was not authorized to give food stamps to someone who had not re-certified her eligibility.

Over the years Francesca has confronted two other “bitches” in my presence. One was a hospital nurse who “refused to let me see the doctor.” The other was a parole officer who told her that if she didn’t keep up restitution payments on an old crime committed by her ex-husband she would be sent to jail. Both times Francesca barraged the “bitches” with pleading, tears and finally curses. I don’t know if they felt fear, anger or shame (probably a combination of all three), but I do know that they are placed in untenable situations like this on a daily basis.

As the public face of social services, they face the despair and rage of people trying to maintain a sense of dignity – albeit sometimes in ways that backfire — in a culture that treats food and housing and freedom as commodities rather than as human rights. Perceived (mistakenly) as the gatekeepers to food, medicine and freedom, the “bitches” Francesca confronts are targets for the anger of hungry, sick, homeless, battered and poor clients who cannot access the help that they need, especially in this era of cutbacks in social services.

In popular culture, “Type A” men drop dead from heart attacks brought on by the stress of their powerful positions. Yet a weighty body of literature shows that the most severe job strain is not characterized by high levels of authority but rather by low levels of authority coupled with high levels of responsibility. Workers tasked with keeping people alive while lacking power over the necessary resources and policies to do so are especially likely to suffer poor health, chronic physical and mental distress, and greater risk of death.

The hundreds of thousands of women who predominate in the lower and middle rungs of the health and social service professions live with the heavy responsibility of granting or denying access to potentially life-saving goods and services to desperate women like Francesca. Deflecting the anger that should be directed at the (usually male, certainly higher paid) policy makers, administrators and supervisors, they are stuck enforcing rules that they have no power to shape or change.

The “bitches” at whom Francesca vents her (righteous) anger are butts of nasty comments about government bureaucrat “fat cats” though they often earn salaries that are barely above minimum wage. As women they most likely carry the double load of paid employment and house / wife / mother work – the impossible task of trying to raise healthy, well-adjusted children in a world of violence, air pollution, aggressive consumerism and 24/7 headsets. It’s likely that they themselves have applied for – and perhaps been denied – food stamps; that they have children or siblings struggling to pay court fees in order to stay out of jail; and that they too can’t get the kind of medical attention that they need.

I’m not sure how I’ll react the next time Francesca blows up at a clerk or a caseworker. I’d like to think that I’ll be able to persuade everyone concerned that the real enemy is not the woman on the other side of the desk but rather the powerbrokers who keep them there. But in truth, I’ll probably be so wracked with feeling both responsible for keeping Francesca in line and powerless to ameliorate her situation that I’ll come down with a migraine.