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States, Counties and Cities: The Long Road to Recovery

As the negative economic news continues, what are we to make of the prolonged recession that has already changed the service landscape for caregiving families? Difficult debate and hard decisions are underway at every level of government from federal, state, county to city levels. The services that families depend on for support such as in-home care, adult day programs, caregiver support, meal services, case management, and transportation – down to the adaptive exercise class at the community center – are all under consideration for funding cuts or elimination. Many have already been cut and there is an expectation of broad proposals for reorganizing government and reshaping the policy priorities for this coming fiscal year and beyond.

What we do know is 46 states are facing deficits in their general funds and that more than half expect to cut services to vulnerable populations like older and disabled adults. While there is a slow recovery coming out of the recession, it will be a number of years before states, counties and cities follow suit.

The fundamental funding foundation for many community services are in fact, a mixture of multiple funding streams from federal to city, combined often with independent fundraising, foundation grants and fees for services. Think of it as a fabric that is gradually losing its threads until there is nothing to hold the whole together – the unraveling of the service infrastructure of support for family caregivers and for those for whom they care. Will all services cease to exist? No, but we expect to see some segments of service be eliminated, eligibility be narrowed, cuts to service providers be enacted and waiting lists to grow in the next two to four years.

But for those of us who work with family caregivers every day, simply a reduction in hours of a service like adult day care brings a host of anxious questions:

How will I continue to work?

With shorter hours of adult day care, how will I get my Mom to the center?

Or, who will stay with her until the transportation arrives?

Should I cut back my hours at work?

If I cut my hours, then how will I pay for adult day care?

Keep my health insurance?

Family caregiving arrangements are usually a delicate balance: one change can alter the whole service set up. Make no mistake: the final impact of these many funding and policy decisions will be felt by caregiving families who are already providing the vast majority of long term assistance to disabled and older adults.

This is an age of disruption. Budget shortfalls and less available private dollars might well mean that all services and systems are evaluated through the lens of efficiency, effectiveness and quality. Disruption brings opportunity with re-tooling existing systems and services, implementing health care reform and bringing consumers together to be effective advocates. We must all work together to make sure that the long term supports do not unravel in our respective communities.