Category Archives: Human Services

Evading the Catastrophic Costs of Nursing Home Care: A Theoretical Inquiry

Source: Gideon Yaniv, Public Finance Review, Volume: 47 issue: 4, July 2019
(subscription required)

From the abstract:
While many countries operate publicly funded programs to help care-needing elderly people finance the catastrophic costs of nursing home care, eligibility to public assistance may be means tested. To qualify for a means-tested program, applicants must first exhaust (spend down) their financial assets on privately paying for nursing home care, thereby wiping out their lifetime savings and children’s inheritance. They may naturally consider the possibility of hiding assets from the health agency, consequently shifting the financial burden to taxpayers. The present article adjusts two classical tax evasion models to capture the decision to evade the costs of nursing home care, focusing on the implications on the evaded costs and the program’s deficit of attempting to cope with the escalating costs of nursing home care by imposing a cost-sharing premium on the applicants’ adult children. Some insights on the socially optimal level of the cost-sharing premium are finally discussed.

Getting poorer while working harder: The ‘cliff effect’

Source: Susan R. Crandall, The Conversation, June 3, 2019

….Given the pressure to earn enough to make ends meet, you would think that low-paid workers would be clamoring for raises. But this is not always the case.

Because so many American jobs don’t earn enough to pay for food, housing and other basic needs, many low-wage workers rely on public benefits that are only available to people in need, such as housing vouchers and Medicaid, to pay their bills.

Earning a little more money may not automatically increase their standard of living if it boosts their income to the point where they lose access to some or all of those benefits. That’s because the value of those lost benefits may outweigh their income gains.

I have researched this dynamic, which experts often call the “cliff effect,” for years to learn why workers weren’t succeeding at retaining their jobs following job training programs. Chief among the one step forward, two steps back problems the cliff effect causes: Low-paid workers can become reluctant to earn more money due to a fear that they will get worse off instead of better…..

The Decline of Cash Assistance and the Well-Being of Poor Households with Children

Source: H Luke Shaefer, Kathryn Edin Vincent, Fusaro Pinghui Wu, Social Forces, Advance Articles, March 19, 2019
(subscription required)

From the abstract:
Since the early 1990s, the social safety net for families with children in the United States has undergone an epochal transformation. Aid to poor working families has become more generous. In contrast, assistance to the deeply poor has become less generous, and what remains more often takes the form of in-kind aid. A historical view finds that this dramatic change parallels others. For centuries, the nature and form of poor relief has been driven in part by shifting cultural notions of which social groups are “deserving” and “undeserving.” This line was firmly redrawn in the 1990s. Did the re-institutionalization of these categorizations in policy have material consequences? This study examines the relationship between the decline of traditional cash welfare between 2001 and 2015 and two direct measures of wellbeing among households with children: household food insecurity and public school child homelessness. Using models that control for state and year trends, along with other factors, we find that the decline of cash assistance was associated with increases in both forms of hardship.

Pervasive Penality: How the Criminalization of Poverty Perpetuates Homelessness

Source: Chris Herring, Dilara Yarbrough, Lisa Marie Alatorre, Social Problems, Advance Article, March 29, 2019(subscription required)

From the abstract:
A growing literature examines the extent to which the criminal justice system perpetuates poverty and inequality. This research examines how anti-homeless laws produce various forms of police interactions that fall short of arrest, yet have wide-ranging impacts on the urban poor. Our analysis draws on a citywide survey of currently and recently homeless people, along with 43 in-depth interviews, to examine and reveal the mechanisms through which consistent punitive interactions, including move-along orders, citations, and destruction of property, systematically limit homeless people’s access to services, housing, and jobs, while damaging their health, safety, and well-being. Our findings also suggest that anti-homeless laws and enforcement fail to reduce urban disorder, but create instead a spatial churn in which homeless people circulate between neighborhoods and police jurisdictions rather than leaving public space. We argue that these laws and their enforcement, which affected the majority of study participants, constitute a larger process of pervasive penality—consistent punitive interactions with state officials that rarely result in arrest, but that do material and psychological harm. This process not only reproduces homelessness, but also deepens racial, gender, and health inequalities among the urban poor.

Public Housing Work Requirements: Case Study on the Chicago Housing Authority

Source: Diane K. Levy, Leiha Edmonds, Samantha Batko, Marcus Gaddy, Urban Institute, April 16, 2019

From the abstract:
This report presents a case study of the Chicago Housing Authority’s (CHA’s) work requirement policy, one of a small number of work requirements implemented by housing authorities. The report describes the CHA work requirement, the policy’s implementation and how it has changed, and perceptions of implementation and outcomes from key CHA and service provider staff and residents. The CHA work requirement has been in place for nearly 10 years, allowing us to analyze implementation over time and outcomes.

Tracking Federal Funding to Combat the Opioid Crisis

Source: Bipartisan Policy Center, March 2019

From the summary:
In 2017, more than 70,000 people in the United States died from a drug overdose, with almost 50,000 of these deaths involving an opioid. The United States is facing a devastating opioid epidemic, and the federal government has responded by investing billions of dollars into prevention, treatment, and recovery efforts over the past two years. This includes efforts to curb the supply of both illicit opioids and unnecessary prescription opioids and to improve access to evidence-based treatment for opioid use disorder. Despite these actions, addiction policy experts believe that the end of the epidemic is not yet in sight.

Considerable attention has focused on the drivers of the opioid epidemic. However, less attention has been paid to whether the federal investments to address the issue are being effectively targeted to the communities most affected and to those with the highest overdose deaths. An effective response requires policymakers to know how resources are allocated and to use that information to minimize duplication and maximize the efficiency of limited resources. The federal government has not previously produced or made available a document that provides this information to the public or policymakers.

Corporations and the American Welfare State: Adversaries or Allies?

Source: Mark S. Mizruchi, Studies in American Political Development, FirstView, Published online: February 18, 2019
(subscription required)

One of the most widely held views about American political life is that business is hostile to the welfare state. In the 1970s, David Vogel asked why American businessmen “distrusted their state.” Kim Phillips-Fein has written of the “businessmen’s crusade against the New Deal.” Jane Mayer and Nancy MacLean have recounted the efforts of the Koch Brothers and their wealthy allies to remake American politics in a more conservative direction. What could be more uncontroversial than the view that American business is broadly opposed to government social policies?

Related:

Ascertaining Business’s Interests and Political Preferences
Source: David E. Broockman, Studies in American Political Development, FirstView, Published online: February 26, 2019
(subscription required)

Medicare is one of the largest social programs in the world. Did organized industry favor Medicare’s passage in 1965? If it did, this would represent powerful evidence in favor of the theory that social programs typically require cross-class alliances to pass, such as alliances between business and labor. However, in a previous article in this journal, I argued that answering questions about political actors’ preferences—such as whether organized industry favored Medicare’s passage—can be surprisingly difficult due to the “problem of preferences”; that is, political actors might misrepresent their true policy preferences for many reasons. For example, when their ideal proposals are not politically feasible, political actors may wish to bolster support for a more politically viable alternative to a disliked proposal—even if they do not truly support this alternative to the status quo. To better understand political actors’ true policy preferences, I argued, scholars should trace how those actors’ expressed preferences change as a function of their strategic context—just as scholars seeking to understand the impact of any other variable trace the effects of changes in it.

Business Interests and the Shape of the U.S. Welfare State: From the Insurance Company Model to Comprehensive Reform
Source: Christy Ford Chapin, Studies in American Political Development, FirstView, Published online: February 18, 2019
(subscription required)

Peter Swenson’s excellent article is a welcome correction to the consensus argument so often found in welfare state literature. That interpretation depicts a never-ending, dualistic struggle between capitalists and “the people,” as represented by welfare reformers. Swenson sorts through the evidence surrounding post-1960 health care debates, particularly Medicare, to demonstrate that “business” is not a fixed, homogeneous group that conforms neatly to class-based analysis. He finds significant business backing for federal programming and also shows that where trade associations took conservative, anti-reform stands, they often did so without strong member support.

“Mom, When They Look at Me, They See Dollar Signs” How rehab recruiters are luring recovering opioid addicts into a deadly cycle.

Source: Julia Lurie, Mother Jones, March/April 2019

….The addiction community has a name for what happened to Brianne. It’s called the “Florida shuffle,” a cycle wherein recovering users are wooed aggressively by rehabs and freelance “patient brokers” in an effort to fill beds and collect insurance money. The brokers, often current or former drug users, troll for customers on social media, at Narcotics Anonymous meetings, and on the streets of treatment hubs such as the Florida coast and Southern California’s “Rehab Riviera.” The rehabs themselves exist in a quasi-medical realm where evidence-based care is rare, licensed medical staffers are optional, conflicts of interest are rampant, and regulation is stunningly lax.

While experts say the practices described in this story are widespread, it is important to note that there are plenty of responsible treatment providers, and not all the facilities named engage in all the practices described. Recovery Villas, which was raided by Florida authorities last summer on suspicion of insurance fraud and is now under investigation by the state, did not respond to my questions. A Compass Detox spokesman said that paying clients for treatment and giving them drugs between rehab stints “is illegal and we don’t do that.” Compass obeys all relevant laws and regulations, he emphasized…..

Library Systems Embracing Their New Roles As Social Service Hubs

Source: Emily Nonko, Next City, January 22, 2019

…. Starting from Esguerra, the San Francisco Public Library now has a team of Health and Safety Associates (now known as HASAs) who use the bathrooms as outreach space. HASAs have since expanded their work outside bathrooms and provide outreach on all seven floors of the main branch. They also work at other branches to support staff and inform patrons about resources and services. The program has placed at least 130 patrons into stable housing, Esguerra says.

San Francisco’s experience directly inspired change at the Denver Public Library. In 2012, the Homeless Services Action Committee — an internal working group with the Denver library — made recommendations to add a social worker to staff. The library eventually hired social worker Elissa Hardy in 2015 to begin building the library’s Community Resource program, bringing on additional social workers and peer navigators. The program has gone from serving 434 library customers in 2015, when it was just Hardy, to 3,500 served in 2018.

Both the San Francisco and Denver programs have grown as affordable housing needs and homelessness increase in each city. The San Francisco Public Library budgeted to hire six HASAs this year; currently, five work with Esguerra. For 2019, Denver Public Library budgeted for a team of 10, including four social workers and six peer navigators — the team now covers all 26 locations within the Denver Public Library. ….

State-level data for understanding child welfare in the United States

Source: Child Trends, February 26, 2019

High-quality data can provide public officials and advocates with crucial details about the populations they serve. State-level data for understanding child welfare in the United States is a comprehensive resource, including easy-to-use interactive features, that provides state and national data on child maltreatment, foster care, kinship caregiving, and adoption. This resource compiles critical data from a variety of sources on children, youth, and families who came in contact with the child welfare system in federal fiscal year (FY) 2017.

These data are important because they help policymakers understand how many children and youth came in contact with the child welfare system, and why. States can also use this information to ensure their child welfare systems support the safety, stability, and well-being of all families in their state.