County Human Services struggle under growing need

by Richard Thomas

The St. Louis County Board held an all-day workshop with the Public Health and Human Services Department April 17. Here are some highlights:

Out of 87 counties, St. Louis ranks 67th for length of life, 77th for quality of life, 77th for health behavior, 74th for social and economic factors (education, poverty, crime, etc.) and 66th for physical environment. (Air and water quality, long commutes, severe housing problems.) On the plus side, we rank 13th in terms of clinical care: doctor/patient ratio, number of uninsured, screenings, etc. (Source: countyhealthrankings.org)

The Public Health Division has 23 programs “spanning womb to tomb.”
Health and Human Services are financed by a combination of property taxes, reimbursement for services, state and federal grants and allocations, and charges for services.

St. Louis County residents received $18.2 million in federally funded SNAP (Supplemental Nutrition Assistance Program) funding in 2017. Two-thirds of the participants are children, elderly or disabled. Of the remaining one third, 80 percent are working. For every $1 issued, $1.79 is created in economic activity, as benefits are used to buy food at local retailers.

“Public assistance and the work that we do is 100 percent mandated,” said Debbie Waldriff, financial assistance division director. “We have multiple funding sources, generally from the fed, the state and certainly the county tax dollars, and what we do actually and financially, we determine eligibility for these programs … We have no discretion in what we do.”

Child Support collected in the county totalled $23 million in 2017.
Chemical dependency treatment costs are at an all-time high with $3.7 million in spending proposed in 2018. 

Over three years (2015-2017), 31 child protection positions were added. 
Between promotions, transfers and new hires, nearly half of the Child and Family Services staff are new to their positions since 2017.

Child maltreatment reports have increased 57 percent since 2014, though that is similar to the statewide trend. The increase is attributed to the opioid epidemic, poverty, lack of housing and other social supports, and higher public awareness. There is also an increase in complexity and severity of cases, required documentation and staff burnout.

Commissioners commented on the “incredible” workload and the “amazing” level of staff turnover. Commissioner Frank Jewell said, “As opposed to looking at why we lose everybody, which I think we have some sense of, why do people stay?”
“I really enjoy the work,” said Heather Larson, financial assistance supervisor. She added that opportunities for promotion help retain employees.

Adult Foster Care

There are 1,319 adult foster care beds in the county. Corporations provide 1,164 of those beds in group homes and families provide 165.

Commissioner Keith Nelson expressed concern that the county houses patients from other counties. “If they’re from out of the metro, which largely they’re coming from, that’s an hour and a half to two hours of travel time for their families to even be with them, and that is just plain wrong. When I talk about it, it’s not just a financial piece of it because, look, there has been an industry that has to some extent been created here, which employs people, too. They’re employing people in our community, I get that. But removing family members from their communities just because there’s available beds here, there’s something fundamentally not right about it.” 

Gena Bossert, adult services division director, said, “It’s a good service, it’s helping a lot of people, but it’s a little worrisome about how much of it is being developed, and it’s one more responsibility that we’re taking on. It’s good to have new service but it’s also something that we’re not getting funded to do, but we feel a responsibility to have some oversight in these situations.”

Burials

The county spent $371,396 on burials in 2017 for people without relatives with the resources to afford such services. 

“I know in the past on this issue that there were townships that were kind of concerned because some of them had very cheap plots in their cemeteries. So where are most of our burials now interred?” asked Commissioner Thomas Rukavina.
Heather Larson, financial assistance supervisor, said the dead are mostly cremated.
“So you don’t have any more?” Rukavina said. “We called them pauper’s graves.”
Waldriff said burial is an option “if there is a known religious reason.”

Commissioner Jewell brought up “when we had the big problem with the county morgue,” referring to 2015 when the chief medical examiner resigned after controversy arose when he planned to conduct two autopsies over the objections of the Native American families. “I ended up having to talk to him a lot about this, but if the person does not have anybody, any person family member or whatever to sign off, they have to be buried, right?”

Waldriff said, “If the coroner’s office is involved, the lone individuals have a full burial in the event they may need to bring them back up. If there is no one attached to a person -- mostly these are John Doe cases?”

“The problem was there wasn’t enough money to pay somebody to bury them and they had to be buried, they couldn’t be cremated,” Jewell.

“So we do both traditional and cremation. It’s just that the other services, things like flowers, receptions, those kind of things, none of those things happen in our regular (service) and the whole package has to fit with the amount of county dollars,” Waldriff said.

“No Irish wake then,” Commissioner Pat Boyle said.

“Applications can be submitted by anybody with a vested interest. That can be next of kin, friend, neighbor, even a funeral home director,” Larson said. “The requirement is that an application is submitted prior to any funeral arrangement to being completed. And that’s because if there are any enhancements made, it can result in the denial of the application. So that’s part of our policy that’s written in this. So the package for formal burial, what’s being approved is really supposed to pay for for professional services, like they crematory fees, cremation, medical examiner fees, that kind of thing.”