Mike Alford of Red Oak was only 16 in 1976 when he dove into Ten Mile Creek in Ellis County one warm May day.
He didn’t come up on his own. The teen struck something submerged in the water — a log from a recent storm, he thinks — and his neck was broken.
“I was conscious the whole time,” he recalled last week. “I floated up facedown. I could see people but not breathe.”
Two onlookers pulled him out of the water and performed CPR.
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Thus began Alford’s life as a quadriplegic, requiring outside help with the basic tasks of eating, bathing and dressing.
Alford, now 57, is on the board of Arlington-based Helping Restore Ability, the largest nonprofit provider of in-home care in Texas. He is also one of its clients.
But now the agency that helped Alford regain his life is itself struggling. Executive Director Vicki Niedermayer calls the situation “desperate.”
The problem, HRA officials say, is twofold: a surge in new clients and a lag at the state level in authorizing new patients and getting the funding pipeline flowing fast enough to cover caregivers’ paychecks.
One service Helping Restore Ability provides is in-home personal-attendant services including bathing, dressing, feeding, grooming, light housekeeping and laundry for people who would otherwise be at risk for institutionalization in a nursing home or hospital. Clients can require as few as five hours a week from a single caregiver or as many as 100 hours from several specialized caregivers.
Clients have long-term conditions including muscular dystrophy, spina bifida, congestive heart failure, dementia, multiple sclerosis, and spinal and brain injuries.
Payment for services is on a sliding scale based on financial need, and Helping Restore Ability contracts with state agencies like the Department of Aging and Disability Services and Department of Assistive and Rehabilitative Services to provide home care for those who can’t pay.
Ninety-five cents of every dollar from the state goes to pay the caregivers, with 5 cents going for overhead, including salaries of 28 administrative employees.
HRA’s growth was steady and manageable until last year, when the Legislature acted to bring hundreds of people off long waiting or “interest” lists and into care provided by the 1,200 “home and community-based service” agencies licensed throughout the state.
HRA has been hit particularly hard by the change.
Surge in clients
Two other North Texas agencies have discontinued their home care programs and referred their clients to HRA, which as a state contractor had to accept them. Halfway through the agency’s fiscal year, it has added 180 clients, and it expects to add 180 more in the second half of the year. That’s compared with typical client growth of 6 to 8 percent a year.
Helping Restore Ability has about 920 clients at present, supported by more than 2,300 caregivers.
The agency’s fiscal 2016 budget, put together last summer, included projected reimbursement from the state of $20,108,072. The revised figure, given the unexpected growth, is “right around” $25 million, Niedermeyer said.
1,000 Approximate number of clients HRA has served since the start of the fiscal year Sept. 1. About 80 of those have moved out of the program or died.
“The burden that this places on our nonprofit agency is enormous,” she said. “By law, we have to pay the employees as soon as they turn in their time sheets, and yet since there is a backlog of two to six months at the state level in entering the authorizations into the state computer system, we can’t be reimbursed for those costs sometimes until months later.”
Cash flow problems
Normally cash flow is not a problem and it takes about two months to be reimbursed by the state. Niedermayer said some authorizations are now taking four to six months to process — sometimes long after clients received services and caregivers were paid.
HRA is stressed like no other agency, said Rachel Hammon of the Austin-based industry group Texas Association for Home Care and Hospice.
“There are some overall delays statewide,” she said. “However, HRA is feeling it more acutely since they’ve taken over some businesses that were closed. That has put them in a very tight spot. I’ve not heard of other providers [across the state] in the same position.”
HRA has been forced to deplete its reserve funds and liquidate investments, and it struggles each week to make payroll, Niedermayer said.
This issue is really one that we’ve never faced, and it could be resolved fairly simply if the state hired the support staff it needs to fully allow these clients access to the services they so desperately need.
Helping Restore Ability Executive Director Vicki Niedermayer
“This issue is really one that we’ve never faced, and it could be resolved fairly simply if the state hired the support staff it needs to fully allow these clients access to the services they so desperately need,” she said.
Helping Restore Ability had its beginnings in 1977 as a nonprofit agency named Arlington Handicapped Association. Sam Provence, the last person to be diagnosed with polio in Tarrant County, and others formed the agency as a resource for the disabled to be able to stay in their homes, participate in employment and community activities and find the services they needed.
HRA leaders hope that two upcoming fundraisers will help with expenses. The annual Game Changer casino night and silent auction is May 6 at the Arlington Museum of Art, and the 2016 Hand in Hand Luncheon follows on June 24 at the Joule Hotel in Dallas.
Speaker for the Hand in Hand Luncheon will be Aron Ralston, whose experience as a trapped climber in Utah’s Blue John Canyon led to the Hollywood film 127 Hours. Ralston was eventually forced to amputate his arm to free himself from a massive boulder.
▪ Online: www.helpingrestoreability.org