Cuts and consequences (continued) BY BRIAN C. JONES

UNDERSTAFFING MAY also be threatening Rhode Island’s progressive welfare program, in which the state is trying to make sure mothers can find jobs that pay enough to enable them to permanently leave welfare. While the drop in the numbers of welfare recipients has not been as rapid as in other states, officials believe the more deliberate approach has meant more people are able to remain in their jobs, with better incomes than when they were on welfare.

But Nancy H. Gewirtz, one of the plan’s architects, says this success is threatened by having too few social workers to work with families to develop training and education programs leading to productive jobs. The Department of Human Services has caseloads running 300 for each social worker in some offices, Gewirtz says, adding, "They do not have the time to provide in-depth service, or service at all, to most of these families."

One sign of a breakdown is the estimated 1300 families that are facing financial penalties because they are not participating in work or other prescribed activities. "Social workers do not have time to follow up; nobody knows what’s going on with these families," says Gewirtz, a professor of social work at Rhode Island College and founder of The Poverty Institute, based at RIC. She estimates that about 80 caseworkers are supervising 15,000 families. That works out to fewer than 200 cases per worker, but Gewirtz says the ratios vary from office to office.

The economy and the extra difficulty that some people have in finding jobs highlight the need for more social workers. As Gewirtz says, "These are the most difficult to place cases, because the ones who can get themselves off, or with a little bit of help, are [able to get] off. And remaining are the people who need the most help."

Ronald Lebel, associate DHS director, disputes this dire outlook. The department, which runs a variety of programs in addition to welfare, has lost 84 workers since mid-2001, leaving a current total of 1059. But the welfare caseload is declining, too, he says, to 14,181 families.

Lebel says there are fewer caseworkers than Gewirtz cited — 68. But he counts in the workforce assisting welfare families another 73 "eligibility technicians" who help families qualify for the system. Combining the two categories, he says, caseloads average one worker to 99 families. As for families facing sanctions, Lebel says, the majority are in that situation not since workers lost track of them, but because they’ve refused to report to DHS offices to discuss their cases after repeated warnings. DHS is no different from any other agency that has suffered budget cuts, he says. "They are working to capacity, no question, their day is filled," Lebel says of the social workers. "And if you were to interview workers, I’m sure they would say they would need help — that’s probably true of every worker at DHS."

A CAP ON the number of authorized positions allowed each year in state government is among the tools being used to control the size of the workforce, according to Peter Marino, policy director of the Rhode Island Public Expenditure Council (RIPEC). The state authorizes a set number of "full-time equivalent employee," or FTEs, which counts part-time as well as full-time workers. "For more than a decade, we’ve had an FTE cap by agency," Marino says. "From our [RIPEC’s] standpoint, it has been a very effective management tool which has forced agencies to make choices: What are the high priorities they want to staff? Clearly, everyone wants to have more resources to do more and better things, but there’s only so much you can do, given a $5.1 billion budget."

Critics say outside consultants are one alternative to the annual FTE cap. The official payroll doesn’t rise, but money is still spent to hire people who may command larger salaries than state workers, critics say.

But some officials, such as James R. Capaldi, director of the Department of Transportation — where the employee count has dropped from 1350 in 1993 to 812, says using outside contractors can be more cost-efficient than maintaining a larger workforce.

One example, Capaldi says, is the state’s approach to snow-plowing: it uses some 90 full-time state workers to run giant wing plows, but brings on 300 private "vendors" to operate other plows for the relatively few — but troublesome — storms that strike in the winter. Given how the number of storms can vary, using hired plows allows the state to adjust its snow-clearing force as needed.

Capaldi says he’s also preparing to hire consultants to supplement the regular force in another critical area — bridge inspections.

Problem bridges are a significant problem here. According to Kazem Farhoumand, a DOT deputy chief engineer, there are 751 bridges in Rhode Island, of which 202 are structurally deficient. Fourteen bridges are closed and another 69 exclude heavy loads. Capaldi says the state is up-to-date on bridge inspections, performing them at least once every two years, with annual or more frequent inspections of bridges with problems.

The 10-person bridge inspection unit has three three-person crews, overseen by an engineer. Using outside contractors will make it possible to keep up with the inspection schedule, for example, if state workers aren’t able to get to 30 or 40 bridges that need examination. "It’s always more expensive to do outsourcing" than to hire state workers, Capaldi says, unless the expanded workforce means more building and capital outlays.

AT THE DEPARTMENT of Health, short-staffing prevents the department from policing restaurants, hospitals, and assisted living facilities to the degree spelled out in state law.

Raymond Rusin, chief of the office of facilities regulation, says the state mandates annual inspection of assisted living facilities, an alternative to nursing homes, where residents who are still largely self-sufficient can live with some help from staff. But Rusin and Donald C. Williams, associate director for health services regulation, say the health department inspected 49 of 71 facilities in 2002 — meaning 22 weren’t inspected. This year, there are 73 facilities, and about 30 percent probably won’t be inspected.

Williams says only 1-1/2 FTEs are assigned to the assisting living inspections, and that probably three are needed. Issues to be checked include whether facilities for frailer residents have enough built-in protections, such as sprinkler systems, and whether residents are healthy enough to be in the facilities instead of nursing homes. The record with the 101 nursing homes in the state is much better, Williams says, thanks in part to federal funding that pays most of the inspection costs. The federal money assures inspections at nine-to-15 month intervals to make sure they meet Medicare and Medicaid requirements.

It wouldn’t take an overwhelming increase, Rusin says, to enable the facilities regulation unit to do all the work spelled out in state law. His 25-person staff would need just six more workers. But without the extra help, much of the routine jobs can’t be done, including overseeing the state’s most complex health facilities: its 14 community and specialty hospitals.

This does not mean that hospitals escape scrutiny. The health department investigates when it receives a serious complaint, and it gets more than 100 a year. Further, once every three years, hospitals are subject to thorough reviews by an outside national group, the Joint Commission on the Accreditation of Healthcare Organizations.

But as a regulator, Williams is uneasy with the status quo. As he says, "It’s hard to be comfortable issuing licenses to entities we don’t inspect."

ALSO WRESTLING with life-and-death responsibilities without enough staff is another health unit — the office of food protection.

One long-time food inspector, who asked not to be identified, has been tracking staffing levels for more than two decades. In 1981, the worker says, there were 33 food inspectors supervised by 10 persons, and the office’s total headcount was 59. Today, she says, the office has a 21-member staff, with 11 inspectors.

The chief of the division, Ernest Julian, says there are 12 food inspectors. But he doesn’t gloss over the problem of a limited staff. If Rhode Island could meet standards recommended by the federal Food and Drug Administration, it would have 73 to 84 inspectors, Julian says.

The shortfall means that thousands of restaurants and other facilities that prepare food escape inspection every year. "We think 1000 to 2000 could be operating right now and don’t have licenses," Julian says. "We don’t know who they are."

To cope with this impossible workload, the division has devised its own triage system. A first priority is to investigate complaints, of which it gets about 1000 a year. The department also makes sure it conducts inspections when new places open, Julian says, "To make sure they get off to a good start." There are also provisions for 1000 reinspections, to make sure problems are corrected once they are spotted.

"High-risk" facilities, so designated because of past problems or since they have people who could face serious illnesses, such as nursing home and hospital patients, or school children, are also a priority. But low-risk operations, mid-sized restaurants, bars, small stores, and markets, Julian says, "Just aren’t done — thousands aren’t inspected every year. We may not see them for years, if there are no complaints."

Asked about the potential consequences, Julian says the lack of inspections could hypothetically result in someone’s death.

For example, a type of bacteria known as Listeria can grow in hot dogs and luncheon meat, if contaminated, and then keep for long periods. Julian says the organism can cause miscarriages in pregnant women and death in elderly individuals.

The division chief says that the majority of problems in kitchens are due to mistakes or lack of knowledge, not deliberate shortcuts.

A commonly used cooking utensil is a five-gallon stockpot, Julian says. If the heated pot is put in a big refrigerator, it takes a full three days for the liquid to cool. In the meantime, it remains a breeding ground for bacteria. Remedial measures call for placing the soup or other liquid in shallow pans, smaller containers, or using ice baths to chill the containers. But some workers "don’t have a clue" about the danger, Julian says, or the ways to avoid it.

ACCOUNTS OF UNDERSTAFFING come up in other departments.

Reitsma says during his four-year tenure heading the Department of Environmental Management, it’s lost 50 workers, with a staff now of about 530. He’s not ready to concede the need for more workers without first trying to use more efficient and innovative techniques, and redeploying staffers to vital areas. But he says water quality inspection, fisheries regulation, law enforcement, and boating safety are vulnerable areas.

Just how many state workers Rhode Island actually needs is unclear. At RIPEC, Marino says the watchdog group thinks the optimal number — and the amount that Rhode Island can afford — may be about 15,000, about 289 lower than current levels.

Rhode Island ranks 16th among the 50 states in the number of state workers per resident, according to the US Census Bureau. That’s lower than Connecticut, which is 14th, and higher than Massachusetts, which is 36th on the list. Some experts feel the estimate may be flawed, because it reflects 20,000 full-time equivalent workers, rather than the 15,289 currently authorized. Further, many states employ workers at county levels who carry out the functions performed by state workers in Rhode Island.

As he anticipates the completion of the Carcieri Fiscal Fitness review, departing administration director Higgins says the answer to the state’s budget problems isn’t to endlessly keep reducing the staff. He notes the administration’s determination to curb the increasing cost of employee fringe benefits by requiring workers to pay a share of their medical insurance premiums and to assume a greater percentage of pension contributions. Higgins says there are also areas that can be streamlined.

Given the rise in unfilled vacant positions in the past 2-1/2 years, says state budget officer Rosemary Booth Gallogly, "There are things that probably aren’t getting done, and things not getting done as well as [department directors] would like. Eventually, we are gong to get to the point where we have to make key decisions: it’s not important to have this service, and these 15 people will have to do something else."

What does seem clear about the current level of the workforce is that, at minimum, certain areas are seriously understaffed. This suggests that life and death problems — that might be prevented — could occur.

When there is demand for reform of a state agency under the public spotlight, adding more staff may be among the measures to improve operations. Carcieri, for example, has pledged to tame the registry of motor vehicles, one of the state’s most infamous agencies. One of his reforms was to add nine customer service workers.

And earlier this year, when the governor and the General Assembly enacted sweeping reforms intended, they said, to make Rhode Island the most fire-safe state in the nation, one of the moves was to boost the staffing in the State Fire Marshal’s Office. Six workers were added — a 29 percent increase. If this difference could have helped prevent the Station fire — a contention that may be thrashed out in the pending wave of lawsuits — the move came months too late.

Brian C. Jones can be reached at brijudy@ ids.net