Arizona Agency Leaving Developmentally Disabled People Behind

Hayden Corn, 52, has received health care services through the Department of Economic Security's Developmental Disabilities Division for the last 25 years.
Hayden Corn, 52, has received health care services through the Department of Economic Security's Developmental Disabilities Division for the last 25 years. Hannah Critchfield
Hayden Corn is waiting for a text message.

It isn’t a vacationing friend's selfie, or a family member wanting to chat.

It’s word from his caseworker, and for Corn, a 52-year-old living with cerebral palsy, a response, or lack thereof, could be the difference between life and death.

He hasn’t heard back in over a week.

Corn is relatively independent — he lives alone in his Mesa home, save the company of four Chihuahuas. He travels by wheelchair, and communicates adeptly with his electronic speech device. But when it comes to his health, he still needs some help, including assistance from caseworkers employed by the state.

Corn has relied on the Department of Economic Security’s Developmental Disabilities Division for a quarter of a century. The division, which provides health care through state Medicaid, seeks to “empower individuals with developmental disabilities to lead self-directed, healthy, and meaningful lives.”

In the last 25 years, conditions have never been as bad as they are now for disabled individuals who rely on the state’s care, Corn said.

Corn is nonverbal, highly intelligent, and has no cognitive disabilities. Using his augmentative communication device, which generates written and spoken speech by pressing buttons on a keyboard, Corn recounted a rapidly changing environment of care over the last year.

He said high caseloads and a steady attrition of caseworkers — Corn's had three new caseworkers in this year alone — has led to inaccurate medical records, inconsistency, and slow service — creating potential danger for both him and his developmentally disabled peers.

The Developmental Disabilities Division (DDD) currently employs 953 caseworkers, also known as support coordinators, according to data obtained by a Freedom of Information Act request. The role of a caseworker is crucial, coordinating all services for developmentally disabled adults and children under the Arizona Long Term Care System, an Arizona Medicaid program that provides affordable care to disabled individuals.

Corn said cracks in the DES service first appeared in 2018, when his case was moved from a DES office near his home in Mesa to the Seventh Street office in Phoenix, a 25-minute drive away. With the reshuffling came reassignment to a new caseworker. Corn said he was provided no explanation for the move. These sorts of changes can be disruptive, as each caseworker must learn his needs and medical history, and the pair must establish a system of communication, as well as a sense of trust and rapport.

But he liked his new caseworker, a woman named Kimberley Spitler, and aside from a four-month stint when the DES temporarily switched him to another caseworker, he worked with her consistently for over a year.

But in March, Corn was informed that his case would again be moved – this time, back to the Mesa office.

“I put my foot down and said no,” Corn said. He asked to stay on with Spitler, but received no response from the DES. He was assigned a new caseworker, he said, whom he met with once. A week after this meeting, he received a text: It was his new caseworker. She was changing jobs, he said, and would no longer be working with him. At Corn’s third DES meeting of the year, he met a third caseworker.

Caseworkers are required to meet with their clients in their homes every 90 days, in order to ensure adequate, relevant care.

“But if you asked to see my file, it wouldn’t be up to date,” Corn said. And he lamented that the practical services he relies on the department to provide have gone unmet.

“I have life alert [on his landline], and am waiting on the caseworker to change it to my cellphone,” he said. He explained that his landline life alert, an installed device that notifies medical professionals of an at-home health emergency with a push of a button, is currently harder to reach than his cellphone, which sat on the table right beside him. Corn texted his current caseworker to check in on this about this a week ago, he said. He still hasn’t heard back. In the meantime, he continues to pay the landline phone bill.

The DES client believes it’s a two-fold problem: Caseworkers have so many clients that they’re required to give each individual the bare minimum – meetings usually last an hour, tops – and the stressful environment, or internal bureaucracy that reshuffles cases, pushes them out of the job, leading a new caseworker to step in where the former left off.

“They don’t have enough people,” Corn said. “I heard people have between 65 and 70 cases. If you do a meeting every 90 days for all cases…” He didn't finish typing, but instead looked up, threw the hand he used to type words into the air, his blue eyes brimming with frustration. His four dogs, racing around his feet in the modest, yellow kitchen, filled the silence with their barking, their paws pitter-pattering against the linoleum tile.

Disability caseworkers employed by the state are required by AHCCCS medical policy to have no more than 40 clients at a time. But recent reports to New Times from over a dozen caseworkers employed within the DDD and advocates who partner with individuals with developmental disabilities, as well as a pending lawsuit against the state, suggest that they’re often assigned far more than that – with some caseworkers servicing as many as 120 people in their caseload. Many caseworkers said the stress of the amount of work they’re being asked to do, and the feeling they’re not able to adequately care for vulnerable clients, has made the job unsustainable.

The DES does not track retention rates of hourly caseworkers employed at the DDD. But records obtained by a Freedom of Information Act request show that of the caseworkers currently employed at the division, around 70 percent have been working there for four years or less. A third of these have been employed for less than a year.

“The turnover rate is just abysmal,” said Jon Meyers, executive director of the nonprofit Arc of Arizona. He believes the high caseworker attrition stems from a lack of consistency in DES leadership over the past few years.

“I’ve been in this role for six years, and in that time, they just hired a fifth DDD assistant director, and we’re going on our fourth DES director,” Meyers said, referring to former DES director Michael Trailor, who announced his resignation from the role last month with little explanation. “There’s no way to ensure a consistent culture, no one to establish a consistent message on the need for DES funding to our Legislature, or to ensure that support coordinators are kept around.”

click to enlarge Corn uses an augmentative communication device to create written and spoken speech. - HANNAH CRITCHFIELD
Corn uses an augmentative communication device to create written and spoken speech.
Hannah Critchfield
The issue is cyclical. Cases are often moved to new offices when a caseworker quits. Or, caseworkers are assigned to new offices without warning to fill employment gaps. Due to this reshuffling, their offices are often far from their new clients' homes, as in Corn's case, leading them to spend many hours in the car each day, and making it increasingly difficult to attend from 40 to 120 client meetings within the 90 day period. This drives up employee dissatisfaction, which drives high caseworker turnover, creating poor service for the people who rely on the state for help.

“It’s a self-defeating system,” Meyers said.

And at the center of it, as if in the eye of a burgeoning hurricane, are people like Hayden Corn.

“Let’s say my communication device breaks. I have to call my caseworker,” Corn said. “If she doesn’t get back to me for a week, how can I talk?

“Think about the disabled people that doesn’t know what is going on.” He points at himself, and then hits the table with his fist. “If I am being walked on, just think what they are doing?”

Brett Bezio, deputy press secretary for DES, told New Times that the agency is "continuously improving its processes to support its employees."

"The retention rates of support coordinators are a target area for improvement for the [DDD] to ensure the quality of care for our members and their families," Bezio said. "Several positions have been added to DDD this year to provide better onboarding and training for support coordinators and improve retention rates."
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Hannah Critchfield was an editorial fellow for Phoenix New Times starting in 2019.