Alcohol Recovery Home Feels the Squeeze of VA Belt Tightening

Jimmy K. Mayer, director of a San Diego alcohol recovery home for veterans, shudders every time the Veterans Administration moans about budget restraints. Budget restraints usually precede program cutbacks, and, for Mayer’s ever fraying shoestring budget, VA cutbacks are always followed by more belt tightening.

In July, officials at the VA Medical Center in La Jolla informed Mayer that they could no longer have a contract with his program, called The Landing Zone, because the hospital was running out of money. Although funding was restored earlier this month, the vagaries of government funding for veterans’ medical needs have put tremendous financial pressure on health providers such as Mayer.

The Landing Zone, for example, would start veterans with alcohol problems on the road to recovery through a 28-day residential program, relying on the VA Medical Center to pay for therapy for up to 90 days per veteran.

‘A Sizable Amount’

Before July, The Landing Zone usually had five or six veterans who were sent there by VA officials to continue on a recovery program. Mayer was paid $17 a day for each veteran while the veteran remained on the program. Although the $17 was much appreciated, Mayer said, it didn’t cover all expenses. It costs The Landing Zone $17.80 a day to house and feed each person enrolled in the program, he said.

“If we got five guys on a VA contract, that means a couple of grand for us. But that ended in July. Two thousand dollars doesn’t sound like much, but with the budget I work with, that’s a sizable amount. . . . The money that we don’t get from the VA, we’ve got to generate somewhere else.”

Mayer runs his recovery home on an annual budget of $253,846. The program provides an alcohol recovery program for 36 men, mostly Vietnam combat veterans, and 10 women, including two single mothers. From that budget, Mayer also has to pay rent, a program manager, a counselor and a full-time cook. The average stay for people in the program is six months, but some stay up to a year.

“Fortunately we aren’t completely (dependent) on the VA for funding,” Mayer said. “The guys whose contracts aren’t paid by the VA still have to pay $220 a month to stay here. . . . But a lot of times I don’t take any money up front from guys who need our help. I usually give them 30 days to find a job to start paying for their room and board. . . . When we do have those five or six VA contracts, it’s a little reassuring because that means guaranteed money. But the money is just not there anymore.”

The cutback in the alcohol recovery program was a discretionary move by the VA Medical Center in La Jolla. Every medical center operated by the Veterans Administration is given wide latitude in determining how its operating budget is used. As a result, many local centers have taken to instituting discretionary cuts in 1988 because their funding from Washington was not increased over 1987.

Same as Last Year

In the case of the La Jolla hospital, its budget for fiscal year 1988-89 is about $86 million, the same as for fiscal year 1987-1988, said spokeswoman Cheryl Korman.

“Because of budget restraints, each facility was required to look at its workload. . . . The VA’s budget was actually reduced, and everyone had to make decisions about how medical care should be distributed,” Korman said of the fiscal 1988-’89 national budget.

Consequently, VA officials in La Jolla announced last month that, beginning Dec. 1, the facility would provide medical care only for veterans with service-connected disabilities and for those with non-service disabilities who are at or below the poverty level of $15,833 a year.

Before 1986, virtually every veteran, regardless of income, was assured medical care at most VA facilities. But, in a move in July, 1986, to reduce government spending, Congress established three income categories for veterans in an attempt to save money by reducing the number of patients treated by VA hospitals. The rationale was that veterans whose earnings were above a certain level either had employer-sponsored health plans or could afford to pay for medical treatment.

Before Dec. 1, VA officials used the three categories--labeled A, B and C--and seven other criteria as a yardstick to determine who qualified for medical care at a VA facility. According to these guidelines, a veteran with no dependents, earning $15,833 or less annually, was placed in category A. Single veterans earning $15,833 to $21,110 were placed in category B, while single veterans earning $21,111 or more were placed in category C. At the high end of the scale, a veteran with six dependents was placed in category A if his income was $24,274 a year or less.

The categories were used to rank care at VA medical centers, with veterans falling in category A having the highest priority. Different income levels were also used in each category for veterans who had from one to six dependents.

Not an Easy Decision

In announcing the discretionary cutbacks in La Jolla, Korman said that, except for medical emergencies, care for all veterans falling in categories B and C would be suspended beginning Dec. 1.

“It wasn’t an easy decision to make, and we realize that many veterans will not be pleased,” Korman said. “But priorities had to be established in terms of medical care so we can work within our allocated budget.”

Despite the cutbacks, Korman emphasized that indigent veterans, including those who are homeless, will continue to receive medical treatment. “It’s only right. . . . We aren’t going to abandon the poorest of the poor,” she said.

Korman estimated that about 2,000 veterans in San Diego and Imperial counties will be affected by the cutbacks. She estimated that the La Jolla facility has had about 236,000 outpatient visits in 1988 and that only about 13,000 such visits would have been affected by the new rules if they had been in effect all year. VA officials estimate that about 264,000 veterans live in both counties.

“We have received a lot of inquiries from people wanting more clarification. . . . When we were planning for this, we met with several veterans groups in order to brief them. They were supportive and were useful in getting the word out to vets in the area,” Korman said.

Although cutbacks and reductions in services were mandated nationwide by VA officials in Washington, response was by no means universal or as quick as that of the La Jolla hospital.

Lewis Stout, a spokesman for the VA Medical Center in Long Beach--another area with a high concentration of veterans--said officials there are “evaluating our options.” For the time being, service continues as normal, he said.

Donna St. John, spokeswoman for the VA in Washington, said the agency’s 1988-’89 budget is about $28 billion, with $10 billion of that earmarked for medical programs. She said the agency submitted a request to Congress for supplemental funding in September and anticipates that additional funding for medical programs may be available early next year. She declined to reveal the size of the supplemental request.

The irony in all this is that savings derived from the controversial cutbacks in local medical care seem in turn to have generated new funding for Mayer’s alcohol recovery program. In mid-December, Mayer was notified by local VA officials that money is again available to finance the La Jolla facility’s alcohol-abuse program, after a six-month absence.

“I just got a letter telling me that funds will be available again beginning Jan. 1,” Mayer said. “That’s good news for us. But you wonder, the cutbacks in medical care went into effect on Dec. 1. That had to produce some savings. Will we be getting some of those savings? . . . I wish we could go back to the times when the VA didn’t have to worry about saving a buck here and there. . . . When we agreed to serve, the government made promises to us that aren’t always being kept.”