Public Assistance--Values and Lacks
JANE M. HOEY
Miss Hoey Was Director of the Bureau of Public Assistance from 1936 to 1954. From her long experience, she discusses in this article some of the achievements of the public assistance programs, not only for the people served but also for the general economy. More importantly, she points out some changes which could add immensely to their service to the nation in the future.
Over 24 million persons, the needy aged, blind, permanently and totally disabled and dependent children, have received public assistance since 1936, when federal grants-in-aid were made available to the states. In a money economy, there is no substitute for cash income to purchase the necessities of life. When other resources are not available or are inadequate, it is the means to life. This financial aid, supplementing their own resources, enabled needy families to stay together in their own homes and to purchase a minimum subsistence standard of living. It also made it possible for mothers with young children to remain at home to care for them, and for children to have essential health services, to continue their education and have school supplies and necessary clothing. Aged and blind recipients were able to decide as to living alone, with relatives or in a non-profit home of their own choice, and to continue participation in community affairs. Payment of the cost of their maintenance in such institutions, through public assistance, released funds of sectarian and non-sectarian agencies and they expanded their facilities and accepted more residents. Expenditure of public assistance funds in every community in the United States helped to rebuild the economy of states and localities in the economic depression of the 1930's. Currently the annual expenditure of over three billion dollars in federal and state assistance funds is important in maintaining economic levels and serves as a brake on drastic reduction in the economy of depressed areas.
Through provisions in the public assistance titles of the Social Security Act, great progress has been made in fulfilling the obligation of government to secure and protect human rights. For the first time in the United States, the legal right of a needy person to public assistance was established for four groups. Requirements for approval of state assistance plans included: the right to apply for assistance and to have prompt action taken on the application, and if eligible, to receive unrestricted money payments for as long as needed, to have personal information kept confidential, except as required for administration of public assistance, and to have the right of appeal to a state agency and the courts if denied assistance by a local agency. These provisions were all intended to prevent discrimination and humiliation and to help recipients maintain or rebuild their independence.
Other federal requirements, such as a state-wide plan of operation of assistance programs and state-wide standards of assistance and administration, assured availability of the program in rural as well as urban areas, a place to apply convenient to applicants' homes, and equitable treatment of all applicants and recipients within a state's financial resources. The requirement of a state agency to inspect and approve all institutions in which assistance recipients live was to protect the safety and health of children, aged and disabled institutional residents.
While great progress has been made in assuring the right to life for certain groups of needy people through provision of the means to life by public assistance, some needy people still do not have this protection due to restrictions in federal and state laws and resources. In a prosperous country no needy person should be denied the necessities of life. Poverty could be eliminated in the United States, as it has in a number of European countries, by a combination of social insurance and public assistance. This should be an American goal for the immediate future. A good beginning would be provision of a federal grant-in-aid to states for general assistance with a prohibition against any residence requirement in state law.
One assumption of the Congress in 1935 was that the states and localities could provide financial aid, out of their own resources, to needy excluded groups, if the federal government shared the cost of public assistance for such large groups as the needy aged and dependent children. The fact was not recognized that low-income agricultural states did not then, and do not now, have sufficient tax revenues to provide adequate public assistance and other essential welfare services even for those recipients for whom federal-state funds are available. Such states will never be able to provide basic welfare and health services to all those who need and want them until their economy has improved through industrialization and the introduction of better methods of soil conservation and farming. Community development programs are as appropriate for underdeveloped states and localities as for underdeveloped countries. Therefore it would he desirable for federal agencies to plan a united approach and pool their resources with those of the states, business corporations and labor unions to improve the economic situation of such areas.
The inclusion of public assistance with social insurance under the Social Security Act was a most important decision. It has made possible close working relationships in planning, implementing and coordinating both programs. From the beginning there was conviction on the part of administrators in both social insurance and assistance, that need that could be anticipated because of common hazards of life--unemployment, accident, sickness, and old age and disability retirement--should be met through contributory social insurance payments. Also, it was agreed that public assistance should be a flexible supplementary program and not be used to carry burdens better met through social insurance or other programs. However, because all workers throughout the nation have not been provided through health insurance with continuing income for maintenance and the cost of medical care during periods of illness, the cost of support and medical care for needy sick persons has had to be borne by public assistance, hospitals and clinics. Even the limited federal disability insurance program excludes otherwise eligible persons who are under 50 years of age. In addition to the great burden imposed on public assistance agencies due to lack of a health insurance program, gaps and inadequacies in existing social insurance programs have increased case loads. Too low insurance benefits and too short duration of unemployment benefits require supplementation or meeting full need where possible, through assistance payments. Increasing coverage and insurance benefits would reduce a current drain on public assistance funds and provide an income in a more acceptable form to eligible workers and their dependents.
Public assistance payments in most states are only, at best, sufficient to purchase the essentials of life including a minimum amount of medical care. Thus assistance recipients must make full use of other community resources providing services free or at low cost. Public hospitals and clinics are a great help but are not available in many localities. Housing is a very important and expensive item in budgets of low income families. The lack of an adequate nation-wide program of public housing and redevelopment has condemned large numbers of public assistance recipients and other low income families to living in unsanitary, over-crowded houses located in slum areas. For years the menace to a community of concentration of poverty, communicable disease and delinquency has been recognized, but only in recent years has any real effort and money gone into eliminating such areas and providing suitable low-cost housing for those requiring resettlement. Continuation of slum conditions and neglect of people who are forced to live under unwholesome conditions threaten the well-being of the whole community. Children in the slums accept as normal, ill health, limited education, and juvenile and adult delinquent behavior, since they see so much of it in their neighborhoods and homes. Even adults who have had higher standards of living, but are forced through illness or death of the wage earner or other reasons to seek low rents in the slums, become discouraged and lose ambition. In their frustration, some indulge in anti-social behavior. To motivate such persons actively to seek improvement in living standards when they have money only for minimum essentials requires expert help. This does not underestimate the great service rendered by all public assistance visitors in reassuring recipients that they will be available to them for consultation and to meet emergencies with necessary financial aid.
Most of the visitors in public assistance agencies have had no professional social work education. Nevertheless they have learned through in-service training to establish eligibility for assistance and universally prompt payments are made. This is a great service to people in need and full credit should be given to assistance staffs. However, it is more difficult to identify and respond constructively to a variety of non-material needs of recipients. Special knowledge, skills, and maturity of judgment are required. Because of the shortage of professionally trained social workers, low salaries and high case loads in public assistance agencies, recruitment of trained workers to these agencies is difficult. Most of those who are employed act in administrative or supervisory capacities and these are very important responsibilities in these large agencies.
Recognizing the need for trained workers, assistance agencies have increasingly recruited college graduates as visitors so that if scholarships were available for professional training these workers would be eligible. Unfortunately, there are no federal and few state scholarships for social work training. The Congress authorized a limited amount of money several years ago but has made no appropriation under it. A federal social work educational program, similar to the one long in operation for the recruitment of doctors and nurses, is long overdue. Seven million needy people, including over two million children, our future citizens, are worth expenditure of the relatively small amount of money involved to secure competent staff in public assistance agencies. Increasing the federal percentage of administrative costs of state agencies would permit some badly needed salary increases.
Although the federal share of assistance costs has been substantially increased over the last 25 years, the problem of insufficient state funds in low economic states still makes impossible adequate assistance payments. It is also recognized that in some states standards of assistance are not revised at regular intervals to meet changing conditions and costs. Thus individual and collective need is not known and not met, and the right to assistance is denied in part. Also workers with high case loads have little time to spend with applicants and recipients, to help them make maximum use of their own and the community's resources. Administration could be greatly improved if case loads were reduced, functions properly allocated, and well-organized staff development programs were in operation in every state and local agency.
While all public assistance agencies give some social services to applicants and recipients, unfortunately many families who could, with proper help, become self-supporting, do not get the assistance they need because the agency lacks the workers qualified to give it. In some urban areas, casework service is provided to limited numbers of assistance recipients by voluntary casework agencies. But they, too, have shortages of staff and so can only offer occasional help for short periods.
Every local public welfare department should be equipped to give social services to all who need and want them, especially assistance recipients and social insurance beneficiaries. If social insurance agencies could purchase such services for beneficiaries who want them, from assistance agencies, a very good demonstration could be made of their value in making possible a better quality of life for the low-income families.
Federal and state expenditures for assistance and administration have risen steadily and in large amounts since 1936, due to expansions of programs, increases in population and cost of living, and lack of extension and improvements in social insurance programs. No immediate reduction in expenditures can be foreseen. One possibility might be research into the causes of dependency and preventive and rehabilitative measures that might be adopted as a result of research findings. To date little money has been provided from any source for such research. Although vast sums have been provided for medical research, the importance of joint medical and social research has not been appreciated. No federal or state funds are available for this purpose and corporations and foundations have shown no interest in research in dependency. A beginning could be made if federal funds were given to research centers of schools of social work where trained social research personnel are employed. Ample material is available for study in governmental and voluntary welfare and health agencies.