Features

November/ December 2011 Taxing the Kindness of Strangers

Foster parents like us willingly pay a heavy price. The GOP wants us to pay more.

By Benjamin J. Dueholm

Children, once an economic necessity, have become a luxury. We are able to afford them—to feed, clothe, house, enrich, and educate them into their teens or twenties in a state of complete economic idleness—with considerable help from the development of the welfare state. This is true, albeit in different ways, for Americans across the class spectrum. The housing, health insurance, and daycare costs of middle-class and wealthy children are subsidized through the tax code. The needs of poor children are met (inasmuch as they are) through a patchwork of direct expenditures that includes Medicaid, nutrition programs, and housing vouchers. Sophia qualified for some of these services automatically by virtue of being in the foster system, and it was incumbent on us to make sure she got them.

In the basement of our county health department, two weeks after Sophia’s arrival, we waited for our first appointment with the Women, Infants, and Children (WIC) nutrition program administrators. We were the only native speakers of English on our side of the counter, and we had to contend with the alien experience of being asked to demonstrate our poverty and to provide a host of documents we did not possess. We finally established Sophia’s eligibility through a splendid transitive property of indigence whereby her Medicaid card was proof of her WIC status. Thus persuaded, a nurse examined her height, weight, and iron levels. We were handed a stack of coupons for formula, baby food, and a few other staples following a course on nutrition that a middle-class parent might be strongly tempted to find demeaning.

WIC coupons work like this: each coupon specifies both what may be purchased (usually the “least expensive brand”) and a total cash value, in case you are tempted to purchase items of your own choosing. Each coupon must be rung up separately, and no personal money may be used to top off an order (though more than once a sympathetic cashier has shaved a little off a total when I miscalculated the weight of $6 worth of fresh fruit). You can also forget about defrauding Uncle Sam by swapping the coupons for cash, since each one needs to be signed in person with a signature that matches the folder that accompanies them.

We adjusted rather quickly to being treated like morons and petty thieves by bureaucrats. The social anxiety that comes with buying welfare food among our fellow citizens was worse. Middle-class people like to think of themselves as self-sufficient. But after a few months of shopping with WIC coupons, and contemplating my own sense of shame at this, I came to realize that we are rather selective in the forms of dependence we disdain. People who would not give a second thought to claiming the child care tax credit or the mortgage interest deduction will blanch at getting a bag of frozen peas on the public dollar. A WIC order grinds the line to a halt and prompts me to feel all kinds of self-consciousness about my deportment, my children, and the purchases I make with my own money. I got to know which cashiers were least given to suspicion or contempt, and I gratuitously mentioned Sophia’s foster status to defuse my own irritation. I don’t relish using the coupons, but they really help. When poor weight gain necessitated supplementing Sophia’s diet with PediaSure (at $12 for six bottles), the coupons became more valuable still.

Over those first few months, Sophia’s broken bone healed, her complexion brightened, and her sleep habits settled down a little. Our son fell for her even harder than my wife and I did. By Christmas they were inseparable, laughing when the other laughed and going together, Spartacus style, into time out when the other was being punished. Even after her initial injury healed, however, Sophia was a sick little girl. In the fall she had a string of ear infections that brought us to the doctor at least twice a month. A specialist determined that she needed ear tubes and was willing to take Medicaid. But this time it was the state that was unwilling to pay—a fact we learned only days before the surgery was scheduled to take place. We ended up leading an impromptu lobbying effort with Sophia’s caseworkers to change the minds of the state’s Medicaid bureaucracy, an HMO of the damned. They relented, in the nick of time, and Sophia was spared more months of perforated eardrums.

We had the same procedure done for our son less than a year and a half earlier with much less drama. But his health care is secured by private insurance and subsidized by a huge income tax exclusion. Sophia’s health care will only become harder to secure as providers leave the field and state Medicaid programs face tightening budgets.

Both the subsidy for our son and the expenditure for our daughter expand the scope of the federal government, and both impact the deficit in the same way. Yet when the time came to strike a deal over taxes and spending in order to increase the debt ceiling in August, the expenditures that support the children of the poor were on the table while the expenditures that support the children of the middle class and wealthy, thanks to the unwavering insistence of Republican lawmakers, were not.

As the “super committee” goes to work, the same story is set to be repeated. The White House successfully insulated Medicaid from the “trigger” mechanism that will produce automatic cuts should the committee fail to reach an agreement. But in that scenario every other program for poor children will get hammered, from WIC to early childhood development assessment. At the same time, plummeting federal aid to the states will tempt state-level lawmakers to cut into their half of the Medicaid spending formula. Either way, the interests of poor children—and the tools that make modern foster parenting possible—are coming to a dangerous pass.

The reward for persistence in foster parenting tends to be more requests to provide foster parenting. In March, a caseworker asked if we would take two brothers, a one-year-old and a five-year-old, for ten days while their foster family took a vacation. “Well,” my wife said reluctantly, “ask the other foster families, and if you really need us …”

“We really need you,” she was told.

Benjamin J. Dueholm is a writer and Lutheran pastor working in Chicago.

Comments

  • Six on October 23, 2011 11:03 PM:

    To foster is to "to promote the growth or development of; to further; to encourage; to bring up, raise, or rear; to care for or cherish." You've taken a small piece of our broken world into your home and hearts to heal, to nurture, to foster in all the senses of the world.

    Thank God for people like you!

  • Fran Ransley on October 25, 2011 12:36 AM:

    Foster parenting pays a lot better than welfare.
    Twenty years ago I was a single parent of four children, a re-entry university student, and a welfare recipient. We were on welfare mainly because the county's child support division was not very zealous at going after the childrens' father for support and I had no private resources to sue him for support.
    I had received a scholarship from the Soroptimist organization to help with my college expenses. At the awards ceremony, a woman came up and introduced herself. She was the wife of a local doctor and had been a foster parent to many children. Two of the children she had fostered were from a large family.
    She said that once a month the foster parents of the children in this family arranged a day when the children could all be together with their biological mother. At one of these gatherings, the foster mother had an epiphany when she looked around the room and did some math, calculating how much the biological mother would have had at her disposal if welfare paid her the same amount per child as the foster parents received.
    She realized that none of the financial problems that led to the mother losing her home and thus her children, would have occurred if the biological mother had had as much income from welfare and child support, as the foster parents were getting from the state to rear her children.
    On a positive note, I finished college, found a job, and eventually paid many times more in taxes than the children and I received from welfare.

  • Fran Ransley on October 25, 2011 12:46 AM:

    Addendum: On another positive note, the author, Mr. Dueholm, has insight and compassion, and articulates very well the many indignities and slights that are the lot of poor parents at the WIC clinic, in the grocery line, and the hospital.
    I must add that my childrens' father did provide medical care through his employment. Our community was also fortunate to have a primary care pediatrician who would never turn away any child regardless of the parent's inability to pay, so even the poorest children could at least get into a doctor's office.

  • toowearyforoutrage on October 26, 2011 11:33 AM:

    Not to make it easier for Republicans to snuff Democrats (a.k.a. "the poor"), but shouldn't foster families be provided with resources NOT tainted with the stigma of traditional assistance programs?

    You trust them with children, you don't trust them with a check to secure necessities?

    Kinda revealing about our values towards money and people. You need to guard the one more closely than the other.

  • Dan B on October 27, 2011 4:29 AM:

    "Foster parenting pays a lot better than welfare."

    It's supposed to. Welfare is supposed to be temporary help, not a lifestyle. It's not supposed to be comfortable.

    Over the years three of my relatives have not gotten married to the fathers of their unborn children because they could get more money from the state that way. At some point "helping" becomes "encouraging dysfunctional behavior".

  • Sarah Laine on October 31, 2011 12:31 PM:

    We foster our niece. We were a family placement, and we got I think a little over a dollar a day. We then got our adoption paperwork partly done (we're still working on the adoption) and now we get over $19 a day, which I am told is what we would have been making all along if we weren't a family placement. In all honesty, I love the money, but it is all unnecessary. I believe people who are in a position (financially) to foster should, not people who are looking to make a buck. The foster system is rife with abuse because of the pay associated with it. Horrible monsters take in kids who in some cases would have been better off with their parents (I've seen it firsthand) and abuse them physically, sexually, and/or mentally because they're lowlife's waiting on a check. I'm not saying most foster parent's do this, but there are people out there abusing the system. My husband and I have even spoke of fostering and having him stay home and making that our source of income. I don't like this idea, as I feel I have enough kids to care for as it is.. I honestly don't know what data the author is using for his article, but it isn't accurate in my experience. We have had absolutely no problems with the medical side of things, and our niece has had to have extensive medical work. But, the key factor here is that if we had to pay for it all ourselves, we could. When he states that no personal money can be used to top off a WIC order, that's just blatantly untrue. If you go over your allotted "$6 worth of fresh fruit" the standard procedure is to pay the $6 with the WIC check, and charge the rest to the customer if they so desire. As far as selling food stamps or WIC checks people do it ALL the time. They buy the food themselves and sell it afterwards to the person they spoke with before and made a deal with. My old roomate used to sell her food stamps. The going rate is $.50 for ever dollar if someone cares to know. Anything that Medicaid was unwilling to pay for we were always reimbursed for by CPS. This country is in crisis economically. We've made wrong turns everywhere, and now we find ourselves in deep. Pouring more and more money into insurance companies and government run medical programs is not the answer though, it is the problem. We have enough money to pay our medical bills, and if insurance companies and government had never been involved, a lot more people would too. We don't however, have enough money to pay for the entire nation. I don't WANT to pay for the entire nation. And I'm not even the 1%. Taking on a foster child is work, it's SUPPOSED to be work, there is a reason raising kids is so hard, and not just financially. Love grows out of service and striving, and I wouldn't want it any other way. This guy needs to stop his whining.

  • emjayay on October 31, 2011 1:11 PM:

    Benjamin J. Dueholm: I think the response from Sarah above needs some sort of reply from you.

  • Anonymous on October 31, 2011 2:45 PM:

    We have been fostering for over 2 years now and have several children, some long-term and some for respite. The author's experience matches ours in most respects.

    We have one child on WIC and yes, we can pay cash for fresh produce that is over the $6 limit. We have never had any problems with getting medical or day care assistance, probably because our area is so poor that most people are used to dealing with Medicaid and DSHS.

    But in other respects, the story was like reading about ourselves. Short notice phone calls, desperate placement workers, very ill children, even the garbage bags of clothes (when you get any) has been the norm for us. We can handle these things, but there is so much more going on...night terrors, hurting themselves or others, destructiveness, usually very low academics, and more. Without the support of the caseworkers, we probably couldn't continue this. And yet, in our state the workers must take furlough days frequently and they are so loaded with cases that they can't always take phone calls.

    And no, you can't make money at this, at least the way we do it. Even leaving off the medical bills (which we could definitely NOT afford, given how sick these children are), clothing, toys, books, sports, all those things that we do for our foster kids just as much as for our biological child far exceeds the child support. Just outfitting the house for our first infant cost more that the support for the week that he was with us. We've purchased multiple car seats/boosters, high chairs/boosters, cribs/toddler beds/twin beds, etc. because each child is a different size or has a different need. Perhaps if we continue fostering we won't have to make new purchases each time a new child arrives.

    However for now we are not taking any more children. Our household has stabilized after one child whose behavior threatened himself, others, our house, and caused stress-related health issues for me, moved to a therapeutic home, and a second child whose sexually reactive behavior required constant monitoring moved home. No amount of money that was offered was enough for us to continue with that situation. Now, though, we have a very nice situation with two foster children and our bio child.

    Fostering is not easy, nor is it a money making enterprise. Cutting the supports in place (Medicaid, WIC, caseworker availability etc.) only makes it less justifiable for us to continue.

  • Artemesia on October 31, 2011 4:16 PM:

    I have been a foster parent and this article resonates -- it is hard work and the support from the bureaucracy makes nearly impossible work. We had intrusive bureaucrats e.g. a case worker who wanted to shop for the child's clothes instead of us spending the allotment on clothing that would fit our home, the child's school etc which we were familiar with; we won that round but there were constant hassles. We could not find a dentist for our child who would take medicaid or a pediatrician; if she was sick we had to go to a clinic and wait for hours. We both had jobs.

    The money doesn't come close to paying the actual expenses. The idea that people are in it for the money is absurd. The only way that would work would be to have lots of kids and feed and cloth them badly.

    Every time we needed advise e.g. should we let the grandparents take the child out on a visit to our town to see her or what permissions do we need and who can sign off on her going to Scout Camp or on other programs needing permissions, we were met with no help at all. It was always 'well what do you think?' I was an amateur, I did not know what we should or legally could do. When the child's mother was filling her head with stories that got her hopes up but were unlikely to come about and we asked that her visits be supervised, they suggested we supervise. It is hard to imagine a more inappropriate role for a foster parent whose child's mother is in jail.

    We did it because we wanted to help this child. We took her on vacation with us. We made sure she had what other kids in her school had and got to go on the trips etc that they did. We made sure she had clothing that helped her fit in. We worked with her on her academics; she was years behind and in a very fast paced school. In her time with us her academic abilities were transformed and her ability to entertain herself and take responsibility greatly increased. It was worth doing and I hope it helped her build a better future.

    But it is tough to have so little support. For us it was never the fact that the money doesn't pay the child's expenses but that we were in so many catch 22 situations with so little help from the experts, themselves underpaid rather clueless bureaucrats.

  • Mom on October 31, 2011 7:33 PM:

    My experience is different from others that have commented in two ways:

    1) Rather than being foster parents, my husband and I chose to adopt through the foster care system, but without fostering the children first (which is what our state recommended in our situation). Nonetheless, we got foster care payments until the adoption was finalized, and are getting "adoption assistance" now, as well as Medicaid for our 2 children (who are biosiblings).

    2) Our state is relatively small and relatively generous, I think.

    We adopted our two kids when they were 5 and 7. They had been in the system for 3.5 years. I think their experience shows what is the best and worst about the system in our state. The worst first: After being taken from their extremely traumatic home situation, they were, at one point, placed with a man and woman with many foster kids who are both now incarcerated for mistreating them. The best part: Despite the fact that their case and their situation was very challengin, everyone in the system who worked with these kids adored them and advocated for them. It still took too long to get them adopted, because they had/have "special needs," and were "older," and there were two of them, but they still had people pulling for them and trying to get them all available resources every step of the way.

    So...four years into it we adore them and are so grateful for them. They are very, very loving and dear. The financial support from the state really helps,and we so appreciate their health insurance. The down side is that parenting them, with their intense behavioral issues, is so demanding and stressful that my husband I both now work only part time (despite both having professional degrees) to be able to do an adequate parenting job. Without support from the state, our employers, and our families, that would not be possible. We hope we will only need to do this for a year or two.

    The hardest thing is that even though their behavioral issues are constantly improving in very concrete and even dramatic ways, my husband and I are incredibly burnt out, because those same behavioral issues make it hard for us to leave them with friends or family so we can have an evening off or even a day-long or weekend getaway. I think my husband and I have had 3 evenings alone together in 4 years, and this is even with DDS funded respite (because one of our children has a developmental disability - much easier for us to deal with than behavioral issues, frankly).

    I think that providing foster care is crucially important, and so is adopting those foster kids who can't return to their first families. At the beginning, we regarding the adoption assistance as something nice that would enable us to do more things for our kids to meet their special needs; now we recognize that without that assistance and the services it allows us to access our situation would be that much more difficult.

    I'll also add that although the many people we have worked with in children's mental health have been great, and have made a huge difference, and probably know much more about how to handle this stuff than 30 years ago, they still don't know everything, and we have been given conflicting advice by very talented and successful clinicians. Again, some good news: attachment issues, thought to be among the most difficult to treat, can be addressed...but there's no quick fix. The special education folks, by contrast, are light years ahead of the behavioral people, and the things they have accomplished with our younger child are nothing short of amazing.

    I wish that more people, especially more middle-class people, would become foster care providers, and I wish that states were not so desperate for foster homes that they place too many kids in certain foster homes. Our kids last home before us was a GOOD home with 7-8 kids in all, and the foster parents did a great job, but I don't think that many people can

  • Benjamin J. Dueholm on November 01, 2011 5:32 PM:

    In response to Ms. Laine's comments above, I would direct her to the sources I used. One was the U.S. Department of Health and Human Services IG report on "Retaining Foster Parents": oig.hhs.gov/oei/reports/oei-07-00-00601.pdf. The other sources are all available at Chapinhall.org. Yes, it's possible to move something from a WIC order to my own order, but the coupons stipulate that no money may be used, and some items can't be divided between orders. It's not the worst thing in the world, but it's insulting and inconvenient. And while fraud in any money-exchanging activity is inevitable, WIC fraud must be trivial and low-margin ($0.50 on the dollar for $49 worth of coupons).

    If Ms. Laine and her husband have never had problems with doctors and case workers, that's wonderful. Other people tell different stories, and as the other people weighing in here and on any forum with foster parents attest, the support of public programs--from caseworkers to DDS respite--is really, really important. Take those things away, or cut them, and this becomes very hard to do. We would happily bear the expenses of Sophia's care, but we can't pay for her doctors if the state won't. People who can are few, and people who will even if they can are fewer still.

    Lastly, there are horror stories about foster homes--we hear them much more often than we hear good stories--but "rife with abuse" is a term that deserves some documentation. The foster parents I know are good people who need support to do what they do. If I meet a "horrible monster" I'll report them to DCFS.

  • OR Foster Mom on November 02, 2011 6:56 PM:

    THANK YOU for such an accurate description of our daily lives! I am sharing this with all my friends who really want to know what it is like. I appreciate your insight, honesty and deep examination of the politics that go on behind the scenes.

  • Tee @ Fostering Thrifty Families on November 08, 2011 12:01 PM:

    Thank you for this excellent article. It was, indeed, like reading our own story. We have been fairly lucky with Medicaid, but with a foster child with serious behavioral and emotional and learning issues and a foster child with medical issues we have found that at times it can be VERY challenging to have such a small selection of specialists and therapists, many of whom are frankly awful, inconsistent, or ultra-rushed. We have also seen our children be treated badly by some professionals because of their race or because they were foster children. Apparently foster children are society's garbage and can be treated accordingly, in the view of some of the privileged in our country.

    Because Medicaid does not travel well from state to state, as you mentioned, when we are out of state for whatever reason we must pay OUT OF POCKET for their (expensive, multiple) meds. Meds which treat issues that are organic but also issues that were created by the trauma someone else inflicted on these children. Our older child is regularly hospitalized in psychiatric hospitals because of his mental health and trauma issues, yet we have *no choice* but to send him to an awful Medicaid hospital which is an entirely untherapeutic environment, rather than to the excellent private psych hospital right over the state border that takes Medicaid but just happens to not take Medicaid from *our* state. If our foster son could go to that hospital, he might have been accurately diagnosed and treated long ago but instead we are in the revolving door of the local Medicaid hospital and there's no hope to get out until/unless we adopt him and can put him on our own insurance. It drives me crazy that we cannot have these children on our private insurance which would allow for their needs to be met more adequately, but it drives me crazier that poor children (and foster children in particular) do not get to have access to the quality care they need and deserve to address their copious developmental, mental, emotional and physical health issues. In our family, the stress of parenting a child who has extreme acting out behaviors and a child who has medical issues that require him to frequently not be able to go to daycare has resulted in my being forced to stay home. We would be a comfortably middle class family if not for the fact that we've chosen to commit (for the long haul, whatever that looks like) to two children with special needs. Due to these needs I have no choice but to stay home, and I do whatever work I can do from home in between doctor's visits and therapist visits and PTSD-fueled tantrums. Because of this, even with the check from CPS (and we live in one of the more generous states in terms of stipends) we barely make ends meet... and some months have to put child-related expenses on credit cards that who knows when we'll pay off.

    But you know how I know we are still middle class? Because of the guilt and discomfort I feel using those WIC checks. Using WIC has been incredibly humbling. I am a healthcare professional, and sitting through those nutrition classes is nothing short of humiliating. Yet I have the privilege to only have to use services like WIC for my foster children rather than to rely upon them for my own survival, and when/if we stop fostering I can step back into the world of people who don't regularly have to wait for hours in crowded public health clinics or hold up the grocery line for an hour because the cashier can't figure out how to process WIC checks. It is crazy to think that if our foster children are not adopted by us but instead reunified with birth family, we will return to the world of "nice respectable people" whose kids do not run out in the middle of the street in traffic to try to get what they want due to no one ever teaching them they could get their needs met without doing drastic and dangerous things or threatening suicide. That I would likely never step foot in a WIC office again. But I would

  • Josh on November 15, 2011 6:36 PM:

    @Sarah Laine - there is great differences between the states in the amount of support and availability of services. Even for federally funded programs. I am not really familiar with the specifics of WIC, but very familiar with foster care and adoption assistance. Many states have gotten stingier on the adoption assistance rates.

    Kinship families often get less support than a stranger foster family, and that needs to change. We need in take workers at CPS to allow relatives involved in the child's life to make informed decision, not divert the children from the foster care system to an informal relative placement.

  • Mary EC on November 18, 2011 11:34 AM:


    I knew I was going to like Benjamin J. Dueholm's article about being a foster parent when I saw the cartoon that accompanied it, the "Uncle Sam" character tiptoeing away from a baby in a carrier with a note saying "Good luck" pinned to the front. As a foster parent myself, I have literally been told "Good luck with that," when I called my social worker for help with a problem.

    I usually don't like things written by other foster parents. They are too sappy and self-promotional. Mr. Dueholm was more honest than most, that foster parenting is really, really difficult, and the worst part usually isn't the kids. Itís the social workers who micro parent one minute, then won't return calls the next. Itís the information withheld until the child is settled in your home. ďDidnít I mention the fire he started in his last foster home?Ē And yes, it is the looks you get from health care professionals when you show your state insurance card. I know what they are thinking. I am a nurse. I want to say, "I am one of you, not them."

    But that us-against-them attitude is something I got over after a few years as a foster parent. I give Mr. Dueholm credit that he seems to reach that point almost immediately. He realized that what he was experiencing was the norm for families who depend on state aid. And it adds to the stress in their lives enormously.

    I just wish he had taken it one step further and considered what it is like for poor families when, on top of everything else, they lose their child to foster care. And that is who loses their child to the system most of the time. It is said that child abuse crosses socioeconomic lines, but foster care doesnít. It is the poor who are put under the microscope at their doctorís offices, their Head Start preschool programs, and their state welfare offices. And sometimes judged unfit to raise the child they love.

    Put yourself in those shoes.

    Once I got to know the parents of the kids in my home, I started wondering if I could have held up under the stresses they dealt with. Most had done their absolute best, loved their kids as much as any one I knew, then made one mistake. And poof! Their kids were gone. Gone into the wildly expensive foster care system that will damage them beyond repair, then send them out into the world to try to make it as low income Americans.

    States that have made family preservation a high priority have saved money and kept kids safer and saner. Politicians should latch onto that.

    I know some children really canít stay with their families, but they would still have the really great foster parents like the Dueholms, because an uncrowded system would give them the support they need to stay in the business.

  • sarah on December 21, 2011 7:18 PM:

    Thank you so much for this touching and honest article about the emotional and financial realities of being a foster family.

  • Fran Ransley on January 03, 2012 4:22 PM:

    @ Tee, I'm not middle class and never was, but the guilt, self-blame and humiliation of having to take "government assistance" to provide for one's children crosses all class boundaries.

  • Richard Pressl on February 27, 2012 2:42 PM:

    To those who perceive life in the same terms as Ms. Ransley: I assume that when it comes your time to qualify for Social Security and Medicare that you will refuse to accept it.

    If not, shut up, and stop being ( fill in the blank )

  • rover27 on February 27, 2012 7:03 PM:

    @Mr. Pressi...I presume you're talking about Ms. Laine, not Ms. Ransley.

  • JF on July 02, 2012 7:00 PM:

    I am an unpaid foster parent. I receive nothing from the state. And I'm a Republican.

    When you complain about the "stinginess" of the state, you fail to acknowledge that states have no income. The money comes from your friends, neighbors, and other fellow citizens. What you are demanding is that taxpayers cough up more money for the keep of your foster child - money that in this economic climate they likely need to support their own families.

    Being a foster parent is a choice. If you are unable or unwilling to bridge the gap between a child's costs and the amount taxpayers are footing, perhaps you should give it up.