In the small building that houses the day center for Open Arms Care in Ooltewah, dozens of languages circulate every day.
Not all the languages are spoken. Some people tap messages into computers or boards. Others communicate their preferences and personalities through a particular wave or word, a special smile or frown. Some paint, or point lasers to show staff members where to put color on a canvas. Some are learning to speak aloud for the first time.
Each client at Open Arms communicates in a completely unique way. That's because the center provides care for people with a wide range of developmental disabilities -- severe autism, long-term brain damage, cerebral palsy, or those impacted by severe injuries. While many are non-verbal, Open Arms works to give them a voice in other ways.
But Director Lisa King worries that these voices will not be heard by state officials as budget season approaches.
Organizations that work with those developmental disabilities -- places like Open Arms Care and Chattanooga's Orange Grove Center -- say they face "a critical threat" as budget season gets underway. Proposed state budget cuts to the Department of Developmental and Intellectual Disabilities (DIDD) amount to $21.9 million -- with the potential to lose millions more in federal funding because of the match that comes through the state's Medicaid waiver.
"We still have to provide these services to our clients. With cuts, how do we do that?" asked King. "Are we going to cut speech therapy? Physical therapy? We will have to pick."
Advocates say such cuts, if adopted and approved, could "devastate" agencies already stretched thin as they try to care for 11,000 of the state's most vulnerable residents on a budget that only gets tighter.
"It's very difficult, because the population we're serving is not one where you can easily say 'this is not needed, that's not needed.' These services are ongoing and extensive," said Kyle Hauth, executive director of the Orange Grove Center, which serves about 1,000 people in the region.
While funding for the department has decreased over the last decade, costs have only gone up as health care costs climb and as people with disabilities live longer. And 6,500 people linger on a state waiting list for disability care.
"We get calls constantly, people begging for help," said Robin Liner, who is program director for Open Arms and whose 40-year-old daughter Lori -- who has Down syndrome -- has lived at Open Arms for 12 years.
Cara Kumari, spokeswoman for the state's Department of Developmental and Intellectual Disabilities, said the cuts had to be proposed, since Gov. Bill Haslam requested a plan for a 7 percent reduction from each department for his upcoming budget.
"We try to make [administrative] cuts to ourself before we ever look at impacting our services," Kumari said. And it remains to be seen, she said, whether the governor will actually include the cuts in his budget.
The governor's spokesman, Dave Smith, did not comment directly to the proposed DIDD cuts, saying the governor's budget for this next fiscal year has yet to be presented. But just because departments proposed 7 percent cuts, Smith said in an email, "doesn't mean those will be taken."
Still, advocates say they cannot sit back. At least 60 providers in the state could be affected by cuts, says Anthony Hicks, who works at SRVS, an agency in Memphis similar to Orange Grove.
Ultimately, he said, the cuts could affect thousands of people "who cannot take care of themselves -- the 'least of these,' so to speak."
"We just feel like this is urgent," Hicks said.
'NOT A BABY-SITTING SERVICE'
To describe the importance of long-term disability services, on Tuesday, Lebron Sterchi just had to look to his right and to his left.
On his right sat his brother Michael Sterchi, who started going to Orange Grove's original day program in the late 1950s. Michael had suffered brain damage during birth, and as a young boy was so aggressive his mother did not know how to care for him.
But Orange Grove helped change Michael. Now 62, he is cheerful and calm. He lives in a group home that is run by the center. He has worked various jobs, and now works at Orange Grove's recycling intake center. He's a big Vols and Titans fan, and has not decided who to root for in the Super Bowl.
On Lebron Sterchi's left sits Rebecca, his niece on his wife's side. Rebecca has long suffered from debilitating seizures. At 28, she also has schizophrenia, is largely wheelchair-bound and is non-verbal. After her mother died seven years ago, the Sterchis thought one of them would have to retire to care for Rebecca full time. But then she was accepted into Open Arms, where she is provided residential care and day services.
"Till you walk in the shoes of someone who has a loved one with disabilities, you have no idea what a blessing it is to have these services," said Lebron Sterchi.
DIDD was created to help provide basic, daily care for those with disabilities. But centers like Orange Grove and Open Arms do much more. Clients are taught self-care and work skills. They receive sensory therapy, with lights, smells and textures. They are able to work at the greenhouse and the recycling center. And with such tailored care, many clients exceed their parents' and doctors' expectations.
Melinda and Kenneth Collier saw that happen with their son Paul, now 42. Paul, who was born with brain damage in his left temporal lobe, first came to Open Arms in 1992. He was an elective mute with the intellect of a 5-year-old.
"He would sit around with his head down and not talk to anyone," Kenneth Collier said. "But through the treatments, interactions and medications, he just "
"He blossomed," Melinda finished. "He won't stop talking now."
While Paul has learned many skills, his parents say one of the most crucial things is that "he knows he is important."
"These are not baby-sitting services," stressed Kenneth Collier. "This is an educational experience for all here."
"These people are just like you and I," Melinda Collier said. "They just need a little bit more than you and I. If anything, there need to be more facilities like this."
THE CUTS
Like other departments, DIDD suffered a blow during the recession, seeing about $36 million in funding cuts between 2008 and 2013, Kumari said.
The department has been spared cuts in recent years, she said, and has seen some funding restored.
This year, though, three key cuts worry local agencies. The first is to the Medicaid waiver program, which allows the state to receive matching federal money to pay providers like Orange Grove. The waiver program, which supports services for about 7,800 people, faces a 2.75 percent cut.
Their second concern is about a 4 percent cut to "intermediate care facility services," designed for the most medically fragile cases that require around-the-clock care.
Providers are also worried about the proposed elimination of a program called Family Support services. Those services, considered a "last resort" for people who cannot find help elsewhere, help pay for everything from wheelchair ramps to doctor visits.
Family Support dollars also help families on the 6,500-person DIDD waiting list. The program serves about 4,000 people in the state, and Orange Grove helps about 400 local families each year. If the proposed cuts go through, the entire $7.4 million program would be gone. But, Kumari pointed out, Family Support has been put on the table before, and has always survived.
If passed, the proposed cuts could translate to a $1.6 million total loss for Orange Grove, which has a $36 million budget, and a $376,000 hit for Open Arms, which has a $9 million budget.
While those may seem like small percentages, the organizations' representatives say, many of the funds they receive are assigned to specific services, and the cuts would be compounded by rising costs and slowed donor giving.
Local lawmakers on both sides of the aisle say they want to avoid cutting DIDD if at all possible.
"Places like Orange Grove have helped so many families," said Rep. JoAnne Favors, D-Chattanooga. "I would hope we would strengthen them instead of cutting."
Senate Speaker Pro Tempore Bo Watson, R-Hixson, said "the Legislature has worked hard to preserve funding in the past, and will try to do so again this year."
But, added Watson, this is "the great challenge" in budgeting, as everyone from educators to health care providers is seeking funds from "a pie that's not getting bigger."
Lebron Sterchi says he gets that.
"This is a small population," he said. "But these adults and children are just as important. They already deal with so much. They deserve the best possible."
Contact staff writer Kate Belz at kbelz@times freepress.com or 423-757-6673.