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Keeping Track of All Those Bills: ESBC’s Money Management Program
From the Director
By Catherine May, Executive Director
The following, Budget: Imbalancing Act, by Al Norman, is reprinted from At Home, the Monthly Newsletter of Mass Home Care, the state wide association of Aging Services Access Points/Area Agencies on Aging.
The bright promise of increasing state support for community care services was broken into a dozen line items this fall, as the General Court released its budget, and then supplemented its budget, and then supplemented its budget again. Although Governor Jane Swift’s Report on Long Term Care recommended more funds for home care services over the next five years, that turned out to be the high point of the year, as the numbers started to slide the opposite way. Home care funds suffered from a base of Newtonian physics: what went up, must come down.
The problem with this year’s home care funding is that the program has been thrown out of financial balance. Home care is really two separate line items, both of which are joined at the hip. If one account is out of balance with the other, the program cannot maximize its beneficiaries. Lawmakers raised one account, home care services, by +3.7%, while cutting the other account, care management, by -9.8%. Home care was given a total of $3.5 million in additional funding over FY 2001, while care management lost $3.7 million. This shift of funds from care management to purchased services left the accounts imbalanced. If Aging Services Access Points have to reduce care managers, each worker carries a caseload of anywhere from 80 to more than 100 clients. Lost care managers means reductions in home care clients. Over the years, the percentage share of the care management account has fallen from 35% to 26% today. Although the home care program was one single account into the mid 1980s, the separation into two accounts has created the dilemma of not having enough care managers to keep intake to the program open. The legislature further restricted the financial box the program is in by eliminating a 3% transfer between the two accounts, which was a standard feature of the home care program for many years.
During the extended budget debate, the legislature added the 3% transfer back into a supplemental budget, but failed to close the shortfall in funding. Just before the New Year, the General Court was still debating whether or not to restore funds for home care. On December 14th, the Senate, under the leadership of President Tom Birmingham (D-Chelsea) and Senate Ways & Means Chairman mark Montigny (D-New Bedford), took the unusual move of initiating a 2nd. supplemental budget, this time including $3.4 million for home care support. The Senate version added $2.4 million out of the $3.7 million lost from care management, $740,000 to prevent cuts in the protective services program, and $140,000 to prevent the closure of two ‘supportive housing’ assisted living programs. The House rejected the Senate supplemental, saying it was unconstitutional for the Senate to initiate a budget.
"If the two home care pieces are not in balance," said John O’Neill, President of Mass Home Care, "elders are the ones who suffer. By cutting funds, and putting those funds into little boxes, we are put into a double bind by the legislature. We can’t absorb a 10% cut in services on top of 7% inflation and not hurt needy people." As of January 2nd, cuts in the home care program and protective services reductions began.