From the Director
Support home and community based services.... and save
By Robert P. Dean
As you may know, the Governor has submitted his proposed budget for state fiscal year 2009, which begins July 1, 2008, to the Massachusetts Legislature for its review and recommendations. The House is expected to make its recommendations in April, at which point the proposed budget will go to the Senate, which will make its recommendations in May. Shortly afterward, a conference committee comprised of House and Senate members will meet to reconcile any differences between the House and Senate recommendations. Once the House and Senate reach agreement, the revised budget will be returned to the Governor - probably in June — for his approval, or his veto of any recommendations that he so chooses.
As the House and Senate engage in their budget deliberations this April and May, we have an important opportunity to support the preference of Massachusetts seniors to remain in their own homes and communities by asking the Legislature to provide an appropriate level of funding for the services seniors need, so that they will have a true choice as to where they will receive their long-term care services - at home or in an institution. As we consider this opportunity, we should keep in mind that it costs far less to provide long-term care services at home than it does in an institution.
The following budget priorities are designed to recognize the overwhelming preference of seniors to live at home and in the community for as long as possible. These priorities need to receive a sufficient level of funding if this preference is to be honored:
1. The Community First 1115 Waiver (line item 4000-0650). This new $45.8 million initiative is described by the Patrick administration as “a multi-faceted initiative that will give elders and people with disabilities more choices so that they can remain at home and in their communities.” Community First will expand the income and asset rules for MassHealth, and the array of services available. The Executive Office of Health and Human Services describes Community First “as a significant commitment to re-balancing the state’s long term care system... to ensure a full continuum of care for people in the community while maintaining necessary nursing facility capacity.” The program will serve approximately 15,600 people statewide.
2. Elder Lunch – Meals on Wheels (line item 9110-1900). Last year, Elder Services prepared more than 270,000 meals in our Lanesboro kitchen. Our Meals on Wheels drivers traveled more than 226,000 miles to deliver over 220,000 of those meals to homebound seniors. The remaining meals (more than 48,000) were served to seniors at 14 lunch sites located throughout the county. The Nutrition/Meals on Wheels program has been dangerously under-funded for years while the cost of preparing, serving, and delivering the weekday meals has continued to increase. Meals on Wheels is a lifeline for Berkshire seniors. In addition to a hot, nutritious noontime meal, the program also provides a well-being check for the frail, homebound seniors who receive the meals. In many cases the Meals on Wheels driver may be the only face-to-face interaction a senior has that day.
3. Enhanced Community Options Program - ECOP (line item 9110-1500). This program provides in-home care to frail seniors who are not yet on MassHealth, but who are clinically eligible for nursing facility placement. The ECOP program provides a higher or enhanced level of the in-home services provided by the State Home Care program (see #4 below) including assistance with personal care needs such as dressing, bathing, and bathroom assistance, and with homemaking. Here in Berkshire County, we are serving almost 1,200 seniors a month in our Home Care and ECOP programs. Sufficient funding must be available to meet the need for these services. Without increased funding, limited income seniors may be caught in the middle and may “fall through the cracks” between the income criteria for MassHealth programs including the new Community First initiative, and the ECOP and State Home Care programs. These limited income seniors may have incomes placing them above the financial eligibility guidelines for the MassHealth programs but may not be able to receive the level of services they need from the ECOP or State Home Care programs without additional program funding. It costs less to provide long-term care services at home than it does in an institution. ECOP, for example, costs approximately one-third of what a nursing facility placement would cost.
4. State Home Care and Care Management (line items 9110-1630 and 9110-1633). This Home Care program provides an array of essential family-like services that are designed to promote independent living. Such services include in-home assistance with personal care needs such as dressing, bathing, and bathroom assistance, and with homemaking.
5. Protective Services (line item 9110-1636). Elder Services is one of 21 agencies statewide that provide a first line of defense for seniors by investigating and resolving reports of physical and verbal abuse, financial exploitation, and self-neglect. This past year more than 13,000 allegations of elder abuse were reported in Massachusetts. Vulnerable, at-risk seniors must be protected.
6. Councils on Aging - COAs (line item 9110-9002). Services provided by Berkshire County Councils on Aging include information and referral, transportation, outreach, food distribution programs, health education and screenings, and fitness, social, and recreational opportunities. Under the current funding formula each COA is allocated $6.50 per senior per year. It is hoped that this amount can be increased to $7.00 per senior per year.
7. Geriatric Mental Health (line item 9110-1640). Twenty percent of seniors in the community experience symptoms of depression. Seventeen percent of seniors misuse or abuse alcohol or their prescription medications. Seniors have the highest suicide rate of any age group, with persons age 85 or older having a suicide rate that is almost double the general population. Almost two thirds of seniors with a mental illness do not receive services. Sufficient Mental Health services must be available to seniors who face debilitating, often chronic, mental health issues.
8. Family Caregivers Program (line item 9110-1650). This program provides advice and counseling to family caregivers who are helping loved ones to continue to live in the community. The support these caregivers provide helps to keep seniors out of costlier forms of long-term care, such as institutions. It is important that the Commonwealth provides an appropriate level of funding for home and community-based services, so that seniors can continue to live in their own homes and communities - which is where they truly want to be.
Robert P. Dean is Executive Director of Elder Services.
