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From The Director
by Catherine R. May
Happy New Year - 2003 - Two new programs that can help !
As the strains of "Old Lang Zyne" fade, and Acting Governor Jane Swift departs the corner office in the State House to make room for Mitt Romney, Elder Services is faced with proposals for and predictions of reduced service availability for elder home care. The Romney administration is making plans to restructure and reformat government, rid the state of the "alphabet soup" of agencies, close the two billion dollar revenue gap projected for Massachusetts, and steadfastly adhere to the "no new taxes" mantra.
One of Governor Romney’s ideas, which he made known during the campaign, is to secure more federal health care monies for the commonwealth, through increased federal Medicaid and Medicare payments. We can only hope that the new Governor and his team do know of new and innovative ways to secure a larger portion of the federal dollar for Massachusetts.
At the present however, the Board of Directors and Staff of Elder Services are greatly concerned about the impact of the state’s financial plight, and the Romney administration’s restructuring plans for services that help needy and low income Berkshire elders stay at home. The Romney team, it is hoped ,will quickly grasp that it is more cost efficient to help elders stay at home, as opposed to sending them to nursing homes, to say nothing of the greatly improved quality of life one can experience at home. To further cut home care and force people into nursing homes will only cost the state more money !!!
Two new programs through which we at Elder Services hope to assist high need elders to remain at home are the PCA (Personal Care Assistance) program, and Community Choices. Declining revenues for the core Home Care program, through which Elder Services assists over 950 Berkshire elders to remain at home, will be a great concern in 2003,but these two new specialized programs can help some elders who are eligible for Medicaid and also eligible for either PCA services or at imminent risk of nursing home placement.
The Personal Care Assistance Program (PCA) is designed to assist people with disabilities or chronic disabling diseases who require physical assistance with such things as bathing, dressing, toileting and medications. In the PCA program, the consumer becomes the employer of his or her personal care attendants. What this means is that the consumer, with support and training from Elder Services, will be responsible for the hiring, training, and scheduling of their PCAs.
To qualify for the PCA program, an individual ,must have Medicaid (Mass Health) or be Medicaid eligible, have a permanent or chronic disability, require physical assistance with at least two activities of daily living (ADLs): bathing, dressing, transfers, assistance with medications, eating, and toileting, and must reside in the community, not in a nursing home or an assisted living facility.
In order to access the PCA program, one can call Elder Services (413-499-0524). A referral from the individual’s primary care physician will be requested before Elder Services staff can do an evaluation. After the physician’s referral is received, the individual is evaluated by a skills trainer, and a Registered Nurse or licensed Occupational Therapist, before Medicaid makes its final determination of how many hours of PCA service are needed per day or week. This evaluation process may take up to eight weeks.
During this time, the individual (or a surrogate if appropriate) will receive training from Elder Services for their duties and responsibilities as the one who hires their PCA worker, and trains and schedules that worker. The worker will be paid by Medicaid at the rate of $10.36 per hour for their PCA work. Family members other than a child, spouse, parent, son-in law, or daughter-in law may be hired ; how many hours they will work is determined by Medicaid.
Until recently, PCA services were available in the Berkshires only through AdLib , the center for independent living. Elder Services sought and received approval to be a PCA Management agency in order to make service available in yet another program available to Berkshire elders. It is likely the eligible persons will receive more hours of service through the PCA program than they would through Elder Services’ core Home Care program, Purchased Services. Elder Services staff will help those seeking help to determine what would best suit their particular needs.
Community Choices is a joint demonstration project of Medicaid and the Executive Office of Elder Affairs, created by the Legislature so that eligible Medicaid enrollees receiving Home and Community Based Waiver Services will receive the necessary services to prevent or delay an imminent admission to nursing homes. To be eligible, a Mass Health (Medicaid) member, aged 60 or older, will fit the criteria for the expanded services available through Community Choices if he or shewas actively seeking nursing care admission within the last six months, or
recently experienced a serious medical event, regression in physical or cognitive functional activity, or
has had a cumulative deterioration in functional ability, or
was discharged from a nursing facility within the last thirty days, or
is at risk of nursing facility admission due to instability or lack of capacity of informal or informal supports, and
also fits certain clinical criteria.
Again, a call to Elder Services will determine if one is a likely candidate for the enriched service package available to people enrolled in the Community Choices program. Those services might include case management, homemaker, personal care, respite care, enhanced personal care, companionship, adult day health, personal emergency response systems, home delivered meals, and/or transportation.
Community Choices services will be paid for by Medicaid and Elder Affairs, on a cost reimbursement basis, with a special data collection tool being used to enable them to determine the amount and cost of the services that enrollees receive. Also collected will be information about how long an elder is enrolled, why he or she was eligible, and why he or she left the program. The information will be analyzed and presented to the Legislature in a report in 2003. The Legislature will then determine the effectiveness and efficacy of the initiative.