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Cut of Prescription Advantage is shortsighted
By Mark E. Rondeau
Reprinted with permission of the Advocate Weekly
Robert P. Dean, executive director of Elder Services of Berkshire County, is concerned that a proposed state government realignment will strip the Executive Office of Elder Affairs of its cabinet-level status.
This is part of a sweeping proposal to reorganize the state Department of Health and Human Services proposed by Gov. Mitt Romney.
“That is something that could very likely happen, and we’re very concerned about that. For over 30 years, the Executive Office of Elder Affairs has been leading the way in Massachusetts — in the country — in terms of advocacy issues for elders. And some of the great successes that we’ve had have been the creation of the ASAP system — the Aging Service Access Points — the Protective Services program, the Caregiver Initiative, and Prescription Advantage plan, and most recently Community Choices,” Dean said. “So we feel that if the Executive Office of Elder Affairs is folded into Health and Human Services, that will be devastating to elders and their voice within Massachusetts government.
“We feel that elders are entitled to have direct access to the government, should not be forced to have a roundabout communication through Health and Human Services in order to advise the governor as to what elder concerns are,” he said.
In response to Romney’s reorganization plan, House Speaker Thomas Finneran’s Task Force on Health and Human Services has developed a plan for a “single office” of long term care. This plan clearly spells out what the role of Elder Affairs should be and creates a more coordinated system of long-term care, according to Dean.
The Advocate interviewed Dean at his office at Elder Services headquarters in Pittsfield last week. He discussed both the proposed reorganization and the effect on services of the state’s fiscal crisis.
A graying population
According to the 2000 Census, 22.4 percent of the total Berkshire County population is over the age of 60. By comparison, 17 percent of the total Massachusetts population is over the age of 60. Additionally, by the year 2030 there will be about 70 million older persons in the U.S., more than twice their number in 2000, Dean said.
“What’s going to happen within the next few years is the beginning of that Baby Boomer population, and that’s just going to continue to grow until we see by the year 2030 that combination of elders living longer and just more elders in the...Baby Boomer population. We’re going to have a huge number of elders, and we need to be prepared for that,” he said. “The way we are providing services to elders at the current time in many ways isn’t working. We are spending an awful lot of money on providing long-term care services in the nursing homes. The nursing homes are a vital part of the continuum of care that must be available to all who need it. We would also suggest that community care be considered a vital part and that there be appropriate funding for community care.”
Home cheaper than nursing home
According to information provided by Dean, there are 340 people enrolled statewide in the Community Choices program, which is a demonstration program which began in November 2002. The Community Choices program saves the state money because it costs less to provide service in someone’s home than it does to pay for someone to live in a nursing home. The average cost of service per person is less than $1,500 a month, which is half the cost of nursing home placement.
“That’s designed to provide sufficient service to people so that they can make the choice: do they want to stay in their own home or go to the nursing home,” Dean said. “And we’ve found since that program started in November 2002 that it’s been a great success at saving this Commonwealth an awful lot of money at the same time letting people stay where they want to stay.
“So we’re hoping that that program will not only be continued but that it will be expanded so that more people will have that choice,” he said. “Currently, to be eligible for the Community Choices program you have to be at imminent risk of nursing home placement, right on the brink of going into a nursing home. You must be Medicaid-eligible, and you must be an elder, and you must need more service in order to stay at home.
“And then the program, if you choose to stay at home, can provide enriched services, and it’s really worth it,” he said. “And it’s a way to save the state money.”
“I think what would happen if that program is continued over time, you’ll see more and more people being placed in that program,” he added. “We are advocating very strongly that Choices be continued. There seems to be money for it in the House budget that came out yesterday.
“One of our major concerns with the House budget...is that they are taking line items which formerly would have been part of the Executive Office of Elder Affairs and putting them into the Division of Medical Assistance. And we’re concerned what this is going to do to the continuity of service that elders have received, and the fact that Elder Affairs won’t be able to have control over its own budget,” Dean said. “This is just a further example of the weakening that we’re seeing of Elder Affairs at a time when it should be strengthened.
“We’re advocating that the role of Elder Affairs be strengthened and expanded and that all long-term care functions be put into Elder Affairs, so that services can be better coordinated,” he said, citing a system called one-stop shopping. “So someone would come to an Aging Service Access Point such as Berkshire County, and a determination can be made ‘what service does this person need, and let’s match this person to their service.’ Whether it’s two hours of in-home community care or whether it’s a nursing home placement, but you can have the choices made all along that continuum, which would save the state money, which would provide the best level of service to that person at that particular point in time.
“And we’re concerned that the governor’s reorganization and also the fact that these line items are being moved to Division of Medical Assistance will defeat any sort of coordinated effort,” he said.
Prescription elimination “shortsighted”
Some 78,000 people across the state were enrolled in the Prescription Advantage program and relied very heavily upon it. In many cases these people may have dropped their previous prescription insurance to take part in the program, Dean said.
“And now these people are going to be left without any type of coverage. Fiscal ’04, in both the Romney budget and the House budget, does not have any money in it — zero — for Prescription Advantage,” he said.
If a federal waiver goes through for $40 million, Gov. Romney may support some form of the Prescription Advantage plan.
“But if that waiver doesn’t go through, the plan is effectively dead,” Dean said. “And these people are left without coverage for their prescription medications, and in many cases may be forced to choose between food or their medications. And you’ll see people that are going to be taking their medications every other day, instead of every day, maybe taking a half-dose instead of a full dose.
“And these people are going to end up in the emergency rooms and in the hospitals. And ultimately it will cost this state more. They’re not savings. They may appear to be short-term savings, and in many cases they’re not even going to be short-term savings. But they’re certainly not long-term savings. And you’re seeing this not only in what’s being done to services to elders but in terms of other health services, education services, etc., etc.,” Dean said. “I would suggest that the cost in the long term of not having these services is going to be devastating to this Commonwealth.”
Lisa Lungo, director of client services at Elder Services of the Berkshires, said cutting out Prescription Advantage was a shortsighted thing to be doing, because people are going to be making choices that are not going to benefit their health.
“And it’s going to burden the system even further,” she said, adding that it might require individuals to need more services in the future. “Say an individual doesn’t take their blood pressure medication and ends up with a resulting stroke. If they return to the community, they’ll need more services. It’s just a very shortsighted view.”
Councils on aging
Dean also expressed concern about funding for councils on aging and senior centers.
“We’re concerned what’s going to happen with the councils on aging. I think that at least from Boston that they’re underestimating the value of the councils on aging, how important they are to each and every community as a link, an everyday link between people and that community, between people and their neighbors,” he said. “It’s a wonderful form of socialization. And that’s frequently where people first are introduced to services that are available to elders and begin to benefit from those services.
“Many of our meal sites are at the various councils on aging, and if you’re talking about a ‘bang for your buck’ there’s no bigger bang for your buck in the elder service world than the councils on aging,” he said. “They’re just so vital to the neighborhood network.”
Dean noted the governor’s proposal to cut state funding of the councils by $1.2 million — 25 percent of their budget. The House Ways and Means budget proposal released last week would cut roughly half this amount — $596,000.