Statement of 
Elder Services of Berkshire County, Inc.

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STATEMENT OF

1. When Massachusetts created the Executive Office of Elder Affairs (EOEA) in 1973, it was the first cabinet level secretariat with an exclusive mission to serve elders and with a mandate for elder advocacy. Its head, the Secretary of Elder Affairs, reports directly to the Governor.

2. EOEA moved Massachusetts to the forefront in serving elders, and has been a strong advocate and voice for Massachusetts elders, who have been well served by a strong free-standing EOEA.

3. The Governor’s proposed re-organization would strip Elder Affairs of its cabinet level status and deny elders the place at the cabinet table that they have occupied since 1973. The re-organization would put Elder Affairs in the closet, instead of the cabinet. Why must we rush to undo in the first few months of this administration, what we have done well for thirty years?

4. Elders deserve to have direct access to the Governor in the form of an Executive Office and a Secretary who reports directly to the Governor, not roundabout communication through another agency.

5. In a letter to the House and Senate, four former Secretaries of Elder Affairs ask that state legislative leaders "keep Elder Affairs as an independent, cabinet level agency". The letter states that "An aging population has concerns related to employment, economic security, housing, transportation, social services, consumer protections, and public safety, as well as health related services".

6. The role of EOEA should be broadened and expanded, not diminished. This is the conclusion reached by Speaker Finneran’s Health and Human Services Task Force after it studied the Governor’s proposed re-organization and heard testimony from dozens of advocates and providers. A free-standing and appropriately funded EOEA will become increasingly important as the elder population continues to grow, and will ensure that elders receive the superior programing and advocacy that they deserve.

7. According to the 2000 Census, 22.4% (30,266) of the total Berkshire County population is over the age of 60. By comparison, 17% of the total Massachusetts population is over the age of 60. The baby boomer population will reach the age of 65 between the years 2010 and 2030. By 2030, there will be about 70 million older persons in the United States, more than twice their number in 2000.

8. The Governor’s proposed re-organization would put Elder Affairs within one of four "clusters" within the enormous bureaucracy that is the Executive Office of Health and Human Services (EOHHS). Elder Affairs will become lost within Health and Human Services, and the voice of elders will go unheard and their needs unmet. EOHHS has a scattered mandate to serve - among others - children, the disabled, those with developmental disabilities, and those with mental health issues. It is a fine mandate, but its focus is not elders. Only Elder Affairs has the single focus and mandate - to serve elders.

9. Already, it has been proposed that 90% of the Elder Affairs budget be moved to the Division of Medical Assistance, which is also part of the enormous EOHHS. Under this proposal, Home Care for elders will now be housed in an agency with a mandate to provide "medically necessary" care as a health insurance plan. This is not the time to retreat from community based services and to "medicalize" the Home Care program.

10. Massachusetts currently spends an average of only $10.86 a day on long term care in the home and the community for home care clients. By comparison, Massachusetts spends more than $100. a day per resident on nursing home care. A typical nursing home placement costs between $3,000 - $3,500 a month ($36,000 - $42,000 a year).

11. The Governor has filed a MassHealth Reform Bill, which will end the nursing home pre-screening program that helped divert 800 people from nursing homes last year; remove the Aging Services Access Points (the ASAPs) from the "2176" community-based waiver program, which keeps nearly 5,000 people in the community; and take away ASAP management of the Community Choices program, which has provided enhanced in-home services to more than 350 elders per month, who are at imminent risk of nursing home placement. The Governor’s MassHealth Reform Bill will also repeal the statutory provisions that require the Division of Medical Assistance to use the ASAPs for clinical screening assessments, service authorization, case management, and coordination of care related to MassHealth covered institutional and community long term care services. What will become of

these elders? If it’s fixed and not broken, why break it? These "reforms" will cost the state more money and provide less service. The elders of Massachusetts are well served by each of these programs.

12. The Community Choices program, for example, is an initiative between Elder Affairs and the Division of Medical Assistance to provide enriched services to eligible elders who are at imminent risk of nursing home placement but would like to receive long term care services in their own homes. The average cost of service per person is less than $1,500. a month, which is half the cost of a nursing home placement. 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 move to a nursing home. There are currently 350 individuals enrolled statewide in the Community Choices program including 24 people who were relocated out of nursing homes.

13. In regards to the Prescription Advantage Plan, EOHHS estimates that there will be a loss of 78,465 clients due to the elimination of the plan. As a result of this zero funding, many elders will be forced to choose between food and their prescription medications, or may need to ration their medications by taking half doses or by skipping doses. Ultimately, the inability to afford to take medications as prescribed will be reflected in increased medical and hospital costs.

14. There are 348 Councils on Aging (COAs) throughout Massachusetts. The COAs and Senior Centers are the heart and hub of many elder communities. In 2002, they provided services to 440,000 seniors (7% of the entire Commonwealth population). Among the many services they provide are Information and Referral, Social Day Care, Transportation, Care Management, Insurance Benefit Counseling, assistance with Income Tax filing, and Health and Fitness Programs. Our COAs and Senior Centers must be supported and appropriately funded.

1. The Executive Office of Elder Affairs remain a free-standing cabinet level agency with control over its own budget and line items; and that its role be strengthened to provide better coordination of services and advocacy for elders.

2. House Amendment 1007 be ratified. According to state statute, the Executive Office Elder Affairs is the principal agency responsible for implementation of the Home Care program for elders, and has successfully managed the program since 1973. This amendment will return the budget for the Home Care program from its recent move to Medicaid back to the Executive Office of Elder Affairs.

3. House Amendments 1007A and 1008 be ratified. Since 1996, the Aging Services Access Points (ASAPs) have played a key coordinating role in the provision of Medicaid and Home Care services to elders. ASAPs are responsible by state statute for a coordinated system of care designed to assist elders to maintain residence in the community in the most cost effective manner. These amendments ensure the continued successful collaboration between Home Care services and Medicaid, and that home and community services are coordinated through a one stop shopping approach. This coordination of the range of available services will enable every elder who has the potential to remain at home to be able to do so, and will save the state money.

4. House Amendment 218 be ratified. This will ensure that Money Management services will continue to be available for elders by placing Money Management as a service which can be provided by the Home Care Program.

5. The Prescription Advantage Plan be restored.

6. Funding for the SHINE (Serving Health Information Needs of Elders) program be restored.