Home care cutbacks put strain on elderly

Plans sacrificed to trim budgets

Dorothy Greewood and her daughter, Mary Nonnette, talked at an LA adult day center. Such programs may be at risk. Dorothy Greewood and her daughter, Mary Nonnette, talked at an LA adult day center. Such programs may be at risk.
(Nick Ut/Associated Press)
By John Seewer and Shaya Tayefe Mohajer
Associated Press / July 17, 2011

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TOLEDO, Ohio - Born with cerebral palsy, Jennifer McPhail relies on a home health aide to help her get dressed for work and ready for bed at night.

Her motorized wheelchair keeps her active, working as an organizer with a disability rights group in Austin, Texas, and volunteering to help people find housing and to staff hurricane shelters. She now fears deep reductions in the state’s Medicaid spending will prevent her from living independently.

“What it says to me is that the state doesn’t value the lives of people with disabilities,’’ said McPhail, 39. “A lot of people are going to be hurt in a very intimate way.’’

It’s a concern facing families across the nation as states with budget deficits cut home health services that help keep the elderly and disabled out of nursing homes. States are reducing how much time a nurse can spend making house calls and ending meal deliveries for the homebound. Many also are gutting adult day-care programs that give seniors a safe place to spend their days while relatives work.

Aging and disability services in three out of four states have been reduced during the past two years or face cuts, even though demand is increasing.

Texas lawmakers underfunded Medicaid by nearly $5 billion in the state budget, a move that home health advocates say leaves the elderly and adults with disabilities unsure how their care at home will be provided.

California eliminated funding for about 330 adult day centers, a move that will affect some 35,000 seniors who use them for medical care and socializing. Lawmakers are hoping to restore about $85 million to transition seniors into an as-yet undetermined alternate program - about half the amount cut from the budget.

Minnesota is considering cuts to home-health aides and a program that allows disabled people to live on their own.

With each cut, the ability to live at home becomes more difficult. “You end up losing control over your decisions,’’ said Neil Johnson of the Minnesota HomeCare Association.

Home-health services are an easy target for budget-cutters because they are not required by federal law, have been subject to fraud, and don’t have deep-pocketed special interests advocating for them. Steep cuts in these services eventually could cost states more money by pushing more people from their houses to nursing homes that would require taxpayer subsidies.

“Just because you cut the budget doesn’t mean their needs go away,’’ said Anita Bradberry of the Texas Association for Home Care & Hospice Inc.

Medicaid, the state-federal program that pays for medical and long-term care for the poor and disabled, is generally required to help fund nursing homes but not home care.

Because the programs are not required, most states first look at cutting home health care funded through Medicaid, even though such programs are much cheaper than nursing homes.

The price of an adult day health center is $67 a day on average, compared with $229 a day for a private room at a nursing home, according to a 2010 survey released by MetLife Inc.

Overall, Medicaid spending on nursing homes came to $46.5 billion in 2007, the latest figures available, while home health services cost $6.3 billion, according to the US Department of Health and Human Services.

Before the recession, states expanded home health programs because they are less costly..

In Massachusetts, Governor Deval Patrick has proposed cutting $55 million from the state’s adult day-care program, two-thirds of its funding.

Among them is the 81-year-old mother of Irva Almonor.

She agonized for months about what to do with her mother, who was forgetting to take her diabetes medicine and turn off the stove inside the Massachusetts home they share, before enrolling her in an adult day center.

The family feared she would hurt herself - or worse - while she was alone, and she resisted going into a nursing home.

Without the adult day health care centers, Almonor’s only choice would be to leave her mother, who has diabetes and mild dementia, alone at their Holliston, Mass., home. Hiring a home health aide would cost about $21 an hour.

“Financially, I can’t afford to have anyone to come take care of her,’’ she said.

One problem for home health care programs is image. Some lawmakers say lax regulation makes the program susceptible to fraud.

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