From the Director: Home and community-based services need support
By Robert P. Dean
The Massachusetts Legislature is currently reviewing the Governor’s proposed budget for state fiscal year 2010, which begins July 1, 2009. 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 thereafter, 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 of the recommendations that he so chooses.
Many home care lines items reduced by the Governor’s 9C cuts this past October remain at their reduced levels in the Governor’s proposed budget for the coming year. This is not good news for seniors, many of whom are already waiting to receive services for which they are eligible. As of March 2009, more than 600 seniors were on waiting lists statewide as a result of a $6.7 million 9C cut to the State Home Care program this past October. The home care programs serve seniors who are faced with disabling conditions. During tough economic times, the need for basic human services goes up - not down. More people need food and fuel assistance, and home care. Home care, which is far less costly than nursing facility placement, and which helps delay or avoid such placements, should be the first resort for seniors in need of services. It does not make fiscal sense to cut home care services because it will ultimately cost taxpayers more in the long run if seniors in need of assistance receive more costly institutional care instead.
As the House and Senate engage in their budget deliberations this April and May, it is important that the following budget priorities receive sufficient funding:
1. State Home Care and Care Management (line items 9110-1630 and 9110-1633). The State 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. In October 2008, the Governor’s 9C cuts reduced these line items by $6.7 million dollars. Here in Berkshire County, we are serving more than 1,000 seniors a month in our State Home Care and ECOP programs (see #2 below). Funding needs to be restored to its pre-9C cut levels.
2. Enhanced Community Options Program - ECOP (line item 9110-1500). This program provides in-home care to frail seniors 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 #1 above) including assistance with personal care needs such as dressing, bathing, and bathroom assistance, and with homemaking. Sufficient funding must be available to meet the need for these services. ECOP costs the state approximately one-third of what a nursing facility placement would cost. Funding for ECOP needs to be increased so that the current “cap” on the number of seniors receiving these services can be removed.
3. Elder Lunch – Meals on Wheels (line item 9110-1900). This past year, Elder Services prepared more than a quarter-million meals in our Lanesboro kitchen. Our Meals on Wheels drivers traveled more than 226,000 miles to deliver over 200,000 meals to homebound seniors. The remaining meals were served to seniors at 14 lunch sites located throughout the county. 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 provide the only face-to-face contact a senior has that day. 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. Increased funding is needed.
4 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, as well as fitness, social, and recreational opportunities. Funding for the COAs was cut in January 2009, during the second round of the Governor’s 9C cuts, from $7.00 per senior per year to $6.50 per senior per year, and needs to be restored to the pre-9C cut level of $7.00 per senior per year.
5. Move MassHealth Long-Term Care line item back to the Executive Office of Elder Affairs (line item 4000-0600). Many senior advocates were dismayed to learn that the Governor’s proposed budget seeks to remove $2 billion dollars in line item authority for MassHealth long-term care services from the Massachusetts Executive Office of Elder Affairs into the Office of Medicaid. These long-term care dollars have been crucial to the development and success of the Choices program, which allows seniors who are eligible for MassHealth to choose to receive the long-term care services they need in their own homes and communities. The Choices program, together with the State Home Care and Enhanced Community Options programs, serve approximately 40,000 limited-income seniors a year statewide. It does not make sense to remove line item authority for programs such as Choices from Elder Affairs, which as the State Unit on Aging, also provides statewide oversight for such senior programs as State Home Care, Enhanced Community Options, Nutrition/Meals on Wheels, Protective, Caregiver, and the Councils on Aging to name but a few. MassHealth long-term care funding is part of this greater whole and should not be isolated from Elder Affairs. With regard to long-term care services, Elder Affairs is best positioned to provide a unified and coherent approach, and to develop and administer the full range of services seniors want and need. This is particularly important at a time when 25% of the Commonwealth’s households include at least one individual age 65 or older. Massachusetts needs a strong Executive Office of Elder Affairs so that Massachusetts seniors will have a say in the types of long-term care services that are available to them and will be able to receive those services in their own homes, if that is their choice. To accomplish this, Elder Affairs needs to retain the $2 billion dollar line item authority for MassHealth long-term care services.
What do you think? Now is the time to make your voice heard.
Robert P. Dean is Executive Director of Elder Services.
