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State Budget Cuts Devastate the Elderly

Thursday, May 03, 2012


A health care advocate says Massachusetts isn't providing basic services to the elderly, putting them in harm’s way and potentially violating state law. Ivy Hest, community organizer for the Mass Senior Action Council (MSA) claims the proposed fiscal 2013 state budget doesn’t provide enough funding for Home Care Services (HCS) and will leave hundreds on a waiting list for essential services.

According to the Massachusetts Executive Office of Elder Affairs (EOEA), a wait list has been put in place for HCS every year since fiscal 2005, when the state Legislature first requested that a list be established.

“We’re not happy,” said Hest. “Seniors have a right to age in their homes and stay in their communities.”

The Massachusetts Equal Choice in Long Term Care Act was passed in 2006, under then Gov. Mitt Romney. In part, the law requires that seniors be given alternative choices to nursing home care. Under the proposed budget seniors won't have an option, Hest said.

“I would say people have a right to have access to services beyond nursing home care,” Hest said. “Beyond funding to home-based services, our seniors don’t have any option other than a nursing home.”

According to the EOEA, the Equal Choice Law  applies to MassHealth consumers who require nursing home level care. It does not apply to the state-funded home care program. The existing wait lists are within the state-funded home care programs. 

Thousands on home care

There are currently 44,514 seniors receiving home care services in Massachusetts, according to the EOEA. Of them, 34,384 receive basic HSC and 4,373 receive Enhanced Community Operations Program (ECOP). That program offers services to seniors who are not yet on the MassHealth plan and are eligible to enter a nursing home facility. Another 5,857 are enrolled in a Choices program for especially frail senior citizens.

Senior advocates are worried about the more than 1,000 others who are currently on a waiting list for HCS. As of May 1, there were 543 seniors on the waiting list for basic HSC. Another 1,013 were on the ECOP wait list. Some of the services they're missing include home-delivered meals, personal care and housecleaning. According to Hest, about 700 seniors are expected to be on the home care waiting list for basic services by the end of the year and another 1,000 who are eligible for more than basic home care won’t get their needs met.

In some cases, seniors are already living in squalid conditions and family members are buckling under the strain.

'Real problem'

“The house is so dirty,” said Donna Kosky, whose father is among those on a waiting list for basic home care. “The whole thing is affecting my health, but I feel responsible for him.”

Her father is 88 and lives on his own in Auburn. Kosky resides in North Grafton. At 68, she tries to help her father as much as she can, but admits it’s something she can’t handle alone. Making it even more difficult are the living conditions. Her father’s house, she said, is in dire need of a good cleaning. Right now, Kosky picks her father up once a week to get him out of the house and do some shopping. She also cleans his clothes.

“I still do his washing,” she said. “But my son recently moved back in and I do his, too. I’m always washing and ironing.”

The wait list, Kosky acknowledged, has become a “real problem."

On the list

There are 50 seniors in 15 Central Massachusetts communities on the HSC wait list, according to Maureen Siergie, assistant director with Elder Services of Worcester Area Inc (ESWA). Of them, 30 are in need of basic home care and 20 are waiting to enter ECOP.

“That’s of great concern to us,” Siergie said. “We don’t want to see anybody go without. But they are people who at least have some support, some help and some family involvement.”

The EOEA mplemented the HCS waiting list in March. It affects seniors served by the state’s 27 Aging Service Access Points, including the ESWA. The frailest seniors continue to receive services. Home Care Services include, among other things, homemaking, personal care, home-delivered meals and home health assistance. A senior on a waiting list receives none of these services, Siergie said. Those who are eligible for these services require help, but do not meet the requirement for nursing home care.

Elder funding

Advocates claim the state budget as it stands now provides no options for hundreds of seniors other than nursing home care. Gov. Deval Patrick level-funded elder home care purchased services at $97.8 million in his fiscal 2013 budget proposal. Advocates asked for $103.2 million.

Of particular concern to people like Siergie is funding for the state’s ECOP. As of April, there were 1,100 seniors on the statewide ECOP wait list. Many of them currently receive basic home care services, but require more. Moving them onto ECOP, said Siergie, would free up room for those on the basic HCS wait list. The current budget, she said, does not accomplish that.

Funding for ECOP in fiscal 2012 was $45.8 million and was not, according to Siergie, enough to address the needs of all seniors. Patrick’s fiscal 2013 ECOP proposal was $45.5 million. The House proposed $47.8 million – much less than the $55.5 million advocates had hoped for. An amendment for that amount was not passed. However, the House did go up by about $500,000 from its initial recommendation of $47.3 million.

“We’re quite certain that that $500,000 increase still won’t be enough,” said Siergie. “It doesn’t shift enough people onto ECOP to open up the basic program. This is very stressful for our staff.”

The EOEA released the following statement to GoLocalWorcester concerning the fiscal 2013 budget: “In developing the budget for FY13, our highest priority was to preserve services for our most vulnerable seniors with urgent care needs, and we have maintained level funding for many of these services. As the senior population has grown over the past several years, we have also experienced some wait lists for home care services. Individuals on the wait list for services are monitored on an ongoing basis and if their need level changes, we make every effort to ensure they receive the appropriate care in a timely fashion.”

Becoming a burden

The way Hest sees it, the state does itself no favors by not fully funding elder home care, saying, “It costs them a lot less if they can stay at home, because the state doesn’t have to pay for nursing home care.”

State lawmakers are also sending the wrong message to senior citizens, Hest said, because, “it’s basically saying you’ve become a burden on us. We’re institutionalizing our seniors.”

Hundreds of seniors, including many from Worcester, made their presence known last week during House budget negotiations, many of them being escorted by security guards out of House chambers. Some were members of the Worcester Senior Center, where Amy Waters is center director and head of elder affairs. About 300-400 seniors show up at the center each day and about 5,000 are registered members. While most of them are not in need of home-based care, Waters said too many others are being underserved.

“I do know it has been very difficult for frail elders who need homecare services,” Waters said.

Not enough

While there is near universal consent among elder advocates that funding for home care services, both basic and ECOP, must be increased, there is recognition that state lawmakers face difficult choices when it comes to meeting the demands of so many state programs. At the same time, they say, what isn’t addressed now will only become a larger problem down the road.

“If we continue to undercut services for the folks that need it, we’re going to be in a lot more trouble,” said Hest. “We don’t want legislators to be cutting education funding to fund homecare, though. We’re saying, step up and increase revenue through things like taxes that don’t overburden the middle and lower class.”

The funding approved by the House is appreciated, Al Norman, executive director of Mass Home Care, said in a press release, but level-funding the home care account is not going to solve any problems.

“Bottom line, the House was better to seniors than the Governor's budget, but we are facing dark days ahead in 2013, with waiting lists for care in a state that is seeking to keep people out of nursing facilities,” Norman said. "There is no rabbit in this hat. We cannot keep people out of nursing homes using magic."

People like Kosky certainly aren’t looking for a magic trick. She wants her father taken care of in a manner that retains his quality of life.

“He needed these services yesterday,” Kosky said. “I understand what the government is dealing with. It’s a sad situation. But I want dignity for my father, the dignity of getting older. That’s what he doesn’t have.”


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