The Sacramento Bee (April 6, 1999) (SB 353 article)
By Jason Bloome
Senior citizen care measure needs support
A law which is cruel to seniors while at the same time needlessly wastes millions of taxpayer dollars does not serve the civic good. This particular law has to do with denying a low income senior the ability to apply dollars from the In Home Supportive Services program to an assisted living environment.
Each month in California, thousands of seniors receiving In Home Supportive Services transition from home to skilled nursing facilities where the State under MediCal pays about $2,400/month. Many need only custodial care assistance, such as help getting out of bed, dressing, bathing, and dealing with incontinency issues. Many are Alzheimer's, Parkinson's and stroke patients. These seniors could live in an assisted living environment which usually costs from $1000-$1800/month, but current law does not allow MediCal nor IHSS to pay for this type of setting.
The In Home Supportive Services program is funded through county, state and federal Medicaid dollars. On average, In Home Supportive Services recipients receive funding for about 72 hours each month, or $415 (the current minimum wage is $5.75/hour), but can receive up to 283 hours each month, or $1,627, as deemed necessary by a county social worker. For most, these care hours are adequate to maintain their independence at home. But there are times - for example, when 24-custodial care is needed - that care in their own homes is not sufficient and alternative-care settings or options are necessary.
In California, there are more than 6,000 assisted living facilities offering varying levels of custodial care. They range from small residential care homes, each with four to six beds with two full time staff, to large hotel-type settings. These homes are licensed and monitored by Community Care Licensing to provide varying levels of custodial care. A low income senior who needs custodial care could afford these facilities by using a combination of In Home Supportive Services money (financed by a personal care services Medicaid waiver) and Social Security supplemental funds. Many states already use this method.
According to the State Assisted Living Policy Report, published by the National Academy for State Health Policy, as of spring of 1998, 35 states reimburse, or plan to reimburse, services in assisted living as a Medicaid service. California is not among the number even though it has more seniors and more assisted-living homes than any other state.
Proponents of a Medicaid waiver consist of a wide array of senior care professionals and organizations. For instance, our coalition, one of many state organizations that advocates for a waiver, include, among other members, the Stroke Association, the American Parkinson's Disease Association, Alzheimer's Association, adult day care center directors, Jewish family service directors, patient and family service nurses, senior center directors, elder law attorneys and geriatric resource managers. This type of waiver is also supported by the Counties Welfare Directors Association which oversees IHSS and MediCal policies throughout California.
Opponents of a Medicaid waiver are usually special interest groups who financially would suffer from this type of initiative. These groups usually use terms like the "woodwork effect" or "opening a can of worms" to describe the bureaucratic and financial pandemonium which will ensue once the state implements a waiver. Every senior will want their piece of pie, they reason, and even seniors who currently do not need care will gain access to funds normally inaccessible to them - eventually costing California millions of extra MediCal dollars each year. They also argue that by accessing these funds the assisted living homes will, in effect, become mini-nursing homes, and start accepting patients who need nursing care. But these arguments simply are not true. Counties already determine the number of eligible IHSS clients and the care hours they are entitled to and Community Care Licensing already monitors that residents in assisted living homes have only custodial care needs. And, since assisted living homes are more affordable, the state saves money, not spends more.
This year, with advice from many agencies concerned about this issue, state Sen. Maurice Johannssen, a MediCal waiver advocate, has introduced Senate Bill 789 that will amend the law to allow a senior to have a choice where to apply In Home Supportive Services dollars. If passed, it will change for the better a portion of the current MediCal reimbursement system which is blatantly unfair to our low income seniors with custodial care needs who no longer can live at home. They deserve our respect and dignity; not a backward state policy which forces them unnecessarily into expensive, over-care facilities. The legislature and the Governor must act quickly and decisively to remedy this intolerable situation.