Daily News (March 11, 1999)

Nursing care costly, but state forces it on many who want other lifestyle.

by Jason Bloome

Some laws beg to be changed. Take, for example, the current law which forces low income seniors on In Home Supportive Services (IHSS) who can no longer live at home into skilled nursing facilities, even though their care needs could be met in assisted living environments.

Each year in California, thousands of seniors make the transition from home to skilled nursing facilities where the state, under MediCal, pays about $2,500/month. But not all of these seniors have to be in skilled nursing facilities. Many of these seniors only need help getting out of bed, dressing, bathing, and dealing with incontinency issues. Many are Parkinson's and Alzheimer's patients. They could benefit from an assisted living environment that usually costs from $1000-$1800 per month for a shared room. Unfortunately, the current law does not allow MediCal to pay forthis environment. The state is needlessly spending millions of MediCal dollars each month while at the same time forcing low income seniors who could be in assisted living homes into skilled-nursing care facilities.

California's antiquated MediCal reimbursement mechanism focuses on hospital and institution- based services instead of utilizing more cost-efficient community-based care options that would best allow a senior to maximize his or her independence.

The In Home Supportive Services program is funded through MediCal dollars. For a senior residing at his or her home, it pays for services including housecleaning, meal preparation, bowel and bladder care, bathing and dressing, and accompaniment to medical appointments. The senior is responsible for hiring someone to provide the authorized services. The provider receives $5.75 - the minimum wage effective March 1, 1998 - for each hour of care that a county social worker has determined the client needs.

On average, In Home Supportive Services recipients receive funding for about 72 hours each month, or $415, but can receive up to 283 hours each month, or $1,627, if deemed necessary. 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, to large hotel-type settings. A low income senior who needs custodial care could afford these facilities by using a combination of MediCal and Social Security Supplemental Income (SSI) funds. Many states already use this method.

According to the State Assisted Living Policy Report, published by the National Academy for State Health Policy (www.nashp.org), as of the Spring of 1998, 38 states already had or plan to have a reimbursement system that permits Medicaid funding for assisted living options. Six other states had developed extensive pilot programs to study the issue.

California is not among the number even though it has more seniors and more assisted-living homes than any other state. Seniors who need care deserve to have the highest quality of life. It makes little sense that MediCal pays for IHSS and SNFs but not for the interim care step, assisted living homes. Since it actually costs the State more money, it also does not make sound economic sense for a low income senior who does not need to be in skilled-nursing facility to be forced into that setting. As senior care professionals who deal with information and referral, we see this happen everyday.

This year, with advice from many agencies concerned about this issue, including AARP, American Parkinson's Disease Association, the Stroke Association, the California Little Hoover Commission, the Counties Welfare Directors Association and the Alzheimers' Association, state Sen. Maurice Johannssen has introduced Senate Bill 353 that would permit MediCal to pay for assisted living homes. 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. These seniors deserve our respect and the dignity to choose their own care options; not a backward state policy which forces them unnecessarily into expensive, over-care facilities.