Day 2: Home Care Program Effective, but Restrictive
Those who qualify often must make deep financial sacrifices
By Jim DeBrosse
Dayton Daily News (OH) – Monday, December 6, 1999
(C) 1999 Dayton Daily News
Rose and Lester Shepherd met in a nursing home, fell in love and married there. But perhaps more remarkable than their late-in-life romance, the Dayton couple was able to leave thenursing home and set up their own household together, with help from the state’s PASSPORT program.
`After I got married (to Lester), I didn’t want to stay in a nursing home,’ Rose Shepherd said. `I’ve always been on my own, and I didn’t want to be confined. I didn’t like the food, and I didn’t like the way they treated people who didn’t have family to look out for them.’
PASSPORT is Ohio’s only Medicaid-funded alternative to nursing home care. It uses state-federal Medicaid money to pay for home health aides, personal assistance and adult day care.
But eligibility is limited to only those elderly who have exhausted nearly all their assets and whose health needs would qualify them for nursing home admission.
Even though PASSPORT costs the state a third of what it pays for the elderly in nursing homes , the program is available only to a minority of families who might benefit from it.
And those who qualify often must make deep financial sacrifices.
When June Nales’ advancing heart condition, emphysema and arthritis made it impossible for her to cook meals and bathe properly, a social worker suggested the 71-year-old Dayton resident look into PASSPORT for her in- home care.
But Nales soon learned she would have to pay $136 a month from her monthly $1,013 disability check to meet the eligibility requirements, or go to a nursing home , where the state would pick up the entire cost after taking all but $40 of her check.
“It seems like as you get older, first it’s the senior center, then it’s the nursing home ,” Nales said.
Last year, Ohio’s Medicaid program picked up the tab for 55,000 residents in nursing homes while paying for the home care of just 15,200 people under PASSPORT. Of each Medicaid dollar spent in Ohio on the elderly, 92 cents goes to nursing home care and 8 cents goes to PASSPORT.
PASSPORT in Montgomery, Greene and Clark counties has about 780 clients and enrolls about 35 new clients a month.
But at any one time, another 60 families who aren’t poor enough to qualify for Medicaid are waiting for assistance from the state’s ComCare program, which helps pay for home health care on a sliding fee basis.
Many other families turn to nursing home care because they can’t afford to wait, said Doug McGarry, executive director of the Area Agency on Aging. The non-profit agency administers the PASSPORT and ComCare programs in the Miami Valley.
`For the vast majority of folks, a waiting list is not really a waiting list. They need something right away,’ McGarry said. `You’re dealing with a very frail population with very real needs.’
Hundreds of others who might benefit from the PASSPORT program discount it because they don’t want to divest themselves of their life savings in order to qualify for help, McGarry said.
PASSPORT clients are permitted only $1,500 in assets, such as cash, savings, CDs or stocks. Their home , if they are living in it, is not counted, however. Nor are household goods, personal items such as jewelry and TVs and a car.
But many elderly are hesitant to `spend down’ their nest egg, even if it’s relatively small, in order to receive help from PASSPORT, in part because they fear they will need the money if their home or car falls into disrepair, McGarry said.
PASSPORT also will pay for adult day care to give family caregivers a rest from their duties and their loved ones the opportunity to get out of their homes , socialize and participate in stimulating activities.
Senior advocates argue that increasing state support for daycare services could actually save the state money by preventing the burnout of family caregivers and by keeping their loved ones healthier longer so they won’t have to go to nursing homes.
Many families still aren’t aware of the wide range of services provided by adult day care centers, everything from meals and showers to physical therapy and tube feedings. “It’s often referred to as the best-kept secret in long-term care,” said Dayna McCrary, president of the Ohio Association of Adult Day Services.
For $40 to $60 a day, or about half the cost of in-home care, day care centers provide a full day of meals, activities and personal care for all but the frailest elderly, including those who are incontinent or suffer from Alzheimer’s disease.
Many centers have full-time nurses on staff to administer treatments and medications and to monitor patients’ health.
Expanding the PASSPORT program to thousands of elderly Ohioans who don’t meet the severe poverty levels required by Medicaid is a top lobbying priority for the Ohio division of the American Association of Retired Person in the year 2000 elections.
“Clearly, this is a forgotten group in Ohio,” said AARP lobbyist Ron Bridges.
Raising the asset limit under PASSPORT to $10,000 instead of $1,500 would increase by about 50 percent the number of clients served, McGarry said, and at the same time “slow down the process of them going to a nursing home .’
That’s exactly what ComCare is doing in nine counties of the Miami Valley, but on an extremely limited scale.
With state and local funds, it provides in-home and adult day care services to about 140 elderly people and their families.
Ohio trails many states in its commitment to community-based programs.
With a 65 and older population of 1.5 million, Ohio spends only $12.5 million on community-based services statewide for the elderly who don’t qualify for Medicaid. Illinois, which has about the same elderly population, spends more than 10 times that much ($127 million) and Pennsylvania, with 1.9 million elderly, spends $182.5 million.
To supplement the state’s efforts, 51 of Ohio’s 88 counties have approved tax levies for elder care services. Hamilton County’s levy, for instance, generates $15 million a year.
And in November, Greene County voters approved an .8-mill levy to collect $1.8 million a year for elder care in that county.
McGarry hopes that Montgomery County, which has five times the number of seniors that Greene County does, will someday follow suit.
Although Montgomery County provides money toward elder services through the Human Services Levy, those programs must compete for dollars against programs for children, for the mentally retarded and other social services.
If the Shepherds have any complaints at all about the PASSPORT program, it’s one shared by most families who receive home health care – aides often fail to show up for scheduled appointments.
At least once a month, the Shepherds say, a home health aide misses an appointment, in which case they must turn to their neighbors in Park Manor for assistance.
Catherine Seri said her family’s experience with absentee aides in PASSPORT was so frustrating they dropped out of the home care program in July. Aides frequently missed appointments, especially on weekends, she said. Or sometimes they brought their children to the home or left early to do their shopping.
`Every single weekend, we had problems,’ she said.
Her mother, 75-year-old Bonnie Ventura of Bellbrook, is unable to walk, feed or bathe herself because of a stroke. She must be lifted 25 times a day, Seri said.
When home health aides didn’t show, family members had to fill in, most often Seri’s 77-year-old father, Joe Ventura, who is recovering from throat cancer.
`My Dad hated weekends,’ Seri said. `He always said, `TGIM – Thank God It’s Monday.’ ‘
All four daughters developed back and joint problems from lifting their mother, and their father had to have hernia surgery, Seri said. In July, the family placed their mother in a nursing home.