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Elderly
care program runs into problems
Shreveport
Times, July 7, 2003
BATON
ROUGE - The creation of a program to give the elderly services to help
them stay at home and out of nursing homes ran into problems with
Louisiana lawmakers and powerful nursing home lobbyists. And the
Legislature's decision could send the state back to federal court.
The program to provide so-called "personal care attendants" to
the elderly is required by a federal legal settlement, but it targets some
of the same Medicaid dollars on which the nursing homes depend.
About 31,000 people live in Louisiana nursing homes, which depend on the
state's Medicaid program for the poor to provide the bulk of their
budgets. Nursing homes get about 85 percent of their dollars - $574
million - from state and federal Medicaid money, according to Joe Donchess,
executive director of the Louisiana Nursing Home Association.
"All we want to do is to ensure that we have adequate funds to take
care of the sickest of the sick and the poorest of the poor."
As the legislative session ended June 23, the state Department of Health
and Hospitals was given the directive: Try to renegotiate the settlement
and see if you can scuttle the planned personal care attendant program
and, instead, expand an existing program to provide community-based
services to the elderly.
The lead lawyer who accused Louisiana of violating the rights of elderly
residents by not offering enough alternatives to nursing home care expects
to go back to court to force the state to honor the settlement.
"We want what we bargained for originally. There's no basis for going
back on it, except for the fact the nursing home industry was so vocal in
the Legislature," said Nell Hahn, a Lafayette lawyer with The
Advocacy Center.
Personal care attendants would help the elderly with feeding, bathing,
grooming, shopping and other tasks up to eight hours a day so they can
remain in their own homes.
Donchess acknowledged he pushed for legislators to stop the creation of
that program so nursing homes wouldn't lose money. He urged the
Legislature to plug the $28 million in an existing home-based care service
for the elderly that is easier to control and includes a cap on the number
of participants. When the money runs out, no more people are eligible to
enroll.
"Our fear is that the more it eats into the overall budget, the more
likely the nursing home program, the hospital program and others are going
to have to get cut," Donchess said.
Lawmakers focused heavily on the personal care attendant program during
the budget debate in the legislative session, saying they feared an
out-of-control program along the lines of the non-emergency medical
transportation program.
When it was started a decade ago, the transportation program grew from $8
million to $80 million in a few years and was fraught with abuse,
according to senators reviewing the budget.
"It has all the earmarks of a fiscal calamity," said Senate
President John Hainkel, R-New Orleans. "You could have everybody
taking care of their grandmother if we don't watch this."
Sen. Joe McPherson, D-Woodworth, a nursing home owner, tried to strip the
dollars from the personal care attendant program. But senators worried the
move could put Louisiana in contempt of court or convince a federal judge
to force even harsher, more expensive requirements on the state.
"It's not the boogeyman everybody's telling you it is," said
Sen. Diana Bajoie, D-New Orleans. "It's a way to help and to have
options for the elderly here in the state. It's sad that it had to come
from a lawsuit."
McPherson withdrew his amendment, but the Legislature delayed the start of
the program from July 1 to Oct. 1 and adopted language that requires DHH
to seek approval from the court to shift that money to other types of
community-based services.
Patti DeMichele, state director of the Louisiana chapter of the American
Association of Retired People, said DHH had strict safeguards for the
program that include requirements that only the extremely poor would
qualify. The care would have to be provided through a licensed agency.
"We don't just go around trying to devise ways to throw away
money," DHH Secretary David Hood said.
Hahn believed legislators balked at the personal care attendant program
because they were trying to protect the financial health of the nursing
homes, whose lobbyists contribute heavily to some lawmakers' campaigns.
"They're supposed to be protecting the civil rights of these people,
which includes their ability to live in their homes," Hahn said.
"You can't be limiting people to keep the nursing home industry
financially viable."
Hood said his staff was meeting with the plaintiffs in the legal
settlement to make the best case DHH can to switch the dollars to the
already existing community-based care program for the elderly. "We
will make every effort to live up to the legislative directive. We
certainly don't want to violate any court order."
The personal care attendant program already has been delayed. It was
included in last year's budget, set to start by Oct. 1, 2002. But DHH
negotiated with the plaintiffs to postpone its start until July 1.
Hahn said the plaintiffs don't want the dollars shifted to the existing
elderly care program because its services are not equivalent to the
personal care attendant program.
"We trusted them and believed that given the time to do this thing
right, they'd have this thing in place July 1," she said. "At
this point, it looks like we'll have to be heading back to court to
enforce our agreement."
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© 2002 Global Action on Aging
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