Improve human services in Pennsylvania

The state should talk to on-the-ground agencies before whacking critical programs

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Your elderly, widowed mom bounces back remarkably well from hip replacement surgery, anxious to get home to her comforting couch, crocheted afghan and collection of Hummel figurines.

Decades ago, this wouldn't have been possible, since she'd be shuttled off to a nursing home for "convalescence." In recent years, however, you and your mother would immediately meet with a skilled nurse who'd assess her condition, discuss options and make a plan to ensure she could return home where her spirits would bolster her recovery. She would avoid expensive nursing home care while still being medically supervised.

That is, until now.

This process of care, which in the Pennsylvania Department of Public Welfare involves the "aging waiver," has helped thousands of seniors across Pennsylvania live safely in their homes while relieving taxpayers of unnecessary nursing home costs, which are estimated to be two-and-a-half-times that of care for seniors who remain at home.

But in July 2011, the state Legislature gave the secretary of DPW power to slash programs without oversight or public discussion under the guise of rooting out "waste, fraud and abuse." As a result, rampant cuts have been made to vital programs. Some 89,000 children have lost health care coverage, people with serious mental illness have received inadequate care, and adults with disabilities have been unable to get help with feeding and bathing.

Then, this past summer, the aging-waiver program was gutted and the counties, which had been Pennsylvania's long-time partner in arranging care for seniors, were forced to leave thousands of seniors without care and in jeopardy of nursing home placement.

Forty of Pennsylvania's 52 Area Agencies on Aging, which run the county programs for the state, could no longer afford to continue them and began to withdraw. Seven actually did.

In the face of these cuts, the agencies battled on behalf of Pennsylvania's seniors. With some 300,000 citizens over age 85, making Pennsylvania the fourth oldest state in the nation, this was a worthy fight, and good news seems to be coming of it.

At the urging of United Way of Allegheny County and with support from other advocates and the governor's office, the DPW has agreed to reinstate some funds for the aging-waiver program and, better yet, work with Area Agencies on Aging, counties and senior care experts to make the program more effective and sustainable.

It remains to be seen whether the aging waiver can survive the "Humpty Dumpty effect" and be put back together again, but it's encouraging that so many are willing to try.

So that's the end of the story, right? Happy ending and all?

Well, it's a step in the right direction. Here are three ideas to build on that momentum.

• 1) Support what works: Let's take the best of our most effective programs and improve them, not cut them. Let's look at data and results, and then arrange funding around intelligent analysis while ensuring Pennsylvanians get the greatest return on their investment. Let's leverage the experience of our leaders in the business and nonprofit communities to design a better system.

• 2) End reckless cost-cutting: In an era when precious resources are limited, we need to examine not just costs, but effects. Removing one block in a game of Jenga can send a structure tumbling. Random program slashing can be even more devastating because peoples' lives are at stake. As with seniors and the aging waiver, consider how the effects of $84 million in human-service cuts in the governor's last budget still ripple through communities, especially among those who have lost help with mental illness. Become a champion for and adequately fund these critical services.

• 3) Working together works: Fortunately for seniors, state Sen. Randy Vulakovich and Todd Shamash of Gov. Tom Corbett's office intervened to get the right people in the right room to address issues caused by irresponsible human-service cuts. But imagine a world where the right people are convened before problems arise, where people involved in the day-to-day workings of a program advise lawmakers and budgeters.

Since the state government funds many programs it does not operate, it relies on a network of community-based organizations. If we've learned anything from drastic budget cuts, it's that the commonwealth should be nurturing relationships with people on the front lines, not shutting them out of the process.

Luckily, your mom returns home and is cheerfully ensconced there, safely recovering from surgery. This is the Pennsylvania we envision -- where decisions are made based on what's best for all people, from those in need of our help to the taxpayers deserving of our responsible stewardship. Let's move forward intelligently and do what works for Pennsylvania.

opinion_commentary

Robert Nelkin is president of United Way of Allegheny County, which has joined with The Pittsburgh Foundation to provide leadership for the Campaign for What Works, a coalition supporting the preservation and improvement of vital human-services programs (bob.nelkin@uwac.org).


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