There's no place like home: Pennsylvania needs to better fund home and community care for seniors

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Allegheny County officials last week announced they will be cutting back on the frequency of Meals on Wheels visits to older residents. Many of the program's volunteers are concerned about how this will affect those who are homebound.

Sadly, the cutbacks here in Allegheny County are being repeated in towns across Pennsylvania as the state's network of home- and community-based services is stretched to the breaking point.

Area Agencies on Aging have more than 6,000 older adults on waiting lists for assistance statewide. Senior community centers are deteriorating physically and many have reduced hours or cut programs. Parts of the state have no adult day care services, and low reimbursement rates are hurting professional caregiver recruiting and retention. This means thousands of older Pennsylvanians are being denied the health care and other services that can make the difference between staying at home and being forced into a nursing home.

Fortunately, Pennsylvania offers a unique way to improve senior support services without spending one state tax dollar. Thanks to innovative games and huge Powerball jackpots, the Pennsylvania Lottery continues to enjoy remarkable success. In fact, it is on track for another record sales year.

All that money is good news for older Pennsylvanians who, by law, are the exclusive beneficiaries of lottery proceeds. For the past few years, though, it's been hard to convince state officials to invest more in essential home- and community-based support programs. Let's hope that's changing.

The 2013-2014 state budget being negotiated in Harrisburg includes a proposed $50 million in new revenues for home- and community-based programs for seniors to help reduce waiting lists and stabilize struggling senior centers and service providers. This new money represents an important step toward improving the balance between nursing-home care and less expensive alternatives that allow older adults to remain at home.

There's plenty of room for improvement. A recent AARP study done in conjunction with the Scan Foundation and the Commonwealth Fund ranks Pennsylvania a disappointing 39th nationally in its balance of funding between institutional care and home- and community-based programs serving older adults.

Increasing state lottery resources for home- and community-based programs would reverse years of neglect for senior programs that were supposed to be funded by lottery proceeds when they were created and are now struggling to survive. In the 2012-2013 budget alone, a record $309 million was shifted from lottery revenues to the Medicaid nursing-home budget. Over the past five years, more than a billion dollars have been diverted from the lottery fund to the Medicaid program, while the budget for other lottery-funded programs remained stagnant.

Transferring lottery money to Medicaid nursing-home care instead of funding home- and community-based programs is short-sighted and doesn't make life better for seniors. Home and community programs allow older residents to stay at home, maintain their independence and remain a vital part of their families and neighborhoods. It's also what the vast majority of seniors want.

According to an AARP Pennsylvania survey, 95 percent of older Pennsylvanians prefer home- and community-care alternatives to nursing-home placements. What's more, national research shows you can provide home and community services to seniors at an average cost that is almost one-third of annual nursing-home fees.

While nursing homes will always be part of the continuum of care for older adults, increasing funding for home- and community-based senior support services represents smart public policy. Helping older adults remain at home saves the state money in the long run by keeping seniors out of nursing homes and off Medicaid rolls longer.

AARP and senior advocates believe the first obligation of lottery proceeds should be funding existing home- and community-based care programs before allocating money to Medicaid or other parts of the state budget. Everyone buying a lottery ticket in the commonwealth deserves to know that their purchase is helping older Pennsylvanians live where and how they want to live.


Bill Johnston-Walsh is state director of AARP Pennsylvania.


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