University of Pittsburgh psychiatry professor Richard Schulz has been one of the nation’s foremost researchers on caregiving stress for
When Bob Fabry needed assistance at home caring for his wife, who has dementia, he turned to a state program that helps elderly Pennsylvanians remain in their homes — without entering far more costly nursing home care.
Despite applying in April of last year, it took until February before home health aides were in their Venango County home to help care for his wife.
“The paperwork is overwhelming,” Mr. Fabry recalled, who also had the assistance of an attorney throughout the process.
Gov. Tom Wolf’s proposal to unify the state’s Department of Aging, Health, Drug and Alcohol Programs and the Department of Human Services into one Department of Health and Human Services promises to save money and provide better services to people like Mr. Fabry.
But advocates for the elderly say they are concerned about the loss of Pennsylvania Lottery funds that now pay for senior services, the loss of a senior “voice” without a Cabinet secretary at a time when the number of older Pennsylvanians is growing, and past missteps in trying to merge services last year.
More than 2.1 million Pennsylvanians are over the age of 65 and that number is projected to grow as baby boomers age.
Advocates express concern
Advocates say they are concerned that an early attempt at another agency handling aging services, such as those Mr. Fabry applied for, resulted in enrollment delays and problems for seniors, and they worry that would get worse in a bigger bureaucracy.
Since April 2016, elderly Pennsylvanians seeking in-home services through Medicaid, such as someone to help them get dressed or prepare meals, have had to apply through a Department of Human Services-hired contractor. Previously, this was handled through local Area Agencies on Aging, which would perform an assessment and see if the individual qualified for the program.
“DHS took a system that was not perfect, but worked, and basically threw it out, despite warnings to the secretary of DHS from aging advocates about the inevitable problems,” said Julian Gray, a local attorney who specializes in elder law, testifying before a state Senate panel last week.
Now, elderly individuals must call a 1-800 number and receive a lengthy and complex enrollment packet in the mail, rather than the one-on-one assistance of local aging offices, he said.
“DHS has not demonstrated an ability to handle this transition effectively,” said Mr. Gray, who also writes a column on legal issues for the Pittsburgh Post-Gazette. “We do not think this will get better with a larger and more bureaucratic department.”
Ted Dallas, the Department of Human Services secretary, has said the department did a poor job handling this implementation but that it has improved the time it takes to process an application to an average of 61 days — the same as under the previous system.
Administration officials also have argued that the state is facing a near-impossible budget situation — a nearly $3 billion gap it must close by the end of next fiscal year.
Officials say that without cutting programs, unification can simplify services provided across multiple agencies: for instance, PACE prescription assistance for seniors through the Department of Aging, information on nursing home quality through the Department of Health, or applying for the aging waiver through the Department of Human Services. These would all be provided under one, streamlined human services agency.
State Rep. Stephen Bloom, R-Cumberland, a conservative legislator who wouldn’t normally be expected to be supportive of initiatives of the Democratic governor, is the prime sponsor of the merger bill in the House.
“I am willing to work with any governor from any party to implement beneficial reforms like this, to make our state government more efficient and effective in delivering vital services, and to save money for our hardworking taxpayers,” he said.
The Department of Aging doesn’t have any state general fund dollars in its budget. It’s funded entirely by about $530 million in lottery revenues and $221 million in federal funds from the Older Americans Act.
“There is a fear among advocates for older Pennsylvanians that the loss of a separate Cabinet-level department that is focused on older Pennsylvanians will eventually result in more lottery funds being diverted toward the Medicaid long-term care budget,” said Ray Landis, advocacy manager for AARP Pennsylvania.
Administration officials have said the merger will have no impact on how lottery dollars support senior programs.
“What the lottery fund can be used for is in statute. That is not going to change,” Mr. Dallas said.
Lottery-funded programs for seniors include home and community-based services, rent rebates, free and reduced-fare transit, the PACE prescription assistance program and money for senior centers. More than 2 million Pennsylvanians are age 65 or older, according to census data.
It’s not clear yet if legislators will ultimately approve the merger proposal.
“I’m not prepared to endorse the plan as it has been presented,” said Sen. Lisa Baker, R-Luzerne, chair of the Senate’s Health and Human Services Committee.
Senate Minority Leader Jay Costa, D-Forest Hills, said he believes the unification could be successful if done thoughtfully.
“I do support the concept, and I believe it will likely happen,” Mr. Costa said. “But I believe we cannot diminish any level of service we provide through any agency. We have to be thoughtful and methodical” in implementation, perhaps phasing it in over time with legislative oversight.
In the House, a bill narrowly passed the Human Services Committee that would prohibit the merger without further study.
A return to the past?
Many supporters of keeping a stand-alone seniors agency say the entire reason it was created decades ago was to give elderly people a voice and to prioritize their services.
“Seniors in Pennsylvania fought to elevate the Office of Aging back in the 1970s to a Department of Aging, and now we have an even larger segment of our population over the age of 60 in need of a voice,” said Art DiLoreto, deputy director of the Pennsylvania Association of Area Agencies on Aging, speaking last week before a state senate panel.
“The seniors themselves were really pressing the legislators to get this done,” recalled Roy Afflerbach, who was chief of staff to the Senate majority leader when the bill creating the agency passed in 1978.
When the Senate unanimously passed the bill creating the new Department of Aging in 1978, “scores of lobbying senior citizens” seated in the chamber’s visitors gallery began singing “God Bless America,” joined by 49 senators, according to an account from that time in the Post-Gazette.
Seniors were lobbying because the state’s Department of Public Welfare (now the Department of Human Services) was not successfully implementing the federal Older Americans Act, which had passed in 1965, Mr. Afflerbach said. That agency was wrestling with other large issues at the time, he said, such as disability issues, welfare safety net programs and administering Medicaid, which had also been created in 1965.
Mr. Afflerbach said the aging agency has been successful, because the creation of the state’s Area Agencies on Aging network gave seniors local services with what they needed in one location.
“It did away with confusion,” he said.
Mr. Afflerbach, who now represents the Pennsylvania Adult Day Service Association, the Pennsylvania Association of Senior Centers and the Meals on Wheels Association of Pennsylvania, testified last week at a joint Senate hearing on the proposed agency unification, although he said his testimony was not on their behalf.
He said he was concerned that the proposed new Department of Health and Human Services would bury aging among four offices and 10 bureaus and divisions — “a risky return to a failed structure of the past with hope that it would somehow work better today.”
Kate Giammarise: firstname.lastname@example.org or 412-263-3909 or on Twitter @KateGiammarise.