New Pa. regulations could affect home care for elderly

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Administrators of Area Agency on Aging offices around the region and state are concerned and confused about new Department of Public Welfare regulations guiding how they arrange services for frail, elderly individuals.

The changes to take effect July 1 in what's known as the Aging Waiver program, which serves more than 20,000 people statewide, mean the agencies will have less funding to plan and supervise the home care given to those clients to keep them out of nursing homes, local AAA executives say.

The result could be fewer staff and less attention given to those needy consumers, the administrators warn. What's more, they contend the welfare department is rushing through the changes in a way that makes it hard for them to prepare.

"What's concerning is the lack of detail," said Mildred Morrison, administrator of Allegheny County's aging program. "The AAAs right now don't know what to do. ... We need time to get it right for consumers."

Discussions of Aging Waiver revisions go back several months, from state officials seeking more consistency among programs that provide means of serving people of low income and fragile health in their homes. Clients can receive a range of services from private providers, such as personal aides who help with meals, bathing and housekeeping. Such help is far less costly to the government's Medical Assistance budget than subsidizing those same people in nursing homes if they lack in-home help.

Welfare department spokeswoman Ann Bale said that with prodding from the federal government, the Corbett administration is making management of the Aging Waiver similar to a group of waiver programs serving disabled individuals under age 60. Because of a special provision in passage of the state budget last summer, the welfare department is able to revamp the program without traditional oversight of its regulations by the Legislature or an independent commission.

One change intended to benefit older consumers, she said, is giving them a range of agencies they can select to oversee supervision of their care instead of automatically relying on their aging agency.

That new management option for consumers is combined with a revised reimbursement structure for the AAAs -- giving them payments allotted for 15-minute chunks of accountable time instead of on a more general basis -- but Ms. Bale said it will not mean any reduction in the in-home help delivered to Aging Waiver participants.

"We are not eliminating programs and services," she stressed.

Agency administrators counter, however, that they're going to be more hamstrung in ability to help waiver clients. Their staffs don't deliver the home services directly but are the ones evaluating what's needed and organizing them for the consumer, which is what they say will be affected. While they will continue enrolling people in the waiver program, the state has yet to confirm how it will compensate them for that initial intake, which is separate from payment for ongoing coordination of services.

Beverly Sullivan, administrator of the Beaver County Office on Aging, said new rates outlined by the state thus far would give her agency only about 60 percent of what it receives currently to manage 220 waiver participants. Those rates in southwestern Pennsylvania are lower than what the welfare department has set for other parts of the state. It has caused Ms. Sullivan to send tentative layoff notices to a staff of five care managers and two nurses assigned to the waiver program, because she's uncertain how many she can afford to keep after July 1.

"We anticipate a significant decrease in the visits they will be able to make to consumers," to monitor and plan their care, Ms. Sullivan said.

Likewise, Ms. Morrison and Leslie Grenfell, executive director of the Southwestern Pennsylvania Area Agency on Aging, which covers Washington, Fayette and Greene counties, expect to retain fewer staff and have them devote less time to clients. They said they will try to assign excess waiver staff to other agency positions instead of laying them off.

Service coordinators in the future will more often assist clients by phone instead of in person, as the latter requires travel costs and time that may not be justified by a reimbursement rate of $13.98 per quarter-hour spent with clients, administrators said. Lower reimbursements also will make it more difficult for them to retain registered nurses on staff to provide medical knowledge in assessing clients' needs, they said.

"The rate is so low it provides a disincentive to us to see people," particularly in rural areas, Ms. Grenfell said. "We feel it will result in a greater number of nursing home placements."

Ms. Bale said a private analysis firm hired to help set rates across the state looked at wage costs, travel time and other factors in recommending lower rates to manage services in the seven-county Pittsburgh area than elsewhere in Pennsylvania. Using the same data, the welfare department also has reduced most rates locally for what aging agencies are now permitted to pay to the contracted providers of in-home services.

In addition, waiver clients who take part in a program in which they can hire subsidized in-home help from people they know or find -- instead of relying on agencies -- face a reduction equivalent to $1.80 an hour in the maximum their workers can be paid.

The range of issues raised statewide has prompted the welfare department to schedule a meeting Monday for AAA directors, who hope to obtain more information and clarity then.


First Published June 16, 2012 12:00 AM


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