Low-cost option: The state should work to keep frail elderly at home

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Nurses and others who care for senior citizens in their homes are seeing disturbing consequences of new rules put into effect July 1 by the state Department of Public Welfare.

More than 20,000 frail, elderly people in Pennsylvania receive help with bathing, housekeeping and meals through what's called the Aging Waiver program, which helps them stay in their residences rather than go into nursing homes. The state changed what providers are paid and how services are arranged for these individuals, who must be elderly, have multiple medical conditions, take at least seven prescription medications and be financially eligible.

In the past six months, the waiting list for participation has grown by 66 percent and now includes 5,300 people, according to Leslie Grenfell, executive director of the Southwestern Pennsylvania Area Agency on Aging, a nonprofit that serves older adults in Fayette, Greene and Washington counties.

Her agency, which had six nurses on staff, now has one, and Allegheny County's AAA, which has 1,700 consumers, reduced its nursing staff from eight to two. Similar cutbacks have been made in other parts of the state. Instead of assigning nurses to evaluate the medical condition of applicants in person, those interviews increasingly are taking place over the phone.

Seven of the state's 52 AAAs, including the one in Butler County, are withdrawing from the program.

These short-term consequences are not nearly as dire as what the advocates predict for the long term: They expect more people to wind up in nursing homes, which costs on average $59,340 per year, instead of remaining at home, where the average cost for comparable services is $21,336.

That seems like a ridiculous result, given that the regulations were changed in an attempt to save money.

The state says the change also was intended to give consumers more options for supervision of their care, but the impact so far seems to be added complexity and reduced efficiency.

This policy cries out for more discussion and revision. The state should rely on its partner agencies, and their decades of experience coordinating care for vulnerable citizens, in crafting a better way to make sure older adults don't wind up in nursing homes unnecessarily.



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