Some ironies that frustrate Lisa Monday, Butler County's chief advocate for elderly people:

There isn't enough money to provide the least expensive services -- such as light housekeeping and grocery shopping -- that often are the first things older people need help with to be able to age in their own homes.

The reason that money is low is because of the push in recent years to have more elderly spend their final, and often sickest, days at home instead of in a nursing facility.

So, although services such as cleaning and shopping are most in demand, they will be the first to be cut -- and those cuts could come in July.

"It's incredibly frustrating,'' said Mrs. Monday, the director of the Butler County Area Agency on Aging, as she references an inch-thick plan for the future that is bleaker than she had envisioned.

Her frustration comes from the hard truth that soon she no longer will be able to provide services to some clients. Come July, her agency will tighten the restrictions on who will be eligible to receive in-home support services, a cost-cutting measure aimed at reducing a waiting-for-service list that has topped 200 at points during the past year and stands at 146.

"We don't know exactly what the requirements will be at this point, but the goal is to cut back on those services because we just don't have enough money to provide them,'' she said.

The heartbreak for her and other advocates for elderly people is that she knows that by eliminating the services considered by some to be "nonessential,'' some clients may be pushed into giving up their own home.

It's a fact that can be testified to by Kathleen Brenneman, director of public relations for St. Barnabas Health System, with campuses in Richland and Valencia on either side of the Allegheny/Butler line.

"We have lots of people living independently well into their 90s and even into their 100s because they're able to utilize some basic supports like grass cutting or housekeeping,'' Ms. Brenneman said. St. Barnabas offers three levels of care: independent living, assisted living and skilled nursing care.

The funding crisis for Butler County Area Agency on Aging results from stagnant allocations from the state and federal governments combined with the increasing costs of services provided.

"The fact is, many of our clients are sicker than they used to be so they require many more services that are more expensive,'' Mrs. Monday said.

This isn't news to leaders in her agency or the stakeholders who met twice in recent months to draft a four-year plan for the future. Waiting lists for services started building about four years ago as the push to have elderly people stay in their own homes picked up momentum.

"We never have enough money to do everything we want to do, but more of our clients are sicker than they used to be and the services we're providing are getting more and more expensive,'' she said. "Ten years ago, you got sick and you went to a nursing home and you stayed there 'til you died. Now, it's nursing home rehab and you're back home again."

And once someone is a client of the agency, service cannot be eliminated unless the eligibility requirements are changed so that a client is deemed ineligible. Hence, a growing waiting list, and the waits can be lengthy.

The crisis came into sharp focus in recent weeks as Mrs. Monday prepared for a state-required four-year plan that looked down the line at big potential increases in customers due to Butler County's increasing population and the aging of baby-boomers into senior citizen status.

In the end, Mrs. Monday said, the decision was made to tighten restrictions on eligibility for those who receive in-home support services.

"We had thought about completely eliminating them to free up more money for the more intensive services, but we just couldn't bring ourselves to do it. If you look at our needs assessment survey and our referrals, the support services are the most top-requested things,'' she said.

The services in question including light housekeeping, laundry and grocery shopping.

The more intensive and costly services that are offered by Area Agency on Aging include personal care such as bathing, home health services such as range-of-motion exercises, and nursing services such as drawing blood for tests.

The agency has a $4.5 million budget. About 1 percent is from the county, and 80 percent to 85 percent is from the state and federal governments. The balance comes from donations and cost-sharing fees paid on a sliding scale by clients based on their income.

Operating on a state fiscal year, July 1 to June 30, about 600 clients are on the books this year and about $1.1 million will be spent for in-home care -- the biggest component of agency services. That figure doesn't include $2 million that the agency spends on Medicaid-eligible clients for more intensive in-home care as an alternative to nursing home placement. The balance of the budget pays for the senior citizens centers, transportation, legal assistance and staff salaries.

"Nobody can argue that home is where you want to be and where you should be, but someone has to provide the money so we care for these people,'' Mrs. Monday said.

She said she rues the day when the less intensive in-home services are reduced because "those are the kinds of things that are the first things someone needs. Light housekeeping or occasional grocery shopping or doing laundry once or twice a month, those services can prevent family burnout or stabilize the situation rather than allowing a rapid decline into a more expensive situation,'' she said.

For the past four years, Mrs. Monday said, she has felt "lucky, lucky, lucky" if her agency has received a 1 percent to 2 percent cost-of-living increase in subsidy. None is planned for the budget year that begins July 1, 2008.

Ms. Brenneman agreed that government funding for the kinds of services that are increasing in popularity is lagging behind demand.

"There is really a trend in the elder-care industry toward aging in place and trying to keep people in their home as independent as possible and as long as possible, but there's a Catch 22 when it comes to funding. Government funding that's in place hasn't quite caught up with what the industry is able to offer seniors,'' she said.

To qualify for Butler County's lower-intensity in-home services through the Area Agency on Aging, a person has to have a medical condition that prohibits the individual from performing the task in question.

"We haven't figured it out exactly, but what we're going to do now is expand -- possibly by requiring that the client need hands-on care,'' she explained.

As a client's periodic assessment is completed, the person will have to meet the new criteria or will be eliminated as a client.

"It could have far-reaching effects on people. We know that, and this will be hard to do and it sickens us, but we have no choice,'' she said. "It was a choice between eliminating it altogether or tightening things up."

Mrs. Monday is asking people to contact their state legislators to request bigger allocations.

She also is looking for contributions of cash and services.

"We would love to have volunteers willing to do light housekeeping or grocery shopping or provide transportation to medical appointments,'' she said. All volunteers must clear a criminal background check, and the agency will pay for the state police clearance.

"Whether it's leaves raked in the fall or snow shoveled in the winter or grass cut this time of year, there's so many ways people could help if they wanted to,'' she said.