Programs for supportive services, in-home healthcare impacted by state, federal changes
By Melissa Flores
Low-income families in the Salinas area who are in need of home healthcare or support with daily activities due to a disability may have a harder time getting that help as state budget cuts and cuts to Medi-Cal and Medicare reimbursements continue.
“It would really be a disaster,” said Fe Stallworth, the director of business development and patient care planning of the Central Coast Visiting Nurses’ Association and Hospice, if reimbursements continue to be cut for home healthcare.
CCVNA is one of two agencies that offer help to those who have limited functionality – CCVNA through skilled medical professionals who can help people recover from surgery or illnesses at home rather than in a hospital and In-Home Supportive Services, which provides help for residents with limited functionality on day-to-day chores.
The main concerns for CCVNA are that it has become harder for clients to qualify for home healthcare and the reimbursements have gone down. The nonprofit agency is funded through grants, bequests, individuals and organizations, and government contracts.
In the 2010 annual report, Steven A. Johnson, the president and CEO, noted “There have been many challenges during 2010 including severe economic downturn, reduced government reimbursement and increasing governmental regulations.”
Changes in Medicare requirements include the new Health Care Affordability Act, which requires patients to have a face-to-face meeting with a home care certifying physician within nine months prior to starting services or within 30 days of starting services.
Stallworth touted the benefits of using home healthcare instead of staying in a hospital or skilled nursing facility.
“The cost of outpatient is probably half the cost of in the hospital,” she said. “It improves your well being.”
She said that patients can have medication administered, receive physical therapy or other medical services at home.
“They don’t have to drive to outpatient (clinics) every day,” she said.
CCVNA accepts patients with private insurance, but they also work with Medi-Cal and Medicare patients.
The services include skilled nursing services, rehabilitation services, certified diabetic educator, cardiac program, a wound care program, enterostomal and wound care, medical social workers, dietary and nutritional counseling and palliative care.
In-Home Supportive Services provides longer-term help to people with a functional impairment who need help with day-to-day activities. Services include assistance with light house keeping, cooking, laundry, medical transportation, and personal care such as dressing, bathing, and grooming.
In-Home Supportive Services received a 3.8 percent cut in the state budget, according to Sam Trevino, the public information officer for Monterey County’s Aging and Adult Services, which services Salinas clients. He said that an additional 20 percent cut is still a possibility.
Trevino explained that the types of activities that are allowed through IHSS have remained the same, but the number of hours available to each patient has been cut by 3.8 percent.
“The scope of the activities covered include daily living – chores and housekeeping,” he said. “There was some reduction of hours, but the initial 3.8 percent was absorbed (by the clients and homecare providers.) We didn’t get much in the way of calls coming in. I think they are doing their best to accommodate it.”
To qualify for the program, a resident must be low-income and have some kind of functional impairment. The impairments can be physical or developmental, and clients of all ages are eligible for the program. Through an interview with a social worker, the staff determines how many hours a client needs, from 20 hours a month up to 9 hours a day of care.
“We are concerned about the trigger cuts of 20 percent,” Trevino said. “It would be a challenge to respond to that if that were to occur.”
He said that he expects to know if the additional cut will come through in mid-December when the state completes its second-quarter reports. The “trigger cuts” refer to possible $601 million in cuts that will be implemented if state tax receipts come in lower than anticipated. If projections fall below estimates by more than $1 billion, the cuts will be enacted, including an additional $100 million to IHSS.
“It’s a threat that is actually looming on worker’s minds and recipients who rely on this service,” he said.
In Monterey County, about 4,000 employees are working with 4,000 recipients. The rate of pay is the same for all IHSS employees, though the number of hours they work varies by the clients’ needs. In 2010-11, employees made $12.10 an hour.
Statewide, 438,000 residents are expected to use IHSS services for the 2011-12 fiscal year, according to The SCAN Foundation, a nonprofit group that focuses on issues affecting seniors.
In March, state officials adopted several measures to save money that impacted IHSS. They included eliminating hours for recipients who do not have a physician certification that personal care services are necessary, for a savings of $67.4 million. They also eliminated an advisory committee that county boards of supervisors were mandated to establish. Counties can still continue with the advisory committee with $3,000 provided from the state.
The legislature is also banking on keeping some services through the federal Community First Choice State Plan Option, which provides community-based attendant services and IHSS for consumers who meet nursing facility eligibility.
Trevino said the IHSS program is funded through state, federal and local funding. A large amount of the money comes from Medicaid and Medical reimbursements.
Residents don’t have to come into an office, as social workers can visit them to determine their needs, with input from a physician. Residents can select their own IHSS worker, if they have a family member, friend or neighbor who wants to assist them. But Trevino said the staff can also pair residents with a provider through the IHSS Public Authority.
“The majority of recipients, about 80 percent, have one already,” Trevino said. “Having a family member can be good because they know the person intimately.”
Trevino noted that the program does help family members who are struggling, who have lost a job or have limited time to work due to caring for a loved one.
“If they have disabled family or aging parents, they might be struggling to stay employed,” he said. “This is trying to maintain the family, financially and be independent.”