Today I am going to wrap up our discussion by speaking about two additional programs that are available to help low-income seniors: Assistive Care Services and VA Aid and Attendance.
Despite the number of low-income seniors needing long term care subsidies to remain at home, except for Mississippi, Florida has one of the lowest reimbursement rates for services. In order to entice private providers to accept clients into their assisted living facilities, the state decided to create the Assistive Care Service (ACS) funding program. This program is a matching fund. By taking some state funds and requesting the federal government to match it, the state was able to provide $9.28 per resident per day to help pay for services. Separate from the Medicaid program, Veterans are eligible to have services paid through the Aid and Attendance program. Unlike the Medicaid waiver program, this is an entitlement program, meaning if you are eligible, you receive it, no waiting lists. However, the time it takes for the VA to approve applications can be long, on average 6 months. Following are the requirements to apply for both the ACS and the VA Aid and Attendance programs.
ACS-Assistive Care Services (State Program)
Call DCF (Department of Children and Families)
VA Benefits – Veterans Aid and Attendance
Call the Department of Elderly and Veterans Services
Broward County: 954-357-6622
I hope that I have helped to inform you of some of the programs and options that exist to help you care for your aging, low-income parents.
As promised, today I will discuss another program that is available to very low income individuals. The Medicaid Diversion program is available to very low income individuals who are eligible for supplementation to their social security check and to those with a small pension. This is a match funding program, meaning the federal government contributes some funds as well as the state. You have to be eligible financially as well as physically. Here are some of the requirements that must be met in order to be eligible.
Diversion – Long Term Care
(State and Federal Program)
Department of Elder Affairs 1-800-963-5337
Florida: www.elderaffairs.state.fl.us 1-850-414-2000
Must be 65 years old.
- Must have a diagnosis of dementia plus need at least 3 out of 5 ADL’s (activities of daily living);
- or require assistance with 4 ADL’s plus medication management;
- or require assistance with 5 or more ADL’s.
- Activities of daily living include: bathing, dressing grooming, ambulation and toileting.
- State CARES unit will come to assess the client to see if they meet the program’s criteria.
- Can also need IADL’s (Instrumental ADL’s which are: housekeeping, shopping, cooking, transportation.
- A physician must complete a 3008 form for the State.
- A physician must complete an 1823 form for admission to an ALF.
- Must have income less than $2,130 for an individual, $4,260 for a couple. (These are 2013 limits)
- Total asset limit is $2,000 for an individual or $3,000 for a couple.
- Facilities are paid per contract; families are responsible for monthly room and board rate to the facility. Facilities may charge COLA increase annually according to a lease agreement.
- Incontinency is a covered benefit.
- medications are covered through Medicare Part D or the individual’s personal insurance.
- PT (Physical Therapy), OT (Occupational Therapy), ST (Speech Therapy), Labs, Physician Visits, Hospital Coverage, Dental, Hearing and Vision will be covered if not otherwise covered by Medicare or personal HMO Insurance. Diversion will also cover any and all non-covered services, co-pays and deductibles.
- The contracted Diversion company becomes the secondary insurance to Medicare.
- Transportation is not a covered benefit. Medicaid should cover under Logistic Care.
- There is a hospital bed hold up to 21 days. if the client is out more than 21 days the facility will not be paid and the family will be responsible for the difference.
- Clients do not have to be on SSI or OSS to qualify for this program.
- Client may NOT receive HOSPICE benefits while on a Medicaid Diversion program.
Next time I will speak about ACS – Assistive Care Services and VA (Veteran’s Affairs) Benefits.
On November 12, 1995, an event occurred that completely changed the course of my life. While serving as Florida Secretary for Aging Services I was summoned to a public housing building in Fort Lauderdale, Florida where a fire had killed 12 of the residents. For the first time I came face to face with the squalid and precarious conditions in which low-income seniors in this country subsist. The image of that day never left me and I made a promise to myself that I was going to make it better. Charged with this moral obligation and strength I was able to secure a deteriorating public housing building in downtown Miami with the promise of turning it around and creating something new. With my political ties in Tallahassee still fresh I secured $1.2 million to retrofit and license that building. In six months it was full with a long waiting list, had become the model for the nation and had won four national awards. Some may say it was luck, I believe it was stubbornness and commitment that made it happen. I had fulfilled my promise. To the 104 seniors living at Helen Sawyer this was the beginning of the best time of their lives. End of story. I never had the intention of doing this over and over in twenty-three states. But it was no longer up to me; the notoriety that this little program gained made it impossible for me to turn the page. And so it began, my journey in replicating this common sense approach to providing 24 hour services to low-income seniors where they live so they will never be forced into a nursing home.
There is no doubt that good publicity helps in creating an innovation, but that alone is not enough. I knew that innovation is almost always built on rejection. There were so many obstacles that had to be overcome. The worst was the mind set of policymakers and public officials reluctant to change the way we care for the poor elderly. They seem to have a spiritual blindside that prevents them from seeing the human side of the dilemma. If I was going to replicate this program in other counties and states, government funding was critical. My experience in government was important in understanding government, what moves them; how to obtain their collaboration. We needed to gather some ammunition to win them over. How about doing more with less? With the funds they spent for each individual forced into a nursing home, I was going to care for four. How about if we could prove to them that our care involved changing lifestyles and improving health? We started gathering data that proved that we were avoiding hospitalizations, emergency admissions, reducing the number of prescription drugs and 911 calls. That certainly caught their attention and in 2010 our little company was able to change national policy. Funding this type of program instead of nursing home care became a priority. The Community First Option program was started in collaboration with two large federal agencies: Health and Human Services and the U.S. Department of Housing. The program was initially funded with $46 million. Until now, they did not talk with each other, and now they were cooperating in making it possible for low-income seniors to live with dignity in the comfort of their homes. What a novel idea!
Now, I said, we can concentrate in avoiding other obstacles in scaling our program. What would it take to convince private investors to provide the capital to purchase distressed properties and hire us to provide the services to this exponentially growing and long neglected population? A good return on their investment perhaps? Although corporate America needs to be seen as having a social impact, what they are truly interested in is good returns. Conquering corporate America became a major goal for us. We never forgot, however, that our social mission had to be safeguarded.
This has been our battle cry for over twenty years. The benefits of keeping seniors at home with needed services has proven to be cost-effective, beneficial to the health of these clients and responsive to seniors’ desires. And yet, change has come slowly particularly in southern states. Under the pressure of skyrocketing Medicaid budgets fueled by the increasing numbers of low-income seniors our policymakers have had to shift toward funding more community instead of institutional care (nursing homes), what is called in the industry: “rebalancing long-term care.”
One state that has been successful in doing so is Oregon that rebalanced their budget back in the early 1980’s. Many other states have followed, including Washington and Colorado. The number of people receiving Medicaid-funded nursing facility care in these states grew at a much slower rate than in the rest of the nation from the inception of Medicaid home and community-based waiver programs in the early 19080s to 1994. The number of people in nursing homes as a proportion of the population age 75 and above in these states decreased faster than the average for the rest of the nation. Total annual Medicaid spending on nursing facilities also increased at a slower rate in the study states than nationally after controlling for growth of the age 75-and-older population.
Today only a handful of states remain committed to forcing seniors into nursing homes when no longer able to live independently – Kentucky, Virginia, Alabama and West Virginia do not pay for assisted living services. Although an increasing number of states have created Medicaid waivers to pay for assisted living services, the funding always falls short of the need which creates long waiting lists. clients in need of assisted living services cannot wait the two or three years it takes to receive an allocation. So seniors and disabled adults are still forced into nursing homes and we continue to pay for poor quality and undesirable care.
In 2003 our firm started the conversation with the Department of Housing and Urban Development urging them to join forces with the Department of Health and Human Services (federal Medicaid program) to properly fund community care at least for those living in public/subsidized housing. Seven years later, it happened and both departments partnered to create the Community Living Initiative that funds housing and services for low-income disabled adults. Seniors, however, have to wait longer and as of today no initiatives have been taken to address the issues of the seniors.
Apparently financial crisis alone will not prompt the federal government to act. I firmly believe the issue of low-income seniors ending up in nursing homes prematurely must arouse public opinion. Those most affected, the seniors, the families, the advocates, need to demand this change. Rather than being remembered as the “silent minority” we must be remembered as the generation that changed the way we care for seniors in this country.
In June the U.S. Supreme Court will determine the fate of the healthcare reform and with it, the fate of many seniors in this country. There is consensus that healthcare reform cannot be viable if the public option is deemed unconstitutional. This comes at a time when the economic and health security of seniors is at its worst. Healthcare reform,although aimed at the 40 million uninsured individuals, provided great benefits to seniors who cannot afford long term care. Included in the healthcare reform were incentives to state to provide affordable long term care to seniors who want to remain in their communities and avoid costly nursing home care.
Lets take a look at what is at stake. Debt and deficit reduction proposals by policymakers include major changes to thre three major entitlement programs, Medicare, Medicaid and Social Security. Some proposals include raising the age of retirement to 67 years, asking higher income Medicare beneficiaries to contribute more to the cost of Medicare and federal block grants to states so they can pay the federal share of their Medicaid program expenses. One mistake made by policymakers is to look at each of these programs separately and failure to recognize how interrelated they are in their effect on the economic security and well being of seniors. For example, stopping annual increases in social security payments will result in less funds available to seniors to pay for healthcare.
Most seniors live on low or modest incomes, 1 in 10 have income below the poverty level ($10,458) and the number of seniors living in poverty increased when you take into account out-of-pocket expenses from 9 to 15%. Many seniors today do not have long term care insurance coverage which means that assisted living and community care services are unaffordable or that paying for them will require a larger outlay. It is predicted that low incme seniors will exhaust all their assets by the time they reach older age. It is estimated that 2/3 of those 65 years and older will need long term care services. Meaning that they will be solely reliant on Medicare and Medicaid to survive. And yet most states restrict long term care funding in community settings forcing these seniors to enter nursing home care prematurely at four times the cost. Dont they see the writing on the wall, or is it that they constantly engage in wishful thinking? Those who will fare the worst are minority groups. Poverty rates among black and hispanic seniors are more than twice as high as those among their white counterparts. To compound the problem they suffer from a multitude of healthcare problems, again higher than the white seniors. One wonders what information our policymakers rely on to make untimely and disastrous cut cutting decisions. Not our seniors.