COVE TESTIMONY BY MICHAEL SIROTKIN TO HOUSE APPROPRIATIONS COMMITTEE: 2/22/11
Good afternoon. My name is Michael Sirotkin and I represent COVE, the Community of Vermont Elders. I am here representing a group of Vermonters who are unable to speak on their own behalf – frail elders, many of whom are disabled, and some of whom may have mental health issues, as well. Thank you for giving us the opportunity to speak for them.
We would like to speak to three points regarding the proposed cuts in the Medicaid Choices For Care, or CFC program – specifically the cuts in respite/companionship services and in instrumental activities of daily living, or IADLs.
- misperception about who these folks are
- miscalculations on the savings
- misdirection on the policy
1. There is a misperception, because the services being cut are Instrumental Activities of Daily Living (IADLs- such as housekeeping, meal preparation, medication management, etc), rather than Activities of Daily Living (ADLs such as bathing, feeding, etc.) that they are not critical and that the people receiving them are not frail and vulnerable to institutionalization. In reality, the individuals who qualify for Choices for Care must be unable to perform at least one activity of daily living without assistance. Many of them are extremely frail and need assistance with constant supervision, bathing, toileting, dressing, or feeding. All are poor with many living below the poverty line. Many live alone and in isolated settings. They are truly the most vulnerable among us.
IADLs are brushed off by many officials in the administration as being help with snow shoveling and house cleaning. They are much more than that. They include assistance with scheduling medical appointments, transportation to get food, management of medications and finances, and preparing food. Imagine someone with dementia living alone, physically capable of doing some of those things, but unable to do them because they can’t remember how, or simply don’t remember to do them at all. We have anecdotal stories about folks like that, and others barely able to manage with the current IADLs – stories that we will share with you, and we will be sending you a video of real Vermonters on Choices For Care.
2. The administration implies that these folks can simply just use families and friends to address these cuts. When you look at our stories and video, you will see that nothing could be further from the truth. Some have no family or friends who can help, while others have family and friends burning themselves out while already providing most of the care. Losing any state services is likely to push many of them over the edge.
Moreover, we surveyed the AAA case managers, who know these clients and their needs personally. We asked them to go through their caseload of about 800 (the home health agencies have the another 800) and tell us how many they think would need to move from their home to a nursing home or other institutional setting. Here are our results:
Area Agency Total Caseload # Likely To Move From Home On Aging To Institutional Care Champlain Valley AAA: 250 cases 62-102 Central VT COA: 120 30-40 Southwestern VT COA 173 76-78 COASEV 120 25-30 NEKAA 120 25-30 TOTALS: 783 218-280
We are also collecting numbers from the visiting nurses. So far we have an estimate of 26 people moving to nursing home care out of 158 CFC patients from two agencies.
For every person who is forced out of his or her home, the cost to the state could be up to $40,000- $60,000/year, average nursing home cost, less $20,000, average HCB CFC cost. (The per person cost could be somewhat less if the senior can find placement and is willing to enter an Enhanced Residential Care (ERC) facility instead of a nursing home).
If the dedicated, knowledgeable workers on the ground are anywhere close to correct (even if you use the lower numbers), all the savings here will be wiped out and that leads to our third point – misdirection. It is important to keep in mind that these folks do have a choice, and an entitlement, to nursing home care if they want it or have no other practical choice
3. Regarding the misdirection of policy, these cuts stand 15 years of state policy on its head. We have saved huge sums of money and provided seniors with the desired option they want to age in place in their own homes and communities by supplying supportive services to help their families and others who give tirelessly to keep their loved ones at home. The policy has worked and is being replicated around the country. The cuts are the policy in reverse and fly in the face of the silver tsunami the governor talks about. We need to increase community based services, not cut them, to help avoid far more expensive care and save even more money. These cuts will send us backwards.
We would also like to mention that this program has already been starved in other ways. We feel strongly that program savings from reduced nursing home care have not been reinvested in home-based care services as required. In fact over the last two and a half years, the number of people on the program in every category (high needs, highest needs, and moderate needs) has gone down. We believe this is counter to the waiver and ARRA requirements, especially maintenance of effort, and we will be asking CMS if it is appropriate for the state to take increased matching federal dollars while downsizing the program
Again, thank you for the opportunity to testify, and I would be happy to answer any questions you might have.
