State to Test Subsidy Program for Home Care of Elderly, Disabled

State to test subsidy program for home care of elderly, disabled

By April Simpson, Globe Staff

Since her elderly mother broke her hip and began using a wheelchair 10 years ago, Elizabeth Connolly has provided 24-hour care. Bathing, cleaning, and cooking for her mother, who’s now 100 years old, was a financial hardship, as her four children approached college age. But when doctors encouraged Connolly, now 59, to check her mother into a nursing home, Connolly refused. “We’re not going to let her die in a hospital,” the Stoneham woman recalled telling them.

A new program enacted by the state Executive Office of Elder Affairs and the Office of Medicaid is aimed at easing the financial burden on families like Connolly’s, by paying them about $18,000 a year to care for an elderly or adult disabled family member at home. The Connolly family is one of several dozen to benefit from a pilot program that will be instituted statewide on Dec. 1.

The Enhanced Adult Family Care Program addresses a growing shortage of paid professional caregivers, and the wishes of many elderly people to spend their last days at home.

“It just takes the pressure off,” said Al Norman , executive director of Mass Home Care, an association of nonprofit providers. “You don’t have to find new caregivers, you don’t have to find new housing — you’re maximizing existing resources to keep people out of foster care homes.”

In December 2004, Mass Home Care proposed the program to the Executive Office of Elder Affairs after studying a similar plan in Oregon. Representative Barbara L’Italien, Democrat of Andover, introduced an amendment to the budget for fiscal year 2006, and the state Senate and House agreed to provide the program at least $2 million a year.

MassHealth, which runs the program, anticipates about 30 new enrollees each month.

“Even with the $18,000, if you think of it as a wage, it’s still abysmally low, but this is the best we can do,” Norman said. “We’re going to improve on it and build on it in time.”

Compared with existing adult foster care support, the program broadens the spectrum of caregivers to include most family members and friends, other than a spouse, parent, or legally responsible relative. Elders and persons with disabilities may move into a caregiver’s home or the caregiver may move in with the participant.

Financial eligibility for MassHealth, the state-funded health insurance program, is determined based on assets and income. The participant must require physical assistance with at least three basic activities, including bathing, dressing, and eating; or with the management of behaviors such as wandering or being verbally abusive or disruptive, said Jennifer Davis Carey , secretary of the Executive Office of Elder Affairs.

The new program also provides caregivers with support from healthcare professionals by linking them via computer to a nationwide network of credentialed care managers, known as SeniorLink.

Connolly is grateful that her mother can still attend Sunday dinners with the family, and that her four children have now pitched in to care for their grandmother.

“This is what family is supposed to do,” said Connolly.

Strengthening In-Home Care for Seniors

State Rep. Barbara L’Italien (D-Andover) announced today that the Massachusetts House of Representatives unanimously backed legislation to establish a consumer directory of qualified personal care assistants, giving senior citizens and people with disabilities improved access to quality in-home care.

The House-approved measure would create a six-member council, led by consumers, to oversee the management of the directory. The council would also establish a back-up system to ensure that those who need assistants can access one when their primary assistant is unavailable.

“Seniors and people with disabilities who want to live at home but need help with their daily routines have struggled for years to find reliable, quality personal care,” said L’Italien. “This legislation will give these individuals and their loved ones peace of mind and help more people maintain their independence in the settings where they’re most comfortable.”

Additionally, in an effort to address the dual issues of low pay and lack of employment benefits that contribute to high turnover rates, the legislation would provide caregivers with the option to unionize. Reducing turnover will make it easier for consumers to find quality care.

Romney signs bill to encourage in-home care for elderly

Bill Championed by Tucker, L’Italien 

By Edward Mason and Zach Church
Staff writers for Eagle Tribune

Yoram and Barbara Shahar of North Andover are more than a decade away from making the hard choices that come with retirement. One choice they do not want to make is having to go into a nursing home.That is why they approve of a bill championed by two local lawmakers and signed into law by Gov. Mitt Romney yesterday, which allows Massachusetts elderly and people with disabilities to obtain state help to live at home rather than a nursing home when they can no longer care for themselves.

The bill allows the state Medicaid program to pay for that home-based care. Previously, the Medicaid program, called MassHealth, paid mainly for nursing home care.

Andover Democrats Sen. Susan Tucker and Rep. Barbara L’Italien helped write the law and guide it through the Legislature.

At yesterday’s bill signing, they talked about how it gives seniors and people with disabilities control over their lives and the ability to live with dignity.

“The No. 1 issue in the mind of seniors is what will happen to me if I can no longer care for myself,” said Tucker, co-chairman of the Legislature’s Committee on Elder Affairs. “The No. 1 answer is they fear going off to a home.”

“The law signed today backs up the assertion that every person has the right to determine where they’d like to live,” L’Italien said.

Barbara Shahar, 51, agrees with L’Italien.

“I think it’s appropriate we do more for senior citizens,” she said. “Compared to a lot of other countries, we don’t do enough for our elderly.”

To the Shahars, the new law is about “options.”

“As we all know, when you get to that age, you are often on a fixed income,” she said. Her husband, Yoram, 52, observed that many people may not need the comprehensive care that comes with nursing homes.

“People are working out. They’re eating healthier,” he said.

Elliot Aronson, 70, of Andover shudders at the thought of having to go into a nursing home.

“I would never want to leave my house,” said Aronson, who has forgone retirement to continue work as an attorney in Methuen.

Aronson said he is doing all he can to keep fit so he can always live at home regardless of the new law. But he said the new choice is a good one for others.

Under the law, seniors and people with disabilities who qualify for MassHealth long-term care coverage would be told they have a choice of home or nursing home care. They would then have their physical and mental health assessed to determine whether they can live at home.

If they don’t need intensive nursing home care, MassHealth would pay for them to live at home and have access to the same services provided by nursing homes. Those include personal care attendants, homemaker assistants, private duty nurses, day habilitation, adult foster care and medical transportation.

The law is expected to reverse an imbalance toward nursing home care.

“We have learned that a community-based approach to care delivery is cost-effective and that it honors the preferences of elders and people with disabilities to remain members of the communities that they helped to build for as long as possible,” said state Elder Affairs Secretary Jennifer Davis Carey.

MassHealth spends about $1.6 billion per year to care for about 32,000 individuals, or 70 percent of all nursing home residents. Choice proponents believe that could shift to a 50/50 split over the next decade.

It also is expected to bring Massachusetts in line with other states, like Oregon and Vermont, which are giving elders and people with disabilities more say in their long-term care.

Moreover, it should save the state money. MassHealth spends $52,000 a year to care for each nursing home resident. That is expected to be cut in half.

As part of the new law, people choosing in-home care also would be allowed to keep more of their own money.

The state wants to raise the MassHealth eligibility threshold for home care from $2,000 a month to $10,000 a month. The $2,000 current limit for nursing home care would remain the same.

Supporters of the bill described its passage as a matter of civil rights, insistent the state ought to offer equal opportunity for residents hoping to stay in their homes.

Some states spend half their long-term care budget on community-based care, double Massachusetts’ 25 percent – a figure Al Norman, executive director of Mass. Home Care, said would change incrementally.

“What we are doing today is helping to eliminate a form of discrimination in our land,” Norman said.

During his visits to senior centers, Norman said, he frequently asks for a show of hands from those hoping to enter nursing homes. “No hands ever go up. There’s a lot of nervous giggling.”

Although the law was signed yesterday, it is not yet clear when people will be able to benefit from its changes.

State Health and Human Services Secretary Timothy Murphy said the state first needs to get a Medicaid waiver from Washington to make the changes in the law. That waiver is due Oct. 1, 2006.

Material from the State House News Service was used in this report.

Bill Establishing Choice of Long Term Care Signed

Equal Choice Bill Signed

Seniors citizens and the disabled who quality for long term care services under the MassHealth program will have an “equal choice” of care at home, or care in a nursing home, under legislation signed into law.

Chapter 211 of the Acts of 2006 will do the following:

• Modernizes the MassHealth program from one which has historically been institutionally oriented, to one which focuses on care “in the least restrictive setting appropriate” to an individual’s needs.
• Will save state taxpayers $134 million in the first five years after implementation.
• Establishes a more focused “pre-admission counseling” program for people who are being referred to a nursing home, to ensure that they are aware of community alternatives.
• Calls for the state to submit a “waiver” to the federal government which will raise the income and asset levels for the MassHealth long term care program, thus allowing the Commonwealth to capture 50% federal match for some elders who are not fully supported with state funding.

Prescription Advantage

State Representative Barbara L’Italien (D-Andover). Co-Chair of the Elder Affairs Caucus, is pleased to announce that Prescription Advantage, the Commonwealth’s pharmacy assistance program administered by the Executive Office of Elder Affairs, will conduct an Open Enrollment March 15 through April 28. This is the first open enrollment since Prescription Advantage became a program that wraps around Medicare Part D, the new Medicare prescription drug benefit.

“I hope all eligible seniors will examine the Prescription Advantage plan, which can assist them with the additional, and sometimes unexpected, cost of prescription drug payments and gaps in coverage.” commented Rep. L’Italien.

Prior to Jan. 1 when Medicare Part D took effect, Prescription Advantage was the state’s prescription drug insurance program, providing primary coverage for seniors and younger disabled individuals who meet specific income requirements. The new Prescription Advantage “wraps around” or supplements the Medicare prescription drug benefit for Medicare eligible individuals by helping pay for co-payments and coverage gaps for an individual’s Part D plan. Those with limited income may also receive help paying for Medicare Part D plan premiums. Prescription Advantage will also provide primary coverage that is comparable to Medicare Part D plans for those who are not eligible for Medicare.

“It is important for people who were not eligible for Prescription Advantage before, or who did not consider the program, to understand how much Prescription Advantage can help them now,” said Elder Affairs Secretary Jennifer Davis Carey. “We are pleased to announce the open enrollment. I encourage people to consider joining Prescription Advantage in order to reduce their out-of-pocket costs for their prescription medications. There is no monthly premium for people who join Prescription Advantage to receive help paying for their prescriptions.”

Who Can Join Prescription Advantage?

Prescription Advantage is available to those who are:

• 65 years of age or older who do not have a gross annual income that exceeds 500 percent or more of the Federal Poverty Level (single $49,000, married $66,000),
• Under age 65, work no more than 40 hours per month, meet MassHealth’s CommonHealth disability requirements, and have a gross annual household income at or below 188 percent of the Federal Poverty Level (single $18,424, married $24,816).

How Will Prescription Advantage Work for Those Eligible for Medicare?

• If you are Medicare eligible, you must join a Medicare Part D drug plan in order to be eligible for Prescription Advantage benefits;
• Limited income applicants (those at or below 188 percent of the Federal Poverty Level – single $18,424, married $24,816) must apply for “Extra Help” also known as “Low Income Subsidy” administered by the Social Security Administration to be eligible for Prescription Advantage benefits.
• Medicare Part D will be the primary drug insurance. Prescription Advantage will be the secondary payer supplementing the Medicare coverage during coverage gaps and will provide protection from catastrophic drug costs.
• Prescription Advantage will cover portions of co-payments. Co-payment amounts are on a sliding scale according to the member’s income.
• There will be no monthly premium for Prescription Advantage members with incomes below 300 percent of the Federal Poverty Level (single $29,400, married $39,600). There will be a $200 annual enrollment fee for those between 300 and 500 percent of the Federal Poverty Level (single $29,401 – $49,000, married $39,601 – $66,000).
• Prescription Advantage may also pay all or part of your Medicare Part D premium.

How Does Prescription Advantage Work for Those with Coverage that is “Creditable” or Comparable to Medicare Part D through a Union or Employer?

• Prescription Advantage will provide secondary coverage to members who are not in a Medicare Part D plan, but have “creditable coverage,” meaning that Medicare has determined that the prescription drug coverage is as good as Medicare Part D coverage. Creditable coverage is typically provided through an employer or union.
• How Does Prescription Advantage Work for Those Not Eligible for Medicare?
• For members not eligible for Medicare, Prescription Advantage will continue to provide primary prescription drug coverage.
• There will be no monthly premium for this coverage; however, members will pay a quarterly deductible and co-payments until an annual out-of-pocket spending limit is reached. At that time, Prescription Advantage will pay the full cost of the member’s covered prescription drugs through the end of the plan year.

Prescription Advantage Open Enrollment will run from March 15 through April 28. Those seeking more information or an application should call 1-800-AGE-INFO (1-800-243-4636) and press 1. Applications will be available on-line at www.mass.gov/elders and www.800ageinfo.com on March 15.

Enrollment in Medicare Part D prescription drug plans is open through May 15. To talk to a local SHINE (Serving the Health Information Needs of Elders) counselor for help making decisions about prescription drug coverage, including information on Medicare Part D and Prescription Advantage, call 1-800-AGE-INFO (1-800-243-4636) and press 2. MassMedLine staff is also available to help with decisions about prescription drug coverage at 1-866-633-1617.

Anyone with additional comments and concerns may contact Rep. L’Italien’s office at (617) 722-2080.

Andover Council on Aging Grant

L’ITALIEN ANNOUNCES STATE GRANT TO SUPPORT ANDOVER COUNCIL ON AGING

BOSTON – State Representative Barbara L’Italien (D-Andover) announced this week that the Andover Council on Aging (COA) has received a Formula Grant through the Executive Office of Elder Affairs for fiscal year 2006.

The Andover COA will receive $29,614 to employ an Adult Social Day Care aide and a wellness program instructor. The funds will also support printing and distributing the COA newsletter as well as pay for conference / meeting attendance. It is the responsibility of the COA to advocate for the health, economic, social and cultural needs of older adults, while encouraging maximum independence. The caring staff of the Andover senior center has been central in fostering a sense of community among the town’s elderly population and is crucial to the center’s continued success.

“The Andover Senior Center provides a welcoming environment for socialization, education, health monitoring and advocacy. I am pleased that they are receiving this State grant as they have been stretched in a time of state, federal and local budget cutbacks,” remarked L’Italien. “Congratulations and keep up your exemplary service to Andover.”

Formula grants from the state to communities are calculated based on a municipality’s population over age 60. Each COA determines its own priorities for expenditures from a broad range of eligible costs established by Elder Affairs. The FY06 budget included a total of $7 million to provide COA programs with a funding increase of $500,000 over last fiscal year.

Methuen Council on Aging Grant

L’ITALIEN ANNOUNCES STATE GRANT TO SUPPORT METHUEN COUNCIL ON AGING

BOSTON – State Representative Barbara L’Italien (D-Andover) announced today the Methuen Council on Aging (COA) has received a Formula Grant through the Executive Office of Elder Affairs for fiscal year 2006.

The Methuen COA will receive $48,181 to coordinate bilingual outreach, volunteer, and social services. The funds will provide for mental health support, transportation, and dues. Also, the funds will pay for conference / meeting attendance and volunteer recognition. It is the responsibility of the COA to advocate for the health, economic, social and cultural needs of older adults, while encouraging maximum independence. The caring staff of the Methuen senior center has been central in fostering a sense of community among the town’s elderly population and is crucial to the center’s continued success.

“The Methuen Senior Center provides a welcoming environment for socialization, education, health monitoring and advocacy. I am pleased that they are receiving this State grant as they have been stretched in a time of state, federal and local budget cutbacks,” remarked L’Italien. “Congratulations and keep up your exemplary service to Methuen.”

Formula grants from the state to communities are calculated based on a municipality’s population over age 60. Each COA determines its own priorities for expenditures from a broad range of eligible costs established by Elder Affairs. The FY06 budget included a total of $7 million to provide COA programs with a funding increase of $500,000 over last fiscal year.

Georgetown Council on Aging Grant

L’ITALIEN ANNOUNCES STATE GRANT TO SUPPORT GEORGETOWN COUNCIL ON AGING

BOSTON – State Representative Barbara L’Italien (D-Andover) announced this week that the Georgetown Council on Aging (COA) has received a Formula Grant through the Executive Office of Elder Affairs for fiscal year 2006.

The Georgetown COA will receive $5,424 to support the meal site coordinator and meal site server positions. The funds will also provide postage for the COA newsletter as well as pay for conference / meeting attendance and volunteer recognition and support. It is the responsibility of the COA to advocate for the health, economic, social and cultural needs of older adults, while encouraging maximum independence. The caring staff of the Georgetown senior center has been central in fostering a sense of community among the town’s elderly population and is crucial to the center’s continued success.

“The Georgetown Senior Center provides a welcoming environment for socialization, education, health monitoring and advocacy. I am pleased that they are receiving this State grant as they have been stretched in a time of state, federal and local budget cutbacks,” remarked L’Italien. “Congratulations and keep up your exemplary service to Georgeotown.”

Formula grants from the state to communities are calculated based on a municipality’s population over age 60. Each COA determines its own priorities for expenditures from a broad range of eligible costs established by Elder Affairs. The FY06 budget included a total of $7 million to provide COA programs with a funding increase of $500,000 over last fiscal year.

Boxford Council on Aging Grant

L’ITALIEN ANNOUNCES STATE GRANT TO SUPPORT BOXFORD COUNCIL ON AGING

BOSTON – State Representative Barbara L’Italien (D-Andover) announced this week that the Boxford Council on Aging (COA) has received a Formula Grant through the Executive Office of Elder Affairs for fiscal year 2006.

The Boxford COA will receive $6,046 to employ a part-time outreach worker and a secretary. The funds will also provide postage for the COA newsletter as well as pay for conference / meeting attendance and volunteer recognition. It is the responsibility of the COA to advocate for the health, economic, social and cultural needs of older adults, while encouraging maximum independence. The caring staff of the Boxford senior center has been central in fostering a sense of community among the town’s elderly population and is crucial to the center’s continued success.

“The Boxford Council on Aging provides a welcoming environment for socialization, education, health monitoring and advocacy. I am pleased that they are receiving this State grant as they have been stretched in a time of state, federal and local budget cutbacks,” remarked L’Italien. “Congratulations and keep up your exemplary service to Boxford.”

Formula grants from the state to communities are calculated based on a municipality’s population over age 60. Each COA determines its own priorities for expenditures from a broad range of eligible costs established by Elder Affairs. The FY06 budget included a total of $7 million to provide COA programs with a funding increase of $500,000 over last fiscal year.

Appropriation for Caring Homes Initiative

Representative Barbara L’Italien (D-Andover) today announced that a $2,000,000 appropriation for a Caring Homes initiative project was included in the FY06 Conference Committee Budget and voted on favorably by the House and Senate. The budget is now on its way to the Governor for approval.

Currently a small pilot program at Elder Affairs, Caring Homes is a housing with services demonstration project which would delay or prevent nursing home placement and enable a MassHealth enrollee to live in the home of an individual or relative, with the exception of a spouse or dependent child, where they would provide their long term supports and 24/7 care in exchange for a stipend and would provide for coordination of care and respite services. The Caring Homes demonstration project provides the Commonwealth with a cost-effective and humane way to support families in their essential efforts to care for their aging relatives.

“Under the Caring Homes program, a son or daughter could take in their parent and provide a home for them in the community, said Representative L’Italien. The stipend would lessen the financial burden on the caregiver and would still be two-thirds the cost of a nursing home placement. The program also has potential to receive 50% federal reimbursement. It is a win-win for our seniors and for our taxpayers.”

The Caring Homes initiative is approximately 65% of the cost of a nursing home placement and would save taxpayers an average of $20,000 per year. Most importantly, the Caring Home initiative will allow elders to stay in the homes and communities which they have been a part of for years, bringing a sense of confidence and joy to their lives. It has proven to be a success in several other states and is sure to be one in Massachusetts as well.