FRAIL ELDERLY DESERVE OPTIONS IN USING FUNDS; NURSING CARE COSTLY, BUT STATE FORCES IT ON MANY WHO WANT OTHER LIFESTYLE.

Byline: Jason Bloome and John Amber

SOME laws beg to be changed. Take, for example, the current law that denies a low-income senior the ability to apply dollars from the In Home Supportive Services program to an assisted-living environment.

Each month in California, thousands of seniors make the transition from home to skilled-nursing facilities where the state, under MediCal, pays about $2,400 a month.

But not all of these seniors have skilled-nursing needs. Many need only custodial assistance, such as help getting out of bed, dressing, bathing and dealing with incontinency issues. Many are Parkinson's and Alzheimer's patients. They could benefit from an assisted-living environment that usually costs from $1,000 to $1,800 per month for a shared room.

Unfortunately, the current law does not allow MediCal or In Home Supportive Services to pay for this environment. The state is needlessly spending millions of MediCal dollars each month while at the same time forcing low-income seniors who do not need skilled-nursing care to live in skilled-nursing care facilities.

California's antiquated MediCal reimbursement mechanism focuses on hospital and institution-based services instead of utilizing more cost-efficient community-based care options that would best allow a senior to maximize his or her independence.

The In Home Supportive Services program is funded through state and federal MediCal dollars. For a senior residing at his or her home, it pays for services including housecleaning, meal preparation, bowel and bladder care, bathing and dressing, and accompaniment to medical appointments. The senior is responsible for hiring someone to provide the authorized services. The provider receives $5.75 - the minimum wage effective March 1, 1998 - for each hour of care that a county social worker has determined the client needs.

On average, In Home Supportive Services recipients receive funding for about 72 hours each month, or $415, but can receive up to 283 hours each month, or $1,627, if deemed necessary. For most, these care hours are adequate to maintain their independence at home. But there are times - for example, when 24-custodial care is needed - that care in their own homes is not sufficient, and alternative care settings or options are necessary.

In California, there are more than 6,000 assisted-living facilities offering varying levels of custodial care. They range from small residential care homes, each with four to six beds, to large hotel-type settings. A low-income senior who needs custodial care could afford these facilities by using a combination of In Home Supportive Services money and Social Security supplemental funds. Many states already use this method. According to the State Assisted Living Policy Report published by the National Academy for State Health Policy, by the spring of 1998, 35 states already had or planned to have a reimbursement system that permits Medicaid funding for assisted living options. Six other states had developed extensive pilot programs to study the issue.

California is not among the number although it has more seniors and more assisted-living homes than any other state.

Since it actually costs the state more money, it does not make economic sense for a low-income senior who does not need skilled-nursing care to have no choice but to go to a skilled-nursing facility. As senior care professionals who deal with information and referral, we see this happen every day.

This year, with advice from many agencies concerned about this issue, state Sen. Maurice Johannssen, a MediCal waiver advocate, has introduced Senate Bill 789 that would amend the law to let a senior have a choice in where to apply In Home Supportive Services dollars. If passed, it will change for the better a portion of the current MediCal reimbursement system which is blatantly unfair to our low-income seniors with custodial care needs who no longer can live at home. These seniors deserve our respect and the dignity to choose their own care options, not a backward state policy that forces them unnecessarily into expensive, over-care facilities.