The Boston Globe
by: Kay Lazar
December 31, 2008
More than 300 disabled senior citizens will enter the new year on a waiting list for basic home care services, not knowing when or whether the assistance might arrive, because of state budget cuts.
Just a couple of months ago, there was almost no wait for a home care aide who could help with daily tasks such as bathing, dressing, and grocery shopping, the kind of services that keep people out of far more expensive nursing homes. But budget cuts announced Oct. 15 sliced nearly $4 million, roughly 3.6 percent, out of the program, said Al Norman, executive director of Mass Home Care. The association represents 27 nonprofits that, in turn, oversee delivery of the care.
The budget cuts resulted in a waiting list that, on Dec. 15, stood at 320 and is expected to grow, especially after yesterday's announcement from Governor Deval Patrick that the state may face a second round of budget cuts of up to $1 billion, Norman said.
"This is like walking below the sword of Damocles," he said, lamenting cuts to a program that "keeps people out of institutions and saves the taxpayers money." It serves 33,400 elders statewide.
The cuts have come amid a broader range of spending reductions that diminished services for some of the state's most vulnerable residents. Programs taking the biggest reductions, nearly $300 million, include the state's Medicaid budget, which pays for health insurance coverage, mental health services, dental care, and an array of other programs for low-income children and elderly residents.
Among those waiting for home care is Phyllis Dubielak, an 84-year-old Bedford grandmother who fractured her hip in early November and now relies on a walker to get around. Dubielak has had home-based physical therapy since she was released from a rehabilitation facility a few weeks ago, but she just found out that service ends on Friday, and she does not yet feel able to live entirely on her own.
For that reason, she was especially eager for home care services to help her bathe and do laundry, she says. But given how far down she is on the waiting list, that is unlikely to happen anytime soon.
"I fear getting in and out of the shower," said Dubielak, who has started wearing a medical alert button around her neck, so she can call for help if she falls again.
With the governor's warning yesterday that more budget cuts are likely, a state spokeswoman said officials are keenly aware of the seniors who are counting on the threatened services.
"During these challenging economic times, the Office of Elder Affairs had to make the very difficult decision to reduce funding for the Home Care Program," Kristina Barry, a spokeswoman for the Executive Office of Health and Human Services, said in an e-mail.
She said that, in total, more than 45,000 seniors receive some home-based care, including those in the program that Dubielak now hopes to enter.
"Our priority is to continue to deliver essential services for the most vulnerable during these difficult times," she added, but declined to say whether the home care program faces further cuts.
In addition to the cuts made in October in the home care program, the budget was also reduced about 7 percent for home care managers, the staff members who help arrange the care for elders and oversee their cases.
Norman, of Mass Home Care, says the program "respects the wishes of elders to remain at home, and it's their civil right to be cared for in the least restrictive setting appropriate to their needs."
He called the cuts ironic.
"The state is restricting the very programs that have been driving down the use of nursing homes," he said.
The state pays about $158 per patient per day for nursing home services, not including the medical care, but only $8.76 daily for each resident enrolled in the basic home care program, according to the association.
By Norman's calculation, the number of patient days in nursing homes in Massachusetts has fallen by 21 percent since 2000, because of the basic home care program and two other home-based services provided by the state. That translates, Norman said, to a savings for the state of more than $439 million since 2000.
"Phyllis Dubielak is an example of someone you can maintain at a fairly low cost at home," Norman said, "so intervention at this point is much more desirable than what the state would spend after a second fall."
Kay Lazar can be reached at klazar@globe.com.