Kansas Health Institute | Information For Policy Makers. Health for Kansans.

Editor:

The Kansas Health Institute ran a well-written series of articles (Monday afternoon, April 27, 2009), about the impact of further cuts to social services. It was not good news.

I sent letters to the editors of the 17 newspapers in my area several weeks ago, informing those papers, and their readers, that our in-home services budgets were being cut, and that seniors could (not necessarily would) lose services. I have had follow up interviews with several local newspaper reporters, who asked more questions, so they could personalize the story for their area.

To the point: Kansas seniors currently on Senior Care Act (SCA) will lose in-home services! I cannot, and I don't know how any Area Agency on Aging (AAA) could, absorb a nearly 20 percent budget cut and not reduce services. Especially when we (AAAs) collectively are losing $750,000 for "base" funding on top of SCA cuts. All AAAs know that case management costs will increase as we have waiting lists — that is a proven fact. If the Legislature deepens cuts to social services, even more frail seniors will lose services.

I believe we do a great disservice to many if we do not inform customers, families, and the general public that, "the emperor has no clothes" (to borrow an illustration).

I am now struggling, after having a long "heart-to-heart" meeting last week with my case managers, on how I must make the cuts that I cannot avoid.

We have done our preliminary review, and because our average SCA Plan Of Care (POC) is just $86/month (the state average is only $106/month), there isn't any "excess" to be cut.

I cannot "shave" 20% from all POCs — it is not possible, especially since some people receive only Lifeline. If I tell people that they can only get a bath every other week, instead of once a week, I will put their health and safety in danger. If I take away their Lifeline service, I know for sure that some will fall, and will not be able to obtain help.

If I choose to remove services from my most expensive customers, I may end up hurting fewer people overall, but those who will be hurt, will be hurt worse. Those with higher POCs will more likely be unable to avoid going to the nursing home. So if they do, they will quickly spend down to Medicaid, and receive the care they so desperately need to survive. While that may be good for their health, it likely will be bad for their spirit. If they really wanted to be in a nursing home, they would already be there.

The impact of doing that will actually hurt the state budget more than anticipated. For every person who enters a nursing home, and goes on Medicaid, the state will spend 12 times more state revenue to care for that person, not counting what it will cost in federal tax revenue.

Unfortunately, I fully understand that not all the people who lose services will choose to go to a nursing home. If I do choose to cut the most costly POCs, then for some, I will be condemning them to no care, and potentially serious, even fatal, consequences.

I guess I can "justify" this by declaring that the customer will be making the choice whether or not to go to the nursing home, and therefore will be responsible for his or her own actions, or lack thereof. (Yeah, right!). But what do I do about the moral imperative involved?

These frail seniors have put their trust in me, to provide care for them when they cannot care for themselves. If they had somewhere else to turn, the vast majority would have already done so. Some do not have family to help; others may have family, but not near enough to help.

The frail elderly people involved — those who stand to lose their services — have already "given" almost everything they have. They have long given to family, friends, community, and country. They have given time, talents, and their lives for others. This is the "America's Greatest Generation" that made America great. The average Senior Care Act customer is an 83-year-old widow, living alone, on a small fixed income, primarily from just Social Security. She needs help preparing her meals, bathing, and transportation to obtain the few groceries she can afford. She doesn’t have a Wall Street pension plan; she never got a “cash bonus” from anyone.

How can we as a state, as a nation, just brush these people aside so we can fund another mile of highway, or another assistant school administrator, or another pork project in Congress?

In one regard, all Americans are to blame for this situation. We have allowed our society to devalue the elderly, and those who care for them. We have forgotten the contributions of those who have gone before us, and focused instead on “What’s in it for me?”

Yes, we may save some tax dollars in a federal, or a state budget, that seems “a little tight.” But is it worth what it will cost us in terms of our humanity? I don’t think so!

Jim Beckwith

NEK-AAA Executive Director

Hiawatha