Monthly Archives for March 2003

Bush’s “just guns, no butter” policy hurts senior programs

Published in the Pawtucket Times on March 31, 2003

President Lyndon B. Johnson’s “Guns and Butter” policy is not in fashion today.

In a recent Washington Aging Report, radio commentator Bill Benson predicted future federal funding of program and services for seniors will take a back seat to President Bush’s worldwide fight against tourism, the high-tech war against Iraq and tax breaks for the upper income Americans.

In his Marh 24 commentary, Benson, a former assistant secretary with the U.S. Administration on Aging and now a principal at Health Benefits ABC – sees tough times ahead for the federal funding of programs and services, especially the creation of a meaningful Medicare pharmaceutical assistance program.

“Guns and Butter” was coined nearly 40 years ago, describing President Lyndon B. Johnson’s two-front war. Back then, a large infusion of federal dollars allowed the Democratic president to fight a war abroad – in Vietnam – along with a war on the domestic front, against poverty and social ills, especially those facing the elderly.

“By the end of 1965, with Vietnam escalating, we had the Medicare program and the Older Americans Act,” noted Benson, adding Medicaid was also created at this time to help millions of low-income older people afford the cost of nursing home care.

Benson’s radio commentary charged the Bush administration and the Republican-controlled Congress are fully committed to funding the “guns” but not “butter” policy initiatives.

“It would be one thing if the commitment to guns over butter was for the president while we topple Saddam and occupy Iraq, and combat terrorism everywhere. “Instead, it looks like the Bush administration is committed to making butter a scarcer commodity for years to come,” said Benson.

According to Benson’s proposed budget for the next fiscal year suggests it won’t be both “guns and butter,” especially in light of the president’s efforts to pursue large tax cuts for upper-income Americans.

What about the spending for guns?

According to the Washington Post, Bush’s proposal for the fiscal year begins on Oct. 1, calls for defense spending that is 16 percent more than the combined total of all other discretionary spending excluding what he would spend on homeland security.

And that figure does not take into account the cost of the war in Iraq, nor expenditures to combat terrorism, Benson says.

Meanwhile, Benson said the Washington Post noted secretary of defense Donald Rumford has proposed a $20 billion increase for defense for each of the next six years, would follow what have been six straight years of real increases in defense spending. The result by 2010 would be annual spending for defense of more than half a trillion dollars.

Combine increased defense with the cost of the Iraq war.

Benson noted the White House estimated the cost for Iraq and related matters will be nearly $75 billion over the next six months.

Benson said that by 2011, the first baby boomer s will turn age 65, and will begin placing huge demands up on Medicare, Social Security and other services for the elderly.

“President Bush’s FY 2004 budget calls for $ 400 billion spread over 10 years for a prescription drug plan for senior,” said Benson.

On the other hand, the Congressional Budget Office estimates Medicare beneficiaries will in fact spend more than $1.8 trillion over the same 10 years for prescription drugs.

That means, said Benson, the president’s plan would cover only a bit more than 20 percent of wat seniors will actually spend. And that is if the $ 400 billion actually goes for drug coverage when there will be many other demands for additional Medicare dollars.

Bush also purposes to cut funding for the Older Americans Act – a federal program that supports such services as Meals on Wheels, transportation for the elderly and ombudsmen to investigate problems in nursing homes -by $24 billion, Benson said.

With a worldwide war on  terrorism combined with the ongoing war in Iraq, the debate regarding “guns and butter” spending must begin in earnest.

Hard choices must be made in times of war, but seniors must continue to press both the Bush administration and Congress for adequate federal funding to create a meaningful Medicare pharmaceutical assistance program, and to shore up the ailing Medicare, Medicaid and Social Security programs.

In this new era of huge defense spending, the Bush administration and Congress will have to make very painful choices in allocating its limited discretionary funds to support a wide variety of domestic policy initiatives.

Only an intense lobby of aging advocates and seniors will keep programs and services benefiting the nation’s elderly on the radar screens of federal officials and lawmakers.

Governor’s Budget is Silent Regarding Many Senior Issues

Published in Pawtucket Times on March 24, 2003

Many of Gov. Don Carcieri’s policy initiatives can be found sprinkled throughout Fiscal Year 2004 Budget address.

While Carcieri’s 3,200-word speech identified his administration’s priorities – that is, maintaining human services, investing in education and creating jobs and fixing the state’s crumbling roads and bridges- it was silent on issues of interest to aging advocates and seniors.

At an AARP debate of gubernatorial candidates, Carcieri was asked if he would budget $15 million to overhaul the existing Medicaid payment system. The additional funding would greatly improve the quality of care and services provided to 10,000-plus nursing home residents.

With this additional $ 15 million in state funding, the federal government would pick up another $ 15 million, for a total increase of $ 30 million.

At the debate, Carcieri acknowledged it would be difficult to find $15 million to fix the system because of the state’s looming budget deficit.

After a first read, Alfred Santos, executive director of the Rhode Island Health Care Association, found the recently released administration budget did not allocate the $ 15 million in new funding to allow nursing facilities to be reimbursed for the actual cost of care that they provide to frail residents.

Santos hopes to schedule a meeting with Gov. Carcieri and his policy staff to discuss Medicaid reimbursement and staffing issues.

“One of the biggest disappointments for seniors in the governor’s budget is his failure to include funding to allow more low-income persons to choose Medicaid waiver-funded assisted living,” noted Maureen Maigret, who serves as Lt. Governor Fogarty’s director of policy and executive director of the state’s Long-Term Care Coordinating Council.

“This has been a priority for the senior advocacy community, and the governor was supportive of this funding during his campaign,” says Maigret.

Maigret told All About Seniors that more than a year ago, the federal government had approved an additional 180 units in the state’s Medicaid assisted living waiver to respond to Rhode Islander consumer demands.

“Failure to fund these units is short-signed in terms of saving taxpayer dollars and denies low-income seniors the option to choose a less restrictive care setting,” said Maigret, who calls the state’s current assisted living waiver program a great success.

According to Maigret, in the last fiscal year, there was a decrease in state-funded nursing home use of about 50,000 days and an increase in Medicaid funded Assisted Living of about the same number of days. “We have reached the funding cap for these Medicaid-funded assisted-living units and have a waiting list of 35 persons,” she said, noting that some of these persons will now be forced to enter nursing facilities at twice the cost of the state.

Meanwhile, Maigret added that the governor’s budget does not address the dire need of more regulatory staff in the Health Department to monitor assisted living and enforce state standards.

On the other hand, the Rhode Island Pharmaceutical Assistance for the Elderly Program (RIPAE) is intact, Maigret said.

“With the costs of prescription drugs increasing at such alarming rates, RIPAE is a vital safety net for thousands of Rhode Island seniors.

Maigret noted that changes this year in Blue Chip and United Health senior plans may further impact many seniors’ accesses to prescription drugs, as these plans have new features which limit benefits for brand name drugs. Legislation proposed by Fogarty and introduced by Sen. Elizabeth Roberts and Rep. Peter Ginaitt will address this pharmaceutical issue, she said.

Finally, Maigret said senior advocates must watch other areas of the state budget that will ultimately impact seniors. Some community grants, such as those that support senior centers, are targeted for 10 percent cuts. While nursing homes are in line for an annual cost of living increase (COLA) in their Medicaid rates, no similar COLA is included for home and community care providers.

Maigret added the governor’s budget cuts about $ 10 million (state and federal funds) to continue its efforts of downsizing the Eleanor Slater Hospital Cranston campus, with a proposal to close two more wards. To offset these closures, the budget includes about $ 800,000 to fund about 20 more nursing home placements and new funds to increase capacity to serve persons with mental illness in community residential settings.

The push to get residents back into the community concerns Roberta Hawkins, state ombudsman and executive director of the Alliance for Better Long-Term Care. She opposes the closure of wards because there are persons in the community who require a higher level of care, a level that is only available at the Eleanor Slater Hospital.

Hawkins noted the administration budget does not include Medicaid funding to pay for dental services to seniors in the community and those residing in nursing facilities.

“The short-sidedness of this fiscal policy ultimately will increase care costs when the resident must be hospitalized for malnutrition, dehydration and bed sores, all caused by dental problems,” Hawkins said. “On a human level, who would want to constantly suffer from pain all night because of a toothache or gum problems?” she added.

Sandy Centazao, president and CEO of Meals on Wheels of Rhode Island, is still waiting to see if Carcieri will ultimately institutionalize her nonprofit group’s funding rather than continue to allocate it as a legislative grant. She expects this decision to be made before the enactment of the state’s FY 2004 budget on July 1.

With a looming recession and a nation at war, Carcieri and the General Assembly must ultimately make difficult decisions as to how to slice the state’s FY 2004 budget. The state’s final budget must  provide the funding and adequate resources to enable long-term care providers to take care of the state’s burgeoning older population. It’s the right thing to do, even n times of uncertainly.

Report Examines Myths, realities of Consumer -Directed Services

Published in Pawtucket Times on March 17, 2003

Eighty-nine-year-old Lillian Brannon raves about the Arkansas-based “Independent Choices (A Cash and Counseling Demonstration Program) that allowed her to stay independent and at home with the assistance of four aides.

The program “has really changed my life so much,” she says. “It has really helped me to live more independently than I have ever have …I would not trade it for anything.”

Tammy Svihla, who suffers from MS gives a thumbs-up to the New Jersey-based “Personal Preferences” programs that has allowed her to more creatively used Medicaid funds. Svihla notes she was able to purchase a “Lazy-boy” lift chair, usually not covered by Medicaid. It was logical for Svihla to purchase the lift chair because it was difficult for her to get up from her couch because of soft cushions.

These two  testimonials, among three others, set the tone for a newly released report that examines the myths and realities that now surrounds the philosophy of consumer-directed services.

The orientation allows consumers to make choices about the services they receive, assess their own needs, and determine how ad by whom these needs should be met, and then  monitor the quality of services they have received.

“The Myths and Realities of Consumer-Directed Services for Older Persons,” authored by Marie R. Squillace, PhD., federal project officer, National Family Caregiver Support Program with the U.S. Department of Health and Human Services, and President and CEO James Firman, Ed.D., of the National Council on Aging, attempts to build upon current knowledge obtained from research and demonstration projects to make   consumer direction “an integral part of the options available for all older persons who may need long-term care.”

Throughout the 24-page report the authors use personal experiences, case studies, and research to dispel 12 myths about the philosophy of consumer-directed services.

Let’s take a look at three of the myths.:

Squillace and Firman urge the reader to not believe the myth that consumer-directed services are not appropriate for seniors with disabilities or for those with cognitive impairments.

Here’s the reality: studies of programs like California’s In-Home Supportive Services (IHSS), show that many elderly can express daily preferences for care and can benefit from that control. For more than 30 years, low-income persons over age 65 who are enrolled in the IHSS program have  hired, fired, trained, scheduled and supervised individual providers.

Moreover, the Family Caregiver Alliance in San Francisco adds research indicates that persons with early to moderate cognitive impairment still can express daily preferences for their care, sharing their values and preferences.  For those with significant cognitive disabilities, a University of Maryland Center on Aging report suggests family caregivers, a circle of friends, or close associates who know the consumer well can interpret the person’s non-verbal expressions.

Another myth of the Squillace and Firman report is that “self-directing consumers will “misuse funds” or “be exploited.”

Not true, say the authors, citing “Cash and Counseling Programs” that will allow consumers to use their alliances to purchase needed services so they can stay in their own homes with the assistance of a fiscal intermediary organization (FIO).

In reality, the authors note most prefer to have their funds held by the FIO, which conducts bookkeeping and accounting services to help them manage their individual helpers and pay taxes for their workers. The management can minimize concerns about misuse of funds and financial exploitation of vulnerable individuals while diminishing the administrative responsibilities placed on self-directed consumers, the report says.

Finally, some spread the myth that consumer direction is just an experiment, noting more, nothing less. But Squillace and Firman say this philosophy has progress “far beyond the experimental phase.

A growing number of consumer advocates, program administrators and policy makers are now embracing this philosophy.”

The authors recite a 2001 survey that identified 139 consumer-directed service programs that were operating across most of the nation, except Tennessee and the District of Columbia. “The estimated total number of people being served by these programs reached about half a million.

Squillace and Firman state: “Consumer direction is not a sliver bullet or a panacea for the nation’s long-term care challenge, but it is an important part of the solution.”

I believe that.

If they haven’t, hopefully the directors of the Department of Elderly Affairs and Human Services will develop programs that encompass the philosophy consumer directed services.  Enhanced quality of life can be a result of aging baby boomers and seniors controlling the choice over the purchase of their long-term care services. Ultimately, it is all about empowerment.

For more information about consumer-directed care, visit www.consumerdirection.org.

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