Integrated Social Services is Key Component in Senior Independence

by Candi Helseth

Without the Lighthouse Program, 93-year-old Nannie Edwards wouldn’t be able to stay in her home. The West Virginia Bureau of Senior Services program offers home-based daily living assistance that makes it possible for Edwards to remain independent. Edwards is among 57.8 million American seniors 60 and older who need home-based, long-term support.

“Survey after survey has shown that nine out of 10 older adults want to live out their lives in their homes,” says Lenard W. Kaye, Director of the University of Maine Center on Aging. “Home-based social services programs provide the support seniors need to do that. Research has proven that older adults with chronic conditions and disabilities maintain a more stable state when they receive assistance at home.”

Demand for community-based programs that help elderly age in place is increasing as the nation’s aging population continues to swell. By 2030, the number of Americans aged 65 and older is projected to be more than twice the over-65 population in 2000, increasing from 35 million to 72 million. According to the Administration on Aging (Now the Administration for Community Living), 27 percent of Americans over 60 have difficulty performing at least one activity of daily living. By age 85, 50 percent need assistance with two or more activities of daily living.

Forty percent of Lighthouse clients are over 85, said Jenni Sutherland, West Virginia Bureau of Senior Services state director. Like Edwards, they are able to manage without 24-hour assistance but they couldn’t remain in their home without some assistance. Edwards, who suffers from spinal stenosis and advanced arthritis, is almost totally immobile.

“I can scoot my chair to get from the table to the microwave to make myself stuff and I have a walker or cane if I really have to move,” she said. “But this is where I want to be. I’ve been here 21 years, just been me and Jesus since my husband died 14 years ago. I just hope and pray to God I get to stay here.”

She looks forward to her daily visits from caregiver Ann Rogers. Lighthouse caregivers provide up to 60 hours per month in personal care, mobility, nutrition, and housekeeping services. In addition to the physical assistance caregivers provide, they also play a large role in reducing seniors’ social isolation, Sutherland said.

“Every day that wonderful woman combs and braids my hair and we visit,” Edwards said. “She prepares my evening meal, bathes me, makes my bed, everything she should do plus more!”

To receive Lighthouse services, patients must be over 60, have two or more areas of functional need and not qualify for Medicaid in-home services. Another West Virginia program, FAIR (Family Alzheimer’s in Home Respite), helps individuals with dementia and Alzheimer’s stay in the home longer by providing supervision and social interaction as well as respite relief for family caregivers.

Throughout the nation, many seniors benefit from Medicaid’s Home and Community Based Services (HCBS) Waiver Program, which currently offers four program options (two of which were created by the Affordable Care Act). States receive grants, based on their share of the national population age 60 and over, to fund their HCBS programs. (Medicare can pay for home health services for senior citizens who need skilled nursing care. It does not pay for 24-hour care or homemaker services.) In Mississippi, for instance, HCBS offers case management, personal care services, adult day care, expanded home health, home-delivered meals and respite services to nearly 16,000 residents throughout the state (services to the elderly and disabled comprise 12,000 of the 16,000 residents). Mississippi’s HCBS services are provided by a variety of organizations, such as home health, case management and personal care service agencies, said Sandra D. Bracey-Mack, a Deputy Bureau Director at the Mississippi Division of Medicaid.

Finding funding for in-home senior care

Funding—or, rather, the lack of it—seems to be one of the biggest barriers for aging in place programs. Viability depends on adequate state and federal funding, Kaye said.

“Over the last 20 years, the funding level from OAA (Older Americans Act) has not kept pace with the needs of the aging population,” he said. “To some extent, those in human services need to build compelling arguments to convince state and federal funding sources that human and social services have equal impact and importance with healthcare services in serving older adults.”

Mississippi’s HCBS services got a boost last year when legislators approved allocating $16 million from a Medicaid surplus after AARP Mississippi convinced lawmakers that the state would save money ultimately. More than 3,000 residents on a waiting list began getting services.

“What we looked at and showed legislators in Mississippi is that it saves taxpayer dollars to provide that funding for people who really don’t need 24-hour care,” said AARP Mississippi State Director Sherri Davis-Garner. “Three people can be cared for at home for about the same cost of caring for one person in a nursing home. AARP Mississippi has made home and community-based services a key issue for years because our members have told us they want to age at home with dignity.”

Sutherland said about 80 percent of West Virginia is rural, and seniors whose income or assets disqualified them for Medicaid services were unable to afford the level of assistance they needed or there were no programs available where they lived. In 2007, the West Virginia Legislature approved state funding that fully covers the costs of Lighthouse and FAIR. Each of the state’s 55 counties has a registered nurse who develops care plans for patients. Counties are responsible for caregiver training and supervision. Lighthouse recipients pay for services on a sliding fee schedule, and their contributions go back into the program.

Integration is key

The RUPRI report, Rethinking Rural Human Service Delivery in Challenging Times: The Case for Service Integration (no longer available online), found that there is “an unprecedented need” for increased human service and safety net programs. “For decades, rural communities have found themselves at an unfair competitive disadvantage, as population-based, formula-driven funding allocations and urban-oriented program delivery designs became the norm in federal and state programs,” the report authors state. “Federal funding formulas that allocate money based on county population formulas are more likely to exclude less-densely populated rural counties from a limited pot of funding.”

The RUPRI report also notes that rural areas must contend with higher costs of service delivery and scarcity of service providers that are quite different from cities with high population concentrations. The report authors recommend moving toward place-based approaches to integrate human services programs that cross geopolitical jurisdictions, share resources and staff, and create new entities to provide fiscal and operational program management.

“I think we all agree that it makes sense but we continue to struggle throughout the nation with ways to effectively and efficiently integrate professionals in a genuine system of collaborative team-based care,” Kaye said. “We are seeing progress. A number of health care entities are presenting encouraging evidence about the importance of services delivered in the home. And the federal government and several forward thinking foundations are promoting creative projects that test out different structures and mechanisms that may enable an integrated system.”

Back to: Fall 2012 Issue