Janice Diolon has dystonia, a neurological muscle disorder. She suffers from a heart problem, a seizure disorder and diabetes. She can’t cook her own meals, bathe herself, clean her house or do her laundry.

A caseworker provided through the Area Office on Aging (AOoA) does those things for her.

Diolon, 68, loves the freedom the AOoA has given her to stay out of a nursing home.

“It’s right for seniors to be at home if we so choose,” she said.

That freedom may be in jeopardy if the governor’s proposed budget passes.

Gov. John Kasich’s proposed budget includes a $9.6 million cut over two years to Medicaid funding for the Area Office on Aging for Northwest Ohio, said Pamela Wilson, the AOoA’s vice president of long-term care.

The majority of the AOoA’s budget goes to PASSPORT, an umbrella program of more than 100 providers of services such as transportation, personal care and home-delivered meals to 2,200 seniors in the region.

Erik Poklar, director of communications for the governor’s office of health transformation, said that number — $9.6 million for the region and $160 million for the state — was misleading unless viewed as a cut to a spending trend rather than an actual budget.

The mystifying part of the cuts for the AOoA team is that PASSPORT is a cost-saving program. Each senior who transfers from a nursing home to the program saves taxpayers an average of 40 percent, said Justin Moor, the AOoA’s vice president of communications and operations.

The average yearly cost for a PASSPORT patient is $14,000, about one-third of the cost for a Medicaid-funded nursing home patient, Moor said. So any budget that would force seniors back into nursing homes is self-contradictory and counterproductive, said Joseph Wells, a doctor of occupational therapy and co-owner of provider AmeriCare.

An applicant for PASSPORT must make $2,100 per month in income or less with no more than $1,500 in assets to qualify, so there are few non-Medicaid options. Chardell Russell, a caseworker for PASSPORT, said she recently spoke with a woman living on $300 a month.

For the AOoA, Wilson said, the cuts mean a smaller staff with greater responsibilities — a case manager with 65 clients today, for instance, might have to take on about 100 in the future. For seniors on PASSPORT, cuts could mean fewer hours of personal assistance and the loss of services such as food, adult day care and assistance with bathing.

Wilson said even the process for approving applicants for PASSPORT would become much less efficient, as the screening process could take weeks longer for an overburdened staff. Wilson said that is unacceptable for most applicants, who may be forced to enter a nursing home while the long process runs its course.

“For the most part, people can’t wait,” she said.

‘I promised I’d keep her’

Pam Feichter, 54, said she doesn’t know how she could care for her 80-year-old mother, Mary Jackson, without the AOoA aid. Jackson has chronic heart disease and receives 25 hours of care per week through Comfort Keepers, a PASSPORT provider.

“I promised her I’d keep her,” Feichter said. “I don’t want to put her in a nursing home.”

Kasich’s budget, Wilson said, includes an 8 percent cut in 2012 and a 15 percent cut in 2013 to the management and case assessment funds and a 3 percent cut to providers. Wilson said the cut could prove devastating for some providers already among the most poorly reimbursed in the state, forcing them to withdraw from PASSPORT.

Wells said seniors who want to stay home will return to hospitals and nursing homes as a result, which increases the pressure for providers. AmeriCare, Wells said, serves 150 clients in the area, and is already challenged by factors such as inflation, rising minimum wage and gas prices.

Cut costs, serve more

In addition to the cuts, the governor has proposed that the AOoA expand the number of its clients by 15 percent in the next two years.

Richard Marion Witcher

While the office’s chief goal is to make at-home care possible for nursing-home level patients — in the past 20 years PASSPORT has pushed the number of nursing-home level seniors from 10 percent at home to 40 percent — Wilson is concerned the staff will be unable to maintain current service levels, particularly as the office has already been operating on a shoestring in recent years.

“We’ve cut the fat and now we’re to the point of cutting the bone,” Moor said.

Poklar from the governor’s office said the cuts to PASSPORT are part of an attempt to rebalance long-term care in a budget facing an almost $8 billion hole. Medicaid, he said, makes up about 30 percent of the state’s total budget. He said the lack of federal stimulus funds is putting pressure on the state.

Some hope

There is a hint of better news for the AOoA. The bill passed the Ohio house with a softened cut of $145 million, down from the $160 million statewide cut proposed by the governor. That’s not enough to solve the problem, but Wilson said the AOoA is communicating with the state about its concerns and needs, and Poklar said PASSPORT administrators have made a good case.

“We’re hopeful,” Wilson said.

The result of those discussions will be immense for legally blind Richard Marion Witcher, 71. Before PASSPORT, he frequently cancelled doctor’s appointments because no one could drive him, so keeping the service is vitally important to him.

“We could survive,” he said, “but it would be difficult.”

Tags: Area Office on Aging, Community, Government, Ohio, PASSPORT, Patrick Timmis

This entry was posted on Thursday, May 26th, 2011 at 4:36 pm and is filed under Community, Cover Story, Featured.
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