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December 11, 2012

Senior service providers wary as New Year approaches

http://www.jewishjournal.com/health/article/senior_service_providers_wary_as_new_year_approaches

Representative Henry Waxman (D-CA) speak during a news conference calling for no reduction in the Medicare and Medicaid budgets, as part of the year end budget talks on Capitol Hill in Washington on Dec. 11. Photo by REUTERS/Joshua Roberts

Representative Henry Waxman (D-CA) speak during a news conference calling for no reduction in the Medicare and Medicaid budgets, as part of the year end budget talks on Capitol Hill in Washington on Dec. 11. Photo by REUTERS/Joshua Roberts

They’ve weathered five years of economic crisis, relentless state budget cuts and growing demand for their services. Now, social service providers for seniors in the Los Angeles area are bracing for a new slew of challenges in 2013.

From federal budget negotiations and the looming “fiscal cliff” to state-level pilot reforms of Medicaid — known in California as Medi-Cal — these are uncertain times for seniors, their caregivers and the agencies that help them. 

“We’re not really sure how it’s going to play out,” said Paul Castro, CEO of Jewish Family Service of Los Angeles (JFS). “We try as best we can to anticipate and plan, but it’s a very uncertain environment and there’s so many parts to it.” 

At the top of most agencies’ watch list is the “fiscal cliff,” the dramatic concoction of federal spending cuts and tax hikes slated to take effect Jan. 2, unless Congress agrees on an alternative. Programs in line for automatic cutbacks include nutrition services for the elderly, funding for in-home care providers, low-income heating assistance, and social and legal support for the vulnerable. The sum of these reductions — $55 billion for all nondefense spending — could have devastating consequences for millions of older Americans, providers fear.

In Los Angeles, JFS says federal cutbacks, if they go ahead, would hamper the agency’s ability to help seniors, particularly those living in poverty. The organization receives federal dollars for numerous programs, including in-home nursing care for the sick and frail; community dining and home-delivered meals; and free transportation services for seniors who need help going to medical appointments, meal sites and elsewhere.

Of those, nutrition services are the most critical for low-income seniors, many of whom rely on the agency for their meals, JFS public policy director Nancy Volpert said. If automatic cuts go into effect, the agency will be unable to feed 83 seniors out of the 1,040 it serves daily. 

“If someone loses food, that is an existential problem,” Volpert said. 

Barbra McLendon, public policy director for the California Southland chapter of the Alzheimer’s Association, said state budget cuts over the past few years have already caused programs to shrink and sometimes even shut down, including adult day care facilities for people with dementia. 

“There’s no more fat to be cut,” she said. “They would be cutting into direct services that people depend on.”

Still, McLendon and JFS officials said they remain optimistic Congress will strike a deal before Jan. 2. They also pointed to positive news at the state level. Voters’ approval in November of Proposition 30, which cleared the way for temporary tax increases, should prevent more funding cuts for senior services in the state budget, they said.

Assemblyman Bob Blumenfield (D-Van Nuys) agreed the budgetary outlook for the state has improved with the passage of Proposition 30. Nevertheless, ongoing shakeups of health-related programs affecting seniors, including a new effort aimed at keeping ailing elderly people in their homes, will need to be monitored closely, he said. 

And if big cuts kick in on the federal level, the system could come tumbling down.

“If the feds take us over the cliff, that could cost us $5 [billion] or $6 billion, and we’re back to the drawing board,” Blumenfield said.

Even if federal lawmakers stave off an immediate fiscal catastrophe, the long-term outlook for programs critical to seniors — including Medicare, Medicaid and Social Security — remains shaky. With the nation facing an unwieldy $1 trillion deficit, large social programs are a conspicuous target. 

Republicans, who control the House of Representatives, have already proposed smaller annual increases in Social Security payments, capping Medicaid spending and raising the Medicare eligibility age from 65 to 67, or turning it into a voucher program.

Jim Specht, spokesman for U.S. Rep. Jerry Lewis (R-Redlands), said the congressman believes reforms to Medicare and Social Security are necessary to avoid the programs’ financial collapse in the future.

“Both the entitlement programs, particularly Medicare, are on a course now to run out of money over the next 10 years or so,” Specht said. “Mr. Lewis believes you cannot just allow that kind of a fiscal problem ... to continue.”

The fiscal cliff, and the automatic cuts it would imply, pose a greater threat to current seniors than proposed entitlement reforms, Specht said. Changes to Medicare and Social Security supported by Lewis would not affect people now over 55. For younger people nearing retirement age, reforms would be phased in, he said.

Lewis “is not interested in reducing any benefits for current seniors,” Specht said.

Still, U.S. Rep. Henry A. Waxman (D-Beverly Hills) said,“Seniors ought to be worried and aware of proposals that have been put on the table. I’m hoping that President Obama will be able to push back hard enough not to get them into law.”

Meanwhile, Los Angeles senior service providers said they are uneasy over another critical issue dependent on action by Congress: reauthorization of the Older Americans Act. The almost 50-year-old legislation authorizes federal funding for a wide range of senior services, including Meals on Wheels and home-based care programs, which is funneled through the Administration on Aging to state and local entities. It was due for renewal in 2011 but remains in limbo.

“It should have been done months ago. It has been introduced, but it’s just not going anywhere, which is a problem,” Volpert said. 

Failure to renew the act means agencies that receive federal funds to help seniors are not sure how to plan for their future, McLendon said. 

In California, another development is adding to the cloud of uncertainty, although there is hope it could bring about positive change. The state is one of 15 across the country participating in a federal pilot project that aims to shift so-called “dual eligibles” — people who qualify for both Medicare and Medicaid — into managed care. Officials say the change will reduce costs while providing beneficiaries with better-quality care.

Los Angeles is among five counties setting up the plan, which affects some of the poorest and sickest Californians, most of them elderly. About a third of the state’s 1.1 million dual eligibles live in L.A. County. Under the project, expected to start some time next year, local health plans L.A. Care and Health Net would be in charge of financing and delivering both medical and social services to dual-eligible patients. Currently, individual providers, such as JFS, are compensated directly by the government based on the number of services they provide.

Castro said JFS and other organizations in Los Angeles that run programs for seniors are anxious to ensure the transition doesn’t wipe away the current infrastructure and leave the elderly without access to services they’ve depended on for years.

It’s “a dramatic change in the service landscape,” he said. “The question is how much money will the state fund the health plans to do this kind of work, and how much will the plans be willing to spend on these clients, particularly those who are most fragile and imply the most cost?” 

Blumenfield echoed those concerns.

“We’ve really got to watch the implementation and make sure it helps seniors and doesn’t harm them,” he said. “The devil is in the details.” 

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