February 24th, 2010
HOLD HARMLESS ACT
MICHAEL DALLAS WAIVER
Rep. Scavello: The Michael Dallas Waiver is up for renewal this year, is there any guarantee that the services for the people under this waiver will continue?
Hall: In order to be for a waiver to be federally renewed, they must demonstrate compliance capabilities. There are 6 assurances and MDW doesn’t meet any of the 6. In order to be renewed, the waiver must be cost neutral compared to being taken care of in a nursing home. MDW is $55k per person/per year above. The plan right now is to move those 88 people on MDW to the Indepedence Waiver, which currently supports 1,400 people. This way, the costs will be distributed among more people and fit under the cost neutrality.
Rep. Manderino: Is there a difference in opinion on the people on this waiver’s need of a skilled nurse? Why will this not be renewed?
Hall: The current waiver is just not sustainable or renewable. There is no question that these people need these services, but the way it is written right now, there is no way to continue it. In the waiver right now, nurse shifts are done in 8 hour shifts. Therefore, if someone requires 4 hours of skilled nursing, they get 8…and if they require 9, they get 16. This is causing the cost of the patient care to sky rocket. If we would want this waiver to continue, it would need to be amended.
Rep. Manderino: If PA is having so much trouble, how are other states not having problems and why aren’t our people meeting it?
Hall: There is a deep structural problem. With the economy the way it is, things that were passed over before are now under deeper scrutiny. They are paying more attention to numbers and errors were previously made in calculations. The current flawed shift design is part of the state plan, not the federal. If we want to reapply for these waivers, we must change the service package but it still may not fix the problem. The best case is to move these patients to Independence Waivers where it is measured on an aggragate basis rather than an individual cost basis.
PENN CARE WAITING LIST
Rep. Scavello: Please update me on the Penncare waiting list which currently stands at 2,700.
Hall: This numner remains stable. We have been working with agencies on this. Right now those who are highest risk or on waivers are the first to get services. This is connected with how we distribute money to counties.
MEDICAID REIMBURSEMENT TO COUNTY HOMES
Hall: We have worked to bring additional funding to state nursing homes. We have renewed the nursing home assessment to now include state nursing homes. In addition, we are working to reinvent state nursing home and to update them to make them more appealing to people.
HB 1152/SB 927
Rep. Conklin: Is there anything in the works of moving the Dept. of Aging out of DPW?
Hall: There is a bill being considered currently in the Senate to combine the Dept. of Aging with the Office of Long Term Living.
Rep. Hennessy: Doesn’t the shift in funding dillute the voice of seniors?
Hall: Right now, long term care is under the office of long term living. They answer to both the DPW and DA. There needs to be some focus because the Office of Long Term Living shares many of the same people as the Dept. of Aging. The 2 biggest programs in LTL serve seniors. Combining these ensures a more unified focus on aging.
ASSISTED LIVING REGULATIONS
Rep. Gingrich: You are adding 8 positions to work under the assisted living regulations, what is the time line on these regulations?
Hall: These regulations are within days of being ready to be reviewed and we have meticulously gone through all comments. They should be ready in April/May and should be ready to start licensing and admitting individuals with waivers January 1.
Rep. Gingrich: Are you confident that we will get this waiver?
Hall: Yes, the new waiver is based on waivers from other states that have been approved.
Rep. Gingrich: How many people are anticipated to participate?
Hall: A small number in the beginning, we have budgeted for 279 people in this fiscal year.
Rep. Gingrich: To be clear, the people in personal care right now will be able to maintain their current level of care and not be transferred to assisted living?
Hal: The advent of assisted living is not to have people change their current way of living.
ADULT DAY
Rep. Denglinger: Many people are concerned with the deficiencies in the adult day program with their limited hours and areas that they are offered.
Hall: This continues to be a priority and it is very important to working families. We need to provide care that the families expect. We are trying to work with programs to encourage expansion and have added 7 programs in the past 18 months. Less than two counties are now lacking adult day programs.
Right now, the rates that the state is paying providers are inadequate, such as $35day less than the national average. This is creating problems. We are working to increase reimbursement which is linked to them being open 5 days a week, 11 hours a day, and being able to address hygiene issues.
There are also grant programs being created to do improvements, such as installing showers.
NURSING HOME UTILIZATION
Rep. Manderino: Why is the nursing home population remaining unchanged when the senior population is growing by 1/3?
Hall: Right now, more people are using the strengthened home and community based programs. The people who are in nursing homes these days are acute/complex, frail patients towards the end of their lives. We used to measure nursing home stays in years, now we are measuring them in months and even weeks. Those living in nursing homes are either near the end of their lives or being rehabilitated from surgery, injury, etc.
FAMILY CAREGIVER SUPPORT
Rep. Kortz: Right now as it stands, the budget holds $12.1 million for the family caregiver support. Will there be a surplus from this at the end of the year?
Hall: The family caregiver support allows relatives to act in a role taking care of their senior family members. Right now, there are state limitations which act as a barrier to keeping many people from accessing this. It is very common for some of this money to go unspent because of these access issues.
Rep. Kortz: Rep. Mundy has introduced a bill to move this forward. It would allow friends/neighbors to care for and keep people out of nursing homes.
March 1st, 2010 at 5:33 pm
I am one of the Nurse Coordinators for the Ventilator Assisted Children’s Home Program. I would like to dispute Secretary Hall’s description of nursing coverage within the Michael Dallas Model Waiver program. Nursing hours are awarded as so many hours per week or per month, not per day. This allows families and patients flexibility with their hours. If a patient only needs 4 hours on a certain day, then he/she only has to use 4 hours on that day, not 8 hours as Secretary Hall reported. If he/she needs 9 hours on one day then they only use 9 hours, not 16 hours.
Also, it is not the fault of the people on the MDW that
Fianlly, I do not know how these people will remain safely at home if they do not have the skilled shift nursing that they need. Not visiting nursing, not attendent care but skilled shift nursing. And to place these people in nursing homes would be a disgrace especially since many of programs in the state work to get patients OUT of nursing homes and into the community.
March 4th, 2010 at 10:31 am
My dear friend’s son is one of the recipients of the Michael Dallas waiver program. Since her husband’s death, my friend cares exceptionally for her son, by herself, with the help of qualified nurses. Without the skilled nursing help, she would not be able to sleep at night, since her son is ventilator dependent, she would not be able to leave her house at all. If you were in the same situation, wouldn’t you have your tracheostomy, ventilator and feeding tube be handled by a qualified caretaker? To place Nick in a nursing home would be disastrous for both my friend and her son. The excellent nursing and motherly care kept him out of the hospital for over 15 years! That should also be considered when deciding on the cost of the program.