State expects savings  in home health care

Ohio wants more seniors in program

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By Everdeen Mason, Staff Writer 11:01 PM Saturday, April 23, 2011

SPRINGFIELD — Bette Carter and Sheryl Aldrich suffer from back problems that require special care. But the similarities end there.

The environment in which each woman gets care is different.

Carter prefers nursing home care, which is more expensive, and Aldrich receives in-home care.

Gov. John Kasich is hoping to steer more people to make Aldrich’s choice.

Kasich budget proposals are meant to steer more seniors towards PASSPORT — a Medicaid waiver program that helps pay for in-home and community services for seniors who need hands-on assistance — in hopes of saving the state $18.7 million through 2013, said Eric Poklar, director of communications for the governor’s Office of Health Transformations.

“In this challenging fiscal climate it’s in the best interest of Medicaid beneficiaries and taxpayers to demand the highest level of efficiency and quality in PASSPORT,” Poklar said. “It will expand the quality of services for seniors without waiting lists.”

The state wants to steer 4,800 more seniors toward PASSPORT. That’s because the cost to keep a senior in a nursing home per month, paid for through Medicaid or Medicare, is more than $4,000. PASSPORT costs about $1,300, said Bonnie Kantor-Burman, director of the Ohio Department of Aging.

Currently, Ohio has more than 32,000 people enrolled in the program, including 580 and 153 in Clark and Champaign counties, respectively, according to the department of aging.

“If they choose and can be accommodated and live in their home the cost of caring for them is far less than in a nursing home,” Kantor-Burman said. “There will always be a need for nursing home services in our state; our goal is to make sure people are appropriately placed and where’s best for them and their families.”

Changes in PASSPORT in Kasich’s proposed budget include cuts of up to 10.4 percent in 2012 and administrative reorganization.

“The challenge they have to work through on the budget is how do you pay for that?” said David Tramontana, president of Home Care by Black Stone, one of the Springfield area’s largest home care providers.

But the state’s plan to reorganize Medicaid waivers should make the program cheaper and more efficient, said Kantor-Burman.

“Just as it’s very difficult for families to navigate, it’s also very difficult for providers and others who are helping folks make this decision,” she said. “When you see different waivers can be very confusing and when we have one waiver it will be far easier for folks who are making these decisions.”

Carter, 83, and Aldrich, 66, made their own choice for care based on what is best for them.

Carter, a PASSPORT member, has tried in-home care and nursing home care. She said in-home care is unable to provide the amount of rehabilitation she needs and currently is getting care at Heartland of Springfield nursing and rehabilitation center at 2615 Derr Road.

“When someone came to my house, no one was available at the times I needed them, like at night,” Carter said. Also, in nursing homes she has more access to therapy, which she needs to get back on her feet.

For Aldrich, also a PASSPORT member, in-home care allows her to stay home and also gives her a makeshift family.

“The (caretakers) run errands for me, they help me in the house and cook, do my laundry,” Aldrich said. “I have them everyday, four hours a day they have been wonderful companions. And the girls that I’ve got I just love them to death.”

Aldrich has two nurses, a bath aid and a therapist who comes once a week.

While the state hopes the changes to PASSPORT will allow more seniors to have access to care at a lower cost, local care providers are concerned about impending cuts. The state plans on handling the increased need for services with a smaller budget by downsizing certain local providers based on their administrative costs and amount of services, said Kantor-Burman.

“We’re working in collaboration with local (Passport Administrative Agencies), looking at figures and where that line is in each county,” Kantor-Burman said. “There will be certain organizations who will need to make some cuts.”

Tramontana, president of Home Care by Black Stone, said he is concerned about how the department of aging will determine who gets cut. Black Stone is one of the largest PASSPORT providers in Clark County, and also serves Dayton.

“Why the discrepancy?” he asked. “I’m worried about it but I’m anticipating more information. The cut I’m most concerned about is the provider reimbursement cut.”

Tramontana said previously the PASSPORT program went long periods of time without increasing the reimbursement for inflation, so providers such as Black Stone have been unable to pay their nurses as much as hospitals and nursing homes pay theirs.

“It’s basic economics,” Tramontana said. “If you’re going to increase by (4,800) slots we’ll need to increase staff, and to increase we have to be competitive with wages. And now we have a 3 percent cut when staff is already underpaid.”

For nursing homes, the change in focus to home care has already hurt business.

“We’re already starting to see a difference (since November 2010),” said Kelly Meckstroth, administrator for Heartland of Springfield. “We have less referrals from the hospital.”

A change in PASSPORT rules also lengthens the admissions process, which means clients are sicker when they are approved for care, she added.

“By the time they get admitted they’re in the hospital and they’re sicker, more unhealthy,” Meckstroth said. “They’re past the point of returning to the community. So are you really saving money? Probably not.”

Contact this reporter at (937) 328-0371.

See PASSPORT on Page A5

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