With money on hand and people who need it, lawmakers irritated by Catch-22

Delores Barker, 83, lives alone in South Burlington. But a string of ailments — arthritis, anemia, torn ligaments in her hip and arms — have made it increasingly hard for her to cook, clean or do her own laundry. Barker is one of about 400 Vermonters on a waiting list to receive help with basic services.

The Department of Aging and Independent Living (DAIL) has $6 million sitting, unused, in its coffers. Under state law, it can only spend the money on one thing — caring for the elderly and the physically disabled to keep them out of nursing homes.

To some of the lawmakers, service providers, advocates and people like Barker, the solution seems like a no-brainer. DAIL could eliminate the waitlist by doling out a fraction of those funds. It costs an average of $2,500 a year to provide the service. Nursing homes cost an average of $70,000 a year.

But that won’t happen, at least not for another six months or so. That’s because the people on the waiting list “do not, by definition, have high needs” and the situation is not an emergency, according to the Joint Fiscal Committee and the Shumlin administration.

Barker, who said she’s been on the waiting list at the Visiting Nurse Association (VNA) of Chittenden and Grand Isle counties for several years, has now added her name to another waitlist — to move to an assisted living facility.

Frustration was palpable at Thursday’s Health Oversight Committee meeting.

Rep. Chris Pearson. VTD/Josh Larkin

Rep. Chris Pearson. VTD/Josh Larkin

“In all my time in the Legislature, I very rarely hear from commissioners and department heads who are identifying a problem and also have the money sitting on the table. I mean that is pretty weird,” Rep. Chris Pearson, P-Burlington, a committee member, told DAIL Commissioner Susan Wehry.

The program in question is called Choices for Care, which uses Medicaid money to support the elderly and people with physical disabilities either at home, in a residential care facility or in a nursing facility.

People who receive services fall into one of three groups: highest need, high need and moderate need, and only the latter group has a waitlist.

The difference between the moderate- and high-needs categories, according to Wehry, boils down to this: “You can probably eat on your own, but you can’t shop on your own. You can get dressed and bathe and groom yourself, but you have trouble doing your housework.”

David Mickenberg, a lobbyist with the firm Sirotkin & Necrason, which represents the Community of Vermont Elders (COVE), described the moderate needs group as “the folks that are straddling the line between being in their homes and communities and being institutionalized.”

The state saves money by keeping people out of nursing homes — hence the spare $6 million — and those savings, under state law, have be reinvested in the program.

“It just makes me crazy to have these pockets of money sitting there when I have to imagine that the waitlist exists because the money is not going to the right places at the right time. What am I missing here?” Pearson asked the commissioner.

The commissioner said she was reluctant to let the waitlists dictate funding decisions.

Choices for Care savings have been a perennial source of budgetary battles. In the past, the state sometimes diverted the money to patch holes in the General Fund budget. A law passed last year put a stop to that practice.

The statute stipulates that DAIL must wait to spend the money until the annual Budget Adjustment Act, which is passed in the spring, unless it can prove that there’s a hole in federal funding or an emergency that needs immediate attention.

The Joint Fiscal Committee, a legislative panel that makes money decisions that pop up between sessions, and Wehry agreed Wednesday that the waiting list wasn’t either of the above. The committee approved DAIL’s request to spend $210,0000 on meals delivery and nutritional programs for elderly people, which lost funding due to the federal sequester.

 Susan Wehry, commissioner of the Department of Aging and Independent Living

Susan Wehry, commissioner of the Department of Aging and Independent Living

Wehry said the department will propose to spend a “significant portion” of the savings to address the waitlist when budget adjustment rolls around.

There is another way to chip away at the waitlist in the interim. DAIL is the source of the funds, but local agencies actually provide the services. Some of them don’t have waitlists, and don’t use all the money allocated to them; others are wrestling with waitlists of well over 100 people. Funds were reallocated between the agencies in FY 2013, but according to Peter Cobb of the Vermont Assembly of Home Health and Hospice Agencies, the recalibration came too late in the year to make much of a difference.

Lawmakers asked if DAIL could again reshuffle the money, redirecting it from agencies without waitlists to those with them.

The commissioner said she was reluctant to let the waitlists dictate funding decisions. She explained that some agencies don’t have waitlists simply because they don’t have the staff capacity to register them; others have long lists because they are “pre-enrolling” people in one of the other programs. “The numbers tell a very small part of the story,” she said.

But if the agencies are on board, Wehry said she’ll consider the idea. “We are very open to an administrative solution before budget adjustment.”

Lawmakers remain irritated that the savings are sitting idle.

In the meantime, lawmakers remain irritated that the savings are sitting idle.

Sen. Sally Fox, D-Chittenden, also sits on the Health Oversight Committee. “This is painful,” Fox told Wehry. “I want to hear you say that there is some way between now and budget adjustment, which won’t probably become law until April, if we are lucky … that within the budget you had allocated in Fiscal Year 2014, you can take people off this waitlist. It sounds like what you’re saying is that until BA the status quo has to stay.”

Barker said she doesn’t understand why she can’t get help.

“I’ve just fallen in the cracks,” she said. “I see people around getting all sorts of help and it’s just heartbreaking.”

She pulled a ligament in her arm while doing laundry, and the arthritis in her hands is making even the simplest of tasks — turning the knobs on her humidifiers on and off — nearly impossible. She’s hoping an assisted-living arrangement will make things easier, but, she said, “I can’t even get help in the meantime.”

Alicia Freese

Comments

  1. Time to reDefine terms, yes?
    Do what government does best in other words.

  2. Fred woogmaster :

    This situation is indeed crazy making and requires remedy.

    “But that won’t happen, at least not for another six months or so. That’s because the people on the waiting list “do not, by definition, have high needs” and the situation is not an emergency, according to the Joint Fiscal Committee and the Shumlin administration.”

    If my reading of the portrayal of this Commissioner is valid, she may not be the most appropriate person to be heading this agency.

    “The Joint Fiscal Committee, a legislative panel that makes money decisions that pop up between sessions, and Wehry agreed Wednesday that the waiting list wasn’t either of the above.”

    The determination rendered by the Joint Fiscal Committee and the Administration(above)was clearly made on the basis of information provided by Commissioner Wehry.

    Regardless of rules, procedures and protocol, there are people in need NOW. Money is available. You are correct, Representative Pearson. It IS crazy (maybe broken?) let’s fix it. You have my support.

    • Fred woogmaster :

      After making the above comment, recognizing that Commissioner Wehry and I have never met. I googled her.

      If I am correct, Dr. Wehry is a most distinguished individual, a medical doctor whose discipline is psychiatry.
      She appears to be an extremely accomplished and active professional.

      It’s hard to understand how such an individual has not created an avenue to utilize those funds. Occupied by other more important things? Perhaps. Human and fallible? Of course!

  3. Wendy Raven :

    shameful…shame on the State of Vermont…..

  4. Kathy Callaghan :

    This is outrageous AND shameful. People are suffering. The money is there to alleviate the suffering. Get creative, work on it NOW instead of later – and get it done! Move money from somewhere else on a temporary basis until a fix can be found. Quit “discussing” it and DO it. That’s what public officials are PAID for! Good grief.

  5. rosemarie jackowski :

    Some disabled and/or elderly could remain at home with very little help…such as a few hours per month. They need someone to lug the 40 LB bags of solar salt for the water softener. They need someone to plow them out after a snow storm. They need someone to move a TV set or make minor repairs such as installing a new mail box after the plows take it down. For those on a very small fixed income even minor problems become big issues.

    One possible solution would be a program modeled after Big Brothers Big Sisters but designed to help the elderly. When anyone loses their home because they need just a little help, there must be a way to fix this.

    Churches, civic groups, schools…anyone out there, please step up and help those who have worked hard all their lives.

  6. Rep. Sarah Buxton :

    This is absurd. I don’t need to compare waitlists or debate what a waitlist represents to see that the need for these resources is overwhelming — especially here in rural VT.

    I’m frustrated by the commissioner’s reluctance to exercise her authority to spend money pending other agency sign-off. The legislature approved those funds because we hear and see the needs of our constituents. This kind of can’t-do approach to governance gives all of government a bad name.

    • Fred Woogmaster :

      Representative Buxton:

      What IS the most immediate remedy for this present conundrum? Thanks.

      • Rep. Sarah Buxton :

        I must admit my review of the current issue is cursory (I sit on a committee of different jurisdiction). But I can’t see why the commissioner can’t revisit the determination that the current waitlist for moderate needs group constitutes an urgent need. This would trigger the ability to present urgent reinvestment needs prior to January.

        I understand that DAIL has suffered a chronic waitlist problem and doesn’t think this situation is what the legislature intended as “urgent.” I disagree. To wait is “to stay where one is or delay action until a particular time.” Because failure to act is causing greater needs in housing and human services – to a population that we have a special duty to serve – the existence of a waitlist for these services on its own creates urgency.

        • Fred Woogmaster :

          Sounds right to me. I assume (and hope) that you will communicate directly with the Commissioner

  7. katrin tchana :

    Another way that the bureaucracy surrounding Choices for Care and Moderate Needs manages to keep people out of the program is by making the application process so difficult and daunting that a stressed elderly person (or even a well-rested social worker) cannot possibly complete it. The documentation requirements to get on the program surpass the most complicated mortgage application.

    • rosemarie jackowski :

      Sounds like an attack of the ‘paper churners’. The more complicated they make the process the more people they need in the bureaurocracy to process the paper work. It gives them job security but is very harmful to those in need. The redundancy of paper work for any benefit is something that should be addressed by the legislature.

      I know one mother of 2 disabled children who had to quit her job because of the avalanche of paper work that was required for any help for her children.

  8. Joanie Maclay :

    Where are the familues of these persons needing the help however great or diminished this need may be? Okay, I get it…some may not have families. ..that this later may be true in more cases than I realize, but service groups might be called into action.
    My question to Commissioner…. were your elderly relatives in need of assistance would you be pleased to know nothing would be done because more thinking, more meetings, more……..more…… must happen before help(monies) from that idle big pile of cash were available. I think pleased may not be
    Correct!!

    The proper word….another readily comes to my mind to describe how you might feel.

  9. rosemarie jackowski :

    Does Vermont have 3 times the average number of suicides? That is one recent report. Poverty is a big issue.

    Please see:
    http://www.countercurrents.org/jackowski090912.htm

  10. rosemarie jackowski :

    Sorry…that was the wrong link. My mistake.
    Here is the correct one.
    http://dissidentvoice.org/2012/03/poverty-in-a-small-town/

  11. Mary Alice Bisbee :

    As a 78 year old elder, I cringe at the thought that the Choices for Care program has come down to this! It was my greatest hope when I moved into subsidized housing that I would never have to move again if I become physically or mentally unable to care for myself. Without close family members nearby or financially able to help, we will once again keep the nursing home beds full of light care patients while those with the greatest needs, will stay at home with round the clock care. Does this make sense?

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