John Raymond has known Matthew Hersey for half of his life – they were in high school together 15 years ago — and now, through Upper Valley Services, Raymond takes care of Hersey, who has a developmental disability.
They have a routine. Raymond takes Hersey swimming at First in Fitness most days, and twice a week they deliver hot and frozen meals to elderly residents in central Vermont through Meals on Wheels.
Hersey likes to sing in the car – Johnny Cash, mostly – and this particular Thursday, when they go to National Life to pick up meals from the cafeteria, is no exception. As Raymond organizes the food prepared by New England Culinary Institute, Hersey sits patiently in the car.
When they arrive at Eudora Kinneson’s tiny-one bedroom apartment in Montpelier, the pair pulls out several trays of warm and frozen foods from an insulated box and walks up to the door. Kinneson gives them a shout, and they walk in to her foyer/kitchen, which is big enough to accommodate a small table.
The 62-year-old woman with striking long white hair has had a series of strokes and seizures over the last nine years and can no longer drive or cook. She says she takes 23 pills a day to control her condition.
“I don’t know what I’d do without them, honey,” she says as she points to Raymond and Hersey.
The duo does a lot more than drop off food to older, isolated Vermonters – they also shovel walks, load wood racks and most importantly, provide a little social interaction.
“A lot of folks appreciate the company,” Raymond said. “And it’s a good way to keep an eye on them.”
Raymond is concerned,however, that soon he and Hersey won’t be able to stop by Kinneson’s place for much longer if lawmakers approve the governor’s budget cuts.
That’s in part because he is paid to take care of Hersey through Upper Valley Services, which is facing budget cuts; the Central Vermont Council on Aging, which organizes the local Meals on Wheels program, is facing budget reductions as well.
Hersey said, “I wish they’d take money where it can be cut.” In his opinion, reducing services for the elderly and the disabled shouldn’t be an option.
Short-term cuts, long-term problems
Meals on Wheels is perhaps the best known program for seniors, and it is part of a network of support services run through the Area Agencies on Aging that help to keep elderly Vermonters in their homes for as long as possible. The five local AAAs, the state’s 11 home health agencies and a variety of smaller programs provide home-based care services for seniors.
In addition, there are about a dozen adult day centers that take care of elderly Vermonters while their families are working.
The Douglas administration has proposed cutting a total of about $6 million in programs for Vermont seniors. About $3.78 million of the reductions would come from the General Fund (the state’s budget), and the state would lose $2.16 million in federal matching funds as a result.
The administration’s proposal comes in the wake of the state’s $151 million budget shortfall. Vermont’s tax revenues have fallen sharply in the recession and economists don’t see the state coffers recovering from the decline for two to three years. That means lawmakers and the administration must find significant permanent budget savings. The administration has warned against raising taxes, dipping into the $60 million rainy day fund or using one-time Medicaid federal stimulus funds, which are expected to total $60 million, for ongoing costs for services. The Legislature is expected to present a counter budget proposal early next week.
Joan Senecal, commissioner for the Department of Disabilities, Aging and Independent Living, did not return calls for comment.
Advocates for seniors are outraged by the Douglas administration’s proposals for eliminating or significantly reducing funding for what they see as low-cost, essential programs for frail, isolated and economically disadvantaged seniors in Vermont.
Ken Gordon, executive director of the Northeastern Vermont Area Agency on Aging, put it this way: “You see this kind of fraying of the social service network for older adults and caregivers that is really on a moral and ethical level unsettling, and on a practical level, in terms of solving a budget problem, what the governor has proposed is not going to save money.”
Besides what they see as a moral obligation to take care of the elderly, advocates say cuts to AAAs, home health and volunteer programs for seniors may look good on paper for fiscal year 2011, but they are going to result in even larger, long-term costs for the state.
Advocates argue that more elderly Vermonters will wind up in nursing homes, an eventuality they say not only undermines the state’s existing policies for home-based care, but also directly contradicts the goals for the new Challenges for Change law which is supposed to “empower” families to support aging Vermonters.
The state has been a national leader in providing home-based care for members of an aging population who would otherwise be relegated to nursing homes, which typically cost about $70,000 a year, Gordon said. Once a senior’s limited financial resources are expended, the state often picks up the tab.
Why should anyone under 40 care? To Gordon, if the state doesn’t continue to support low-cost, home-based care programs like Meals on Wheels, home health and adult day services, nursing home expenses will put “extraordinary pressure” on the General Fund budget over the next two decades.
“If ever there were an instance of being pennywise and pound foolish, this is it,” Gordon wrote in a letter to Rep. Sue Minter, a member of the House Appropriations Committee.
That pressure will increase dramatically as Baby Boomers reach the Golden Years. The number of Vermonters age 65 to 74 is expected to grow 63 percent from 2007 to 2017. Seniors age 85 and older will increase by 23 percent.
“It’s not a good mix,” Gordon said in an interview. “Eventually, what will happen is, programs will be deconstructed just at the point when we need to build a structure to support a whole lot more adults living in the community.”
Dolly Fleming, executive director of the Community of Vermont Elders, said the governor’s proposal arbitrarily decimates services for aging Vermonters.
“We’re not saying, here is the vision, make the necessary cuts, use the rainy day funds, alternative tax funds and wait for the FMAP (Medicaid stimulus funds) that will be coming and then decide how best to organize things,” Fleming said. “Instead, we are not only hurting the most vulnerable, but we’re also damaging programs that took decades to build. It’s like the Champlain Bridge. You look underneath it with all these cuts, and it’s a very vulnerable place to be.”
Fleming said if the state erodes supports and services that “allow people to live independently and with dignity and remain in the community” it will end up with costly long-term problems. She predicted if the relatively inexpensive network of programs for the elderly is dismantled, more Vermonters will have to turn to nursing homes, hospital emergency rooms, and mental health and substance abuse services, all of which cost a great deal more.
“We can’t cut our way out of this, and we can’t not look at long-term costs to our citizens and our economy,” Fleming said.
The cuts, blow by blow
The administration has proposed a 3 percent reduction, amounting to $147,000, to the Area Agencies on Aging this year, or about $28,000 per agency. Gordon says this is the third year in a row the nonprofit agencies have taken a hit – in the previous two years, they have lost 2 percent of their funding at a time when demand is up because of the recession. In addition, the agencies must find $92,000 in savings under the new Challenges for Change reorganization law.
The agencies employ about 175 people statewide and work with about 1,000 volunteers statewide; they work with 18,000 to 20,000 seniors and family caregivers a year, according to Gordon. Through Meals on Wheels, the nonprofits serve 1 million meals; they also take 25,000 calls on the senior help line and provide Medicare Part D advice for 10,000 Vermonters. The cuts could lead to the loss of 20 or so jobs statewide.
“Most of the agencies are using reserves in order to keep services at their current level,” Gordon said. “Our ability to do that is limited. The Baby Boomers wash ashore at this point, and there will be more demand.”
Home health agencies are taking a 15.8 percent cut this year, and Peter Cobb, executive director of the Vermont Association of Home Health Agencies, said the biggest losses for the agencies’ services are in the Choices for Care Medicaid waiver program, which provides personal care services and is one of the most important services for home-bound seniors.
He estimates they’ll lose as much as $2.6 million in income for case management and personal care services to seniors this year. Cobb said the cuts will bring the agencies to the tipping point financially.
“If we get cut 15 percent, we’ll serve 15 percent fewer people,” Cobb said. Each home health agency is going to have to meet with their boards and decide what to do.”
On top of cuts to the AAAs and home health, the governor has proposed the elimination of grants for specific programs that leverage volunteers and federal matching funds to provide services for thousands of seniors.
Two of the services slated for the chopping block under the governor’s budget – the Neighbor to Neighbor and Senior Companion programs – are low-cost, high-impact programs that provide services to thousands of older Vermonters.
The state match for the Neighbor to Neighbor AmeriCorps Grant is $120,000; the federal match is $232,000. The program employs 20 young people who organize a group of 800 volunteers a year. The program provides 5,000 service hours for about 1,000 seniors and disabled adults.
Senior Companion costs $74,500 for the state; the federal match is $304,000. The money is used to pay $2.65 an hour stipends to eligible volunteers who work one-on-one with disadvantaged seniors. In 2008-2009, there were 68 companions who provided 70,720 hours of service for 400 Vermonters.
The House Appropriations Committee is considering the governor’s budget proposal as part of marking up the “big bill,” the budget bill, this week.
Rep. Sue Minter, D-Waterbury, who reported on the impact of the cuts to other members of the committee was clearly distressed by the idea of reducing funding for what she deemed successful programs, particularly when they have, as she put it, “bent the cost curve” for long-term care.
“DAIL has reported that they have saved approximately $79 million in long-term care costs since 1996,” she said. “The cost was rising at 8 percent a year for long-term care. We’ve been able to (level out those costs) through community-based care, through policies of aging in place.”
Minter said the governor’s proposals would undermine these successes and cost the state more in the long run.
“I really believe we have a moral imperative to take care of those people who are most vulnerable,” Minter said.
The state’s five Area Agencies on Aging are taking the following hits:
AmeriCorps $120,000 General Fund $232,000 Federal match
Senior Companion $ 74,500 General Fund $304,000 Federal match
Federal match
Choices for Care $135,000 General Fund $190,000 Federal match
3% Reductions $147,000 General Fund
Challenges $ 92,000 General Fund
Total $568,000 General Fund $726,000 Federal match
Here is a list of the programs the governor has proposed cutting for fiscal year 2011.
• elimination of Housing and Supportive Services, $351,000 General Fund
• 3% cut to AAAs from General Fund, $147,000
• elimination of $41,000 Foster Grandparent Program grant
• elimination of $74,500 Senior Companion Program grant ($304,000 Federal match)
• reduction of $127,000 for Long-Term Care Ombudsman Program
• elimination of $40,000 Direct Care Worker Registry contract
• redesign of Attendant Services Program – instituting means testing–$1 million general funds
• elimination of $120,000 for Neighbor to Neighbor Program (Americorps), $232,000 – federal match
• elimination of Home Access Program – Vermont Council on Independent Living $100,000
• change reimbursement rates to Nursing Homes with lowest case mix, $285,000 General Fund, unknown federal match
• change case management reimbursement – to be paid a monthly rate – reduction for moderate needs $108,000 – reduction for high/highest needs $152,000; federal match, $380,000
• change to Home Health personal care rates – $692,000 reduction from global funds; $1.25 million in federal match
• tighter controls on personal care variances $208,000, unknown loss in federal match
• reduction in case management hours $9,000 General Fund, unknown federal match amount
• change to Flexible Choices program $90,000 General Fund, unknown amount of federal match
• adult day program changes, $133,000 General Fund, unknown amount of federal match
Total: $3.7 million state GF and $2.16 million in federal funding.
