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.
“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.
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.”