Advocacy Update

Expanded Home First could help seniors and taxpayers

"I expect I would have stayed at the nursing home some more years if it wasn't for (Home First) and I wouldn't be independent now. It gets you your life back." ~ Carol moved to an apartment after living in a nursing home for four years, following a stroke.

Efforts are underway to pass legislation that would allow more elderly and disabled adults who are headed for nursing facilities to opt instead for home or assisted living care.

Legislation to expand Ohio's Home First law has bipartisan support, but faces challenges as state officials and lawmakers scrutinize language in the proposed bill. It was introduced in the Senate on Nov. 24 (SB 214) and in the House on Dec. 15. It was introduced in the Senate by Sens. John Carey (R-Wellston) and Dale Miller (D-Cleveland) and in the house by Rep. Peggy Lehner (R-Kettering) and Rep. Deborah Newcomb (D-Conneaut). There are numerous co-sponsors, including several from our area. (See list of sponsors below)

Lawmakers told gatherings of media and supporters that the bill would reduce costs in Ohio's long-term system and improve access to care options that people want.

More than 90 percent of older adults prefer to receive care in their own homes as they age, according to a study by AARP.

"By helping more Ohioans enter home and community-based care settings, the Home First program not only creates greater choice in our state's health care system, but could work to save Ohio taxpayers millions of dollars per year," Carey said.

According to the Ohio Business Roundtable, if Ohio simply achieved the national average on spending for home and community-based care -- we currently rank 39th in the nation -- the state could save $900 million a year in Medicaid costs.

Ohio's current Home First law goes into effect when there is a waiting list for Medicaid-funded home and community long-term care services. It allows people in nursing facilities to move out, bypass the waiting list and enroll in PASSPORT, Assisted Living or the Program of All-Inclusive care for the Elderly (PACE). Without this law to help them avoid the waiting list, many in nursing homes would remain there unnecessarily and at additional cost to taxpayers.

Medicaid nursing home care costs an average $4,800 per month, compared with $1,100 for PASSPORT and about $2,100 for the Assisted Living Waiver.

Many bypassing waiting list via Home First
Since late July, when state budget cuts brought on the first waiting list since 2007, Home First has helped hundreds of elderly and disabled Ohioans leave nursing homes and enroll in home or assisted living care. They include people like Carol, who moved to a nursing home at age 58 after she had a stroke. She stayed there nearly four years, but, through Home First, is now in a College Hill apartment, receiving care through PASSPORT and undergoing therapy in hopes of walking again.

The new bill would expand Home First to include people at high risk of entering a nursing home, not just those who are already there. This would include people discharging from hospitals; medically fragile seniors; those in unsafe living conditions; and those who have spent down their assets while in assisted living and need to go on Medicaid.

Some assisted living facilities use benevolent funds to help those who have run out of money; others require residents to move out immediately or relocate to a nursing wing where they can access Medicaid, said Kim Clark, COA's Housing Business Manager. "The waiting list is only about a month (for the Assisted Living Waiver)," she said, "but unfortunately we have to tell people there are no guarantees. They may have to move to a nursing home if the waiting list doesn't open up for them in time…Families think it's ridiculous."

Many organizations are supporting the proposed legislation, including:

AARP
AOPHA (not-for-profit providers of senior services)
Ohio Assisted Living Association
Ohio Association of Adult Day Services
Ohio Association of Area Agencies on Aging
Ohio Association of Gerontology and Education
Ohio Association of Regional Long Term Care Ombudsman
Ohio Association of Senior Centers
Ohio Coalition of Adult Protective Service
Ohio Council of Home Care and Hospice
Ohio Olmstead Task Force
Older Ohioans Nutrition Network

Waiting for care
Meanwhile, the waiting list is slowly growing for PASSPORT, the Assisted Living Waiver, and PACE. From an average per monthly enrollment of about 920 people statewide, the available openings were cut to 680 a month and then again to 500 a month as of December 1, a 45 percent drop. On November 30, there were 451 Ohioans on the waiting list.

Council on Aging has been allocated 62 openings per month for our five-county area. On December 1, we filled the openings with people on our waiting list. As of December 14, 33 people remained or had been added to the list. For now, the wait for an opening can be up to one month, depending on when a person applied.

COA district sponsors for expanded Home First
House

Louis Blessing, Jr. (R-Cincinnati)
Danny Bubp (R-West Union)
Timothy Derickson (R-Oxford)
Denise Driehaus (D-Cincinnati)
Dale Mallory (D-Cincinnati)
Connie Pillich (D-Montgomery)
Peter Stautberg (R-Cincinnati)

Senate

John Carey (R-Wellston)

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Advocating for the needs of seniors

One of the goals of advocacy is to make sure elected officials always remember seniors, especially the homebound who count on COA to carry their message. One effective strategy is to bring elected officials and members of COA boards to the homes of our Elderly Services Program and PASSPORT clients where they can see for themselves how the programs work. Our clients are not shy about advocating on behalf of all those who want to stay in their homes as they age.

We also meet regularly with elected officials and candidates to educate them about COA, the aging network, and the need for reform in Ohio's long-term care system. Issues we addressed in meetings with elected officials last fall include:

The need for a Unified Long-term Care System in Ohio (Let consumer choice and need drive the system by eliminating the funding bias that favors expensive institutional care. Combine Medicaid long-term care funding into a single line item in the state budget, allowing seniors and disabled adults to choose among home, assisted living, other community options, and nursing facilities.)
Impact of the state budget cuts (waiting list for PASSPORT, Assisted Living and Program of All Inclusive Care for the Elderly- PACE; major cut in funding for services such as congregate meals and transportation)
Importance of Home First (law allowing nursing home residents to discharge and bypass the home and community care waiting list)
Bed bugs (a worsening problem concentrated in Hamilton County at first, but now spreading throughout Ohio)
The need to modernize PASSPORT's provider contracting and rate system (allow for competitive bidding and other reforms)
Efforts to divert people from unnecessary nursing home placement and transition those already in nursing facilities back to their homes or other less intensive settings as quickly as possible

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Elderly Services Program Home Visits

	^{Pictured L to R: COA Hamilton County ESP Care Manager, Jeanne; HCESP client, Margaret; COA Board Member, Dot Christenson}
On Oct. 13, COA Board member Dot Christenson visited ESP client Margaret in her Green Township home. Margaret said that she is very grateful for the ESP program that allows her to remain in her home. "I do everything I can for myself, but at 93, I need a little help!" she said. "I am happy and Jeannie is just Johnny-on-the-spot and gets me whatever I need. She always has time to listen and we work together." Dot Christenson thanked Margaret for the visit. "You're an inspiration," she said.

	^{Pictured counterclockwise from left: Clinton County ESP Care Manager, Brenda; ESP client Roma; Clinton County Commissioner Mike Curry; and Roma's brother, Kenneth}
On Aug. 26, Clinton County Commissioner Mike Curry visited Clinton County ESP client Roma in her Sabina home. Roma asked Commissioner Curry to keep the Elderly Services Program going and said, "I am 91 years old and live alone. That's what the ESP program enables me to say. I am so grateful for this program, for Brenda and my family. Brenda does a great job and makes sure I get what I need to stay safe at home -- which is what I want." Commissioner Curry thanked Roma for her time and said, "It is wonderful to see firsthand the benefits of our ESP program. I am very supportive of the program and will do everything in my power to make it available to our seniors in Clinton County and to make it grow to meet our increasing needs."

	^{Pictured L to R: Hamilton County ESP Care Manager, Kathy; ESP client, Kathy; Hamilton County Commissioner Greg Hartmann}
Hamilton County Commissioner Greg Hartmann visited with ESP client Kathy in her Groesbeck home on Sept. 1. Kathy was very excited about the Commissioner's visit. She thanked him for "this wonderful program that helps me stay at home and keeps my family from worrying about me." "[Hamilton County ESP Care Manager] Kathy does an excellent job watching over me and is very dear to me," she said. "At levy time, I work very hard for this program and I hope you will also." Commissioner Hartmann agreed with Kathy. "I am so pleased you would allow me to come visit you," he said. "You are right; this is an excellent program and what our community needs for our seniors and their families. We all need to work hard for this program which gives back to seniors by providing them with long-term care choices."

	^{Pictured L to R: Hamilton County ESP client, Henrietta; Cincinnati Mayoral Candidate, Brad Wenstrup; Hamilton County ESP Care Manager, Gary}
2009 Cincinnati Mayoral candidate Brad Wenstrup visited with ESP client, Henrietta in her Oakley home on Oct. 27. Wenstrup told Henrietta he was pleased to be able to visit with her and learn more about Council on Aging and the Elderly Services Program. "You came to the right place," Henrietta told him. "This program is wonderful and helps support me in all my needs. Gary is a darling, keeps me on my toes and does a great job." "I want seniors to have options when choosing their long-term care and not be forced in nursing homes, when unnecessary," Wenstrup said. "This is a very beneficial program to our county in saving money and most important, giving seniors a choice."

	^{Pictured L to R: Warren County ESP client, Jean; and Warren County ESP care manager, Lauren}
Because of serious health problems, Jean and her husband receive care in their Lebanon home through Warren County ESP. Jean says they are very grateful for the help and support that ESP and their care manager, Lauren, provides. "This wonderful program and Lauren help my wonderful family to take care of us…at home…where we want to be."

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PASSPORT Home Visits

	^{Pictured L to R: COA PASSORT Care Manager, Monica; PASSPORT client Virgie; State Representative Dale Mallory (D-West End)}
State Representative Dale Mallory visited PASSPORT client Virgie in her Fairmont home on August 18. During the visit, Mallory said "I believe strongly in the PASSPORT program as a welcomed alternative to nursing home placement. I will continue to work hard in Columbus for you." Virgie told Mallory, "I am 89 years old and have worked hard all of my life. I still do community work at the school. Thank God for PASSPORT and Monica that I can stay in my home. It's old too."

	^{Pictured L to R: COA PASSPORT Care Manager Jennifer; PASSPORT client Mildred; Representative Dale Mallory (D-West End)}
State Representative Dale Mallory visited Mildred in her College Hill home on Aug.18. Mildred told Mallory during the visit, "I love my independence and want to remain in my home. Without PASSPORT, I would be unable to do this. Jen is a wonder and helps me with everything." Mildred added, "I would be in a nursing home without the PASSPORT program and Jen. I am so sorry there is a waiting list now, for my friends who need help." Mallory told Mildred, "My priority is to help seniors and the PASSPORT program. I will continue to fight for sufficient funding."

	^{Pictured L to R; State Representative Dale Mallory (D-West End); PASSPORT client Drusilla; COA PASSPORT Care Manager Monica}
State Representative Dale Mallory visited Drusilla in her West End home on Aug. 18. Drusilla spoke her mind with Mallory about how the state's budget problems are affecting the PASSPORT program. "PASSPORT is a blessing and you need to take good care of it. We (seniors) need to have choices," she told Mallory. "When you have worked hard all of your life, you want respect and do not wanted to be forced into a nursing home simply because our leaders can't get it together." Mallory called the PASSPORT program a win-win. "It helps seniors by giving them the right to choose their long term care and saves the state money." Drusilla said, "I am safe at home. I have my family, Monica and PASSPORT. Monica is a wonder and I am blessed" She told Mallory she wanted the program to continue to grow so others could get help in their homes. Mallory agreed and said, "I will continue to work hard for this program." But it was Drusilla who got the last word. "You'd better or you will hear from me," she said.

	^{Pictured L to R: PASSPORT Care Manager, Karen; PASSPORT client, Sadie; State Representative Tim Derickson (R-Oxford)}
State Representative Tim Derickson (R-Oxford) visited with Sadie in her Trenton home on Aug. 24. Sadie told Rep. Derickson that she was very grateful for the PASSPORT program and that Karen did an excellent job "keeping me safe at home. We work together," she said. Rep. Derickson said that he was very concerned about the cuts made to the PASSPORT program and he would do everything in his power to support Council on Aging's mission to serve seniors in their homes. "Even without the major cost benefit to the state, seniors need to have the PASSPORT program without waiting lists to provide them with the option of remaining in their own homes," he said. "It's what we do for families."

	^{Pictured L to R: Senator Eric Kearney (D-Hamilton County); PASSPORT client, Mary; COA PASSPORT Care Manager, Barb}
Senator Eric Kearney visited PASSPORT client, Mary in her Avondale home on Aug. 28. Mary told the senator how honored she was that he would take the time to visit with "an old lady." She said she "thanks God every day for the PASSPORT program. Without it, I would definitely be in a nursing home." Mary asked Senator Kearney to support PASSPORT. "Do whatever you can for this wonderful program. I am happy here and want to have the choice of where I live." "Senior issues are a priority," Kearney told Mary. "I will continue to fight for the PASSPORT program to give seniors access to long term care choices."

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Legislative Meetings

	^{Pictured L to R: Representative Courtney Combs (R-Hamilton); COA Communications Director, Laurie Petrie; and COA Director of Program Operations, Ken Wilson}

	^{Pictured L to R: COA Director of Program Operations, Ken Wilson; Legislative Assistant, Patrick Maloney,(Columbus); Representative Timothy Derickson (R- Oxford); COA Board Member, Donald Barnhart; COA Board Member, Ronald Surface and COA Long-term Care Manager, Frank Savino}

	^{Pictured L to R: COA Advocacy Coordinator, Polly Doran; Representative Jean Schmidt (R-OH); and COA Director of Program operations, Ken Wilson}

	^{Pictured L to R: COA Board Member, William Thornton; Representative Peter Beck (R-Mason); COA CEO Suzanne Burke; Former COA Board Member, Robert Dell; and COA Director of Program Operations Ken Wilson}

	^{Pictured L to R: COA Director of Program Operations, Ken Wilson; Representative Lou Blessing, (R-Colerain); and COA CEO Suzanne Burke}

	^{Pictured L to R: COA Director of Program Operations, Ken Wilson; COA CEO Suzanne Burke; Representative Denise Driehaus (D-Westwood); and COA Board Member, Dot Christenson}

	^{Pictured L to R: COA Director of Program operations, Ken Wilson; Representative William Coley (R-Liberty Township); andCOA Long-term Care Manager, Frank Savino}

	^{Pictured L to R: COA Director of Program Operations, Ken Wilson; Advocacy Coordinator, Polly Doran; Representative Steve Driehaus (D- Ohio); and COA CEO Suzanne Burke}

	^{Pictured L to R: COA Director of Program Operations, Ken Wilson; Senator Shannon Jones (R-Springboro); COA Board Member, William Thornton; and COA CEO Suzanne Burke}

	^{Pictured L to R: Director of Program Operations, Ken Wilson; and Representative Connie Pillich (D-Montgomery)}

	^{Pictured L to R: COA Director of Program Operations, Ken Wilson; Former COA Board Member, Eli Yovich; and Senator John Carey (R-Wellston)}

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Legislator of the Year

This year the Ohio Association of Area Agencies on Aging (O4A) voted to present the Consumer Advocate for Seniors/Legislator of the Year award to State Representative Dale Mallory of the 32^nd House District in southwestern Ohio. This award was given to Representative Mallory for his work on bringing Ohio's bed bug problem to light and advocating for the prevention and treatment of bed bug infestations in housing for seniors and others.

	^{Pictured L to R: Ohio Department of Aging Legislative Liaison, Grace Moran; Representative Dale Mallory (D-West End); and Ohio Department of Aging Director Barbara Riley}
	^{Pictured L to R: COA's Long-term Care Manager, Frank Savino; COA Communications Director, Laurie Petrie; Representative Dale Mallory (D-West End); COA Advocacy Coordinator, Polly Doran; and COA Director of Program Operations, Ken Wilso}