Senior Programs Expect More State Cuts

Florida legislators are expected to trim services for the elderly, even as demand skyrockets in a weakened economy.
BY ANA VECIANA-SUAREZ
aveciana@MiamiHerald.com

For Jose Rodriguez, the twice-a-day visits from a home health aide are a godsend. The retired accountant has been caring for his wife, Ana, since 1999, when her erratic behavior and memory loss were diagnosed as Alzheimer's Disease. It is the only respite he gets from his round-the-clock job.

''I cannot handle my wife by myself,'' says Rodriguez, 70, of Miami. "She doesn't walk. She doesn't talk. And she needs two people to move her. Doing it alone is mission impossible.''

Rodriguez, however, may lose that help soon. Legislators already trimmed 4 percent of the $13.3 million budget for the Alzheimer's Disease Initiative, which provides in-home help for caregivers like Rodriguez. Legislators trimmed funding for other programs during January's special session cuts, but Gov. Charlie Crist vetoed cuts to the popular Community Care for the Elderly and limited others to a 2 percent trim.

More cuts are expected when the Legislature convenes March 3, though the proposed dollar amounts and percentages won't be known until mid-March, when lawmakers find out the state's projected revenue. Some estimate that as much as 15 percent will be slashed from some programs, while others may be closed for months.

''This is a tough year. We have less money, so everybody should expect that they'll have less,'' says Rep. Marcelo Llorente, the Republican House budget chief who oversees health spending.

Advocates, however, warn that thousands of Florida's elderly will be left without services, from adult day care to free meals. ''What we have been saying is that you cannot continue cutting these programs without deeply affecting the population,'' says Leslie Spencer, lobbyist for AARP in Tallahassee. "These are real people with real needs. For many it's a life or death situation.''

Florida's 4.3 million seniors are not alone. Elderly in nearly 70 percent of the other states are anticipating cuts in programs even as the demand for services skyrockets in a weakened economy.

''We have a decidedly unambitious and unaggressive wish list this year,'' says Jon Peck, spokesman for the Florida Department of Elder Affairs. "Our hope is to maintain service levels at what they are. We recognize the reality of the economic downturn.''

Now advocates have focused their efforts on saving a few of the more cost-effective programs, reforming the way the state delivers long-term care, and providing palatable funding alternatives:

• Home and community-based care. Advocates want to prevent cuts to Community Care for the Elderly, Alzheimer's Disease Initiative and others that provide in-home help with meals, bathing, medical transportation and chores. When these services help seniors remain in their homes instead of moving into an institution, the savings can be considerable. These services often provide the safety net for those whose physical and cognitive health could worsen without the extra help.

The Florida Council on Aging estimates that the average annual cost of care provided by the program runs $4,680 per person, funded entirely by the state's general revenue pot. Institutional care: $65,251 annually, most of it from federal monies.

''It doesn't make economic sense,'' says Max Rothman, executive director of the Alliance for Aging for Miami-Dade and Monroe counties. "They're cutting services that enable people to remain at home where they want to be and that cost taxpayers less money.''

In addition to continued funding for these services, advocates want state agencies to be given the authority to shift funds between nursing home and community-based care budgets in order to maximize services and cost.

''There's very strong support for that,'' says Republican Juan C. Zapata, chair of the house's human services appropriations committee, "but it's an implementation issue. You want to do it slowly and you want to do it right. First, we have to see how it works and not do it all at once when you can possibly lose the quality we expect.''

• Medicaid reform. Many seniors in a two-year-old Medicaid pilot program that provides medical services to the poor and elderly in five counties, including Broward, have complained it takes too long to see a doctor under the new program. Advocates don't want to expand the program until there is independent data to assess how well it delivers health care.

Under the regular Medicaid program, Florida's 2.26 million recipients usually see their own physicians, who are then reimbursed by the government. Under the pilot program the government pays private companies a set amount for treating a specific number of residents. Though the idea was to improve services and cut costs, affected patients, particularly those in populous Broward, say too many doctors have dropped out of the program and they're struggling to get prescription drugs.

• Alternative funding. To pump more revenue into state coffers, advocates have proposed increasing the cost of cigarettes by $1 per pack, generating an estimated $1 billion this fiscal year alone. They're also asking legislators to look at taxing Internet sales ($3 billion more) and expanding the sales tax system ($1 billion more).

''We're taking a two-prong approach,'' explains Spencer of AARP, which has joined forces with other organizations, including Florida Tax Watch and Children's Home Society, to offer revenue-producing proposals. "We're not just asking them not to cut. We're also bringing alternatives.''

In Broward, Edith Lederberg, executive director of the Aging and Disability Resource Center, is also hoping to convince legislators to approve a local-options real estate tax, levied at the county level and earmarked for senior services. Local option taxes have come in the form of a sales tax or a real estate tax in the past. If the legislature OKs the concept, the county commission must vote to put it on the ballot. Voters then have final approval. Seven counties have already passed this special tax for seniors, Lederberg says.