We’re in the midst of a funding crisis: Anyone who’s picked up a newspaper in the last few months — since Gov. Tom Corbett outlined his starvation-level budget proposal — knows that. A more complex, lesser-known story: how new policies from the state Department of Public Welfare (DPW) threaten Philly’s most vulnerable populations, like the elderly poor and those with intellectual disabilities.
First, there’s a new DPW policy, to take effect July 1, eliminating nurse supervision for elderly people who live at home through the state Aging Waiver program. Holly Lange of the Philadelphia Corporation for the Aging says without that supervision, mistakes and gaps in care are inevitable. Take Daisy Mitchell, 92. She’s suffered three strokes and numerous injuries. For months, while she waited to have a stair lift installed, she was essentially trapped in her bedroom, says Bobbi Jones, Mitchell’s daughter and caretaker. Doctor visits required an ambulance, making in-home nursing care critical. “I really depend on the nurses,” says Jones. “They know the history, they’re able to observe things.”
In this case, the same number of elderly will be served at a lower standard of care. For intellectual disabilities service providers — already facing a 15,000-person waiting list statewide — new DPW-set fees for services, also to begin July 1, could mean even fewer people served.
The problem is, fixed rates don’t acknowledge varying needs. “There seem to be wide swings in whether or not the providers’ actual costs … are covered,” says Gabrielle Sedor of Pennsylvania Advocacy and Resources for Autism and Intellectual Disabilities. Kathy Brown McHale of Special People in Northeast (SPIN) says SPIN is struggling to make sense of rates, like day-service rates cut by up to 40 percent. “There’s winners and losers, and there’s no look at quality,” she says. “You could be a lousy program, and you might have just gotten a windfall, while some of the best programs could have gotten devastated. And those things are happening.”
There’s a common thread among these cuts, providers say: They’re penny wise but pound foolish. Putting seniors into nursing homes is three times more expensive than home care, notes Lange. And driving people with intellectual disabilities out of community-based care and into institutions is twice as expensive, says Maureen Cronin of The Arc of Pennsylvania, an advocacy group. She says, “The number of people admitted this year has grown dramatically from previous years, so it’s already a sign that providers are less able to provide services with the funding policies of the department.”