Home care assistance offers relief for seniors
For 40 years, until his wife, Margie, was diagnosed with Alzheimer’s disease in 2016, retired San Francisco bus driver Johnny Cherry enjoyed the perks of being married to a skilled home cook.
“She was a good cook,” said Johnny, 78. “I miss it.”
Margie, 74, struggles with shortterm memory and doesn’t cook much anymore. Johnny adapted, teaching himself to make spaghetti and pork chops, but daily life was still a struggle.
Two months ago, things improved. Margie’s social worker tipped them off to a new city-funded voucher program, Support at Home, which provides $600 every two weeks to help pay for a home aide to prepare meals, do laundry and run errands for the
Cherrys four times a week. The Cherrys pay $198 every two weeks for the services, sharing the cost of care with the city.
“To get this help has taken a lot of pressure off me,” Johnny said.
The Cherrys are among the beneficiaries of a pilot program, believed to be the first of its kind in the country, that provides financial assistance to middle-income people — mostly seniors and some younger adults with disabilities — to help pay for home care. In San Francisco, one of the nation’s most expensive cities, the need is critical. The city has more than 14,000 seniors and many disabled younger adults whom Support at Home could help.
The program is designed for people who have long struggled to afford home care on their own but who earn too much to qualify for free or low-cost home care like InHome Supportive Services provided by Medi-Cal, the insurance program for the poor. To be eligible, San Francisco residents must earn no more than $80,700 a year, the city’s median income, and have less than $40,000 in assets, excluding a house or car. The program costs the city $1.5 million a year and provides assistance in amounts ranging from $300 to $1,300 a month, depending on a person’s income.
Six months since the program began, however, Support at Home has not generated as much interest as city officials and aging advocates had expected. Administrators have enrolled 60 people and are assessing the applications of about 60 more — short of the 175 to 250 people they hoped to attract. They are planning additional outreach efforts, including a Facebook campaign and presentations at California Pacific Medical Center, UCSF and Kaiser hospitals.
“We thought people would be clamoring for it, but we do have some strict guidelines ... that may be keeping some people out,” said Shireen McSpadden, executive director of the city’s Department of Aging and Adult Services, which funds Support at Home and oversees the program’s administrator, the San Francisco nonprofit Institute of Aging. “But we know from initial research there are lots of people who need help paying for this kind of care. Generally, people go without it. I think it’s just a matter of time before people learn about it.”
About 14,000 seniors with physical or cognitive impairments in San Francisco make too much to be eligible for Medi-Cal’s In-Home Supportive Services — which provides free or low-cost in-home care for people who earn roughly $15,000 a year or less — but cannot afford private care on their own, according to a 2016 analysis by the San Francisco budget and legislative analyst’s office.
“This group of 14,419 lowincome, at-risk seniors is not generally served by public programs and is of particular concern,” the analysis found.
Medicare, the federal insurance program for seniors, covers some home care but only if it is intermittent skilled nursing care, physical therapy or speech pathology. It does not pay for housekeeping, bathing, dressing or other daily tasks. Medi-Cal’s in-home program does cover these daily tasks.
Support at Home is something of an experiment. It is a two-year program that will end in April 2019, after which it will be evaluated by UCSF health policy experts for its effectiveness and cost savings, including whether subsidized home care helps prevent people from being admitted into nursing homes or other institutionalized care settings.
“We want to know ... does it keep them out of hospitals or skilled nursing, or does it have other positive impacts?” McSpadden said.
So far, most beneficiaries have been seniors. But city health officials are pushing to attract more younger adults with disabilities. Only 10 younger adults have signed up for the subsidies.
“We want to make sure word gets out there quickly,” said Jeanne Caruso, program director for Support at Home. “This is an unhelped sector of the population that isn’t aware something like this could even exist. This isn’t on their radar, and they’re struggling.”
For Johnny Cherry, having an aide take care of the small things, like bringing breakfast or folding laundry, eases the daily routine. Since his wife was diagnosed, his duties have included managing her medications and doctor visits, cooking and cleaning at their Bayview home, and helping care for their adult daughter, who has cerebral palsy. Now he hopes he can start attending his church in Hayward more regularly again.
The aide, he said, has “been a great help.”