New help available for at-home nursing care
Help will continue to be available for eligible seniors who need nursing facility care but choose to live in their own homes or other community living arrangements.
But changes to the Pennsylvania Department of Aging Medicaid Waiver program, a means for many older adults to access services, are on their way to Berks County in January.
Delaware, Bucks, Montgomery and Chester counties were part of an earlier Phase II rollout of the program that took effect in January 2019.
Under today’s Aging Waiver, Pennsylvanians who are age 60 or over and U.S. citizens or qualified noncitizens, have a Social Security number, meet the level of care served by a skilled nursing facility and financial requirements determined by the local county assistance office, are eligible for a range of services for care at home.
Services including home health care, even that given by a qualified family member; adaptive equipment and home modifications; meal delivery; transportation; various therapies; and personal emergency response systems.
Despite the positive outcomes for seniors who are receiving help under the program, Stephanie Quigley, acting director at Abilities in Motion in Reading, notes that there have been concerns.
“There is a large amount of 50-plus people applying,” she said. “There was a huge backlog. And it’s never quick enough to get people enrolled with the services they need.”
According to Quigley, the current Aging Waiver Program application process begins with a senior’s application to the PA Independent Enrollment Broker.
“They are the key to open services,” she said.
Send assessor
Next, county agencies will send an assessor out to the applying senior’s home and use an objective assessment tool to confirm whether the senior meets the criteria of needing a skilled nursing level of care.
And the county assistance offices make the final determination on financial eligibility for a senior to receive benefits, with qualified applicants then receiving options of service coordination entities, such as Abilities in Motion, from which to choose.
With about 2000 people getting help with waiver benefits through the service coordinators at Abilities in Motion alone, about half of the recipients are using the aging waiver, according to Quigley.
Developing a plan of care for people enrolled in waiver programs is the task for the 45 service coordinators at Abilities in Motion.
Whether a senior needs help in bathing, dressing, meal delivery, could use a personal emergency response system or home modifications installed, the service coordinator will plan the needed services and provide a senior with a list of service providers from which to choose.
Amramp, an accessibility solution provider in headquartered in Marple Township, Delaware County, has been making residences easier for seniors to navigate through aging waiver benefits for about 15 years.
Franchise owner Nick Marcellano serves customers through south and central Pennsylvania with solutions for seniors to remain safely at home.
Benefits are far reaching
Marcellano confirms his company must comply with specific regulations in accordance with the waiver program as a service provider but is able to supply its recipients with benefits as far-reaching as bathroom conversions from tubs, walk-in showers and ramps to vertical lifts to access a dwelling.
An Amramp evaluation of a residence for a senior in the waiver program is sent on to the service coordination entity for approval by the state, he said.
If modifications are approved, the waiver recipient could receive a stair lift, allowing a senior to enter the second floor of a home that was previously inaccessible, grab bars for bathroom safety or an Americans with Disabilities Act-compliant toilet with side rails.
“It assists a lot of Pennsylvanians that may not have the resources on their own,” said Marcellano of the current aging waiver. “A lot of states don’t have this type of thing. It’s a great
benefit.”
Aida Lone, administrator of Precision Health Care, with locations in Ontelaunee Township and Orwigsburg, Schuylkill County, provides seniors in the Aging Waiver Program with full-scale, home-health care, including skilled nursing, physical therapy and nonmedical care.
Changes to the waiver program, funded under the state Department of Human Services, were rolled out in phases, confirms Lone, with the last phase encompassing Berks County.
“We don’t have specifics on who’s doing what,” she said. “There are still a lot of gray areas.”
Some not participating
Some major health providers have decided to wind down their participation in the program.
One of those is the former Berks Visiting Nurse Association, now Tower Health at Home, Wyomissing.
According to a spokeswoman for Tower Health, prior to being acquired by the Tower Health health care organization in January 2019, Berks VNA evaluated their full complement of services. Upon evaluation, it was determined that continuing to provide services to “waiver” patients was not sustainable.
Berks VNA took proactive steps to ensure the continued care of this patient population and worked with each individual to transfer their care to a new provider without interruption of services, she said in a statement.
Through this attrition process, Berks VNA, now Tower Health at Home, has reduced its number of waiver patients from 33 to 6. The spokeswoman wrote in a statement that continuing to offer the waiver service would jeopardize other clinical services provided by Tower Health at Home.
Accommodate growing number
Lone agrees the program is being overhauled to accommodate the growing number of seniors seeking services.
“I think it’s a wonderful program from a provider’s point of view,” Lone said. “Consumers who want to stay at home are able to make that decision. Their services are customized.”
According to www. healthchoices.pa.gov, current waiver benefit recipients will be choosing a managed care organization through the new program, Community Health Choices, with the state’s goal of improving services for hundreds of thousands of Pennsylvanians.
Quigley simplifies the changes by explaining that instead of choosing a service coordinator entity, a waiver recipient will be choosing one of three managed care organizations available under Community Health Choices: AmeriHealth Caritas, PA Health & Wellness or UPMC Community Health Choices.
“A lot of consumers are intimidated by large health plans,” she said. “We’re moving from where they chose their service coordinator to where they’re choosing their health plan.”
But despite the bumpy ride Quigley believes may be coming for aging waiver recipients, she says the job for service coordinators at Abilities in Motion is to assure consumers that business will continue as usual with their service benefits and they have help in place to guide them through the changes.
“Part of our responsibility is to advocate for people who don’t have access to the internet,” Quigley said. “There is a multitude of concerns with different types of communications.”
Consumers could have vision or hearing loss, or even reading problems affecting their ability to understand information sent about the Aging Waiver Program.
“This will be the third rollout, and it’s the largest one,” Quigley said. “The commonwealth has taken lessons learned. The communication was a big one. There’s a positive result to having it phased in.”