Budget cuts take toll on assistance programs
Long Term Care Ombudsman, General Relief Assistance struggle to meet mission
June 1, 2019
Years of declining oil prices and increased spending of state funds came to a head for a number of state-subsidized senior assistance programs this legislative season. After taking office in Dec. 2018, Gov. Dunleavy’s proposed operating budget for FY20 sought to match state revenue to state expenses and asked Alaskans to look at the hard truth of the financial situation the state is currently facing. While a fiscally responsible budget is desired, programs that benefit low-income seniors in need, such as the Office of the Long Term Care Ombudsman and the General Relief Assistance program, are facing a degradation in quality of care due to expected cuts.
Long Term Care Ombudsman
The Long Term Care Ombudsman Office (LTCO) operates independently under of the state Department of Revenue’s Alaska Mental Health Trust Authority. LTCO relies on in-person visits to assisted living facilities and nursing homes to assist residents in resolving issues including mistreatment or elder abuse. Servicing 269 assisted living facilities and 18 nursing facilities across 28 communities, Alaska’s six ombudsmen attempt to visit each community two to four times a year, depending on the size of the community. LTCO Director, Teresa Holt, emphasizes the importance of face to face contact when working as an ombudsman.
“We really need to meet residents in person,” said Holt. “For seniors living in assisted living homes and nursing facilities, if the staff are mean or rough it can be really scary for seniors to talk about the people providing their care or resolve issues without retaliation. We need to be able to meet with them in person in order to develop trusting relationships so they will tell us when things are not going well.”
For LTCO, Gov. Dunleavy suggested cutting $14,600 for travel expenses after former Gov. Walker removed $30,000 from the program in his FY20 budget, created before leaving office. After adjusting Gov. Dunleavy’s budget in the Senate and House Finance Committee meetings this legislative session, the House returned the $14,600 written out of Gov. Dunleavy’s proposed budget.
“With $30,000 still cut, we will only be able visit each site once a year,” said Holt. “And there’s a lot of facilities to visit. In Kenai and Soldotna, there are 11 facilities and 291 residents to visit. If you went for two days - even if you went for four days - you would not be able to visit all the residents or even all the facilities. The quality of care will go down. There’s no way around it.”
LTCO is the only organization that directly visits seniors in long term care to assist them in resolving issues that arise. Other than LTCO, Residential Licensing inspects assisted living homes once every other year, and Health Facilities and Licensing and Certification inspect nursing facilities each year to ensure that seniors and other vulnerable adults at increased risk for abuse and neglect are safe and that facilities are following state and federal regulations. Both of these programs also received cuts to do onsite visits with Gov. Dunleavy’s proposed budget.
“Reduction of onsite visits by all of these agencies could result in exploitation,” said Holt.
General Relief Assistance
GRA, an Adult Public Assistance program that provides funding for Alaskans seeking financial help with basic needs during emergency situations, is 100% state funded. More specifically, the General Relief Assisted Living Home Program (GRALH), a subset of Senior and Disabilities Services, offers funding to seniors needing emergency transition to an assisted living facility, another aspect of the GRA program that is 100% state funded. Both programs are under the jurisdiction of DHSS, and as per Gov. Dunleavy’s FY20 budgeting requirements, programs that rely solely on state funding are to be re-evaluated.
Funds provided by GRA GRALH are given directly to the vendor providing the services for the person in need. In the case of GRALH, nursing facilities, assisted living homes and hospitals are directly given funds. Eligibility is reserved for people in need of last resort funding and household resource limits including cash, savings or personal property cannot exceed $500. Additionally, household income limits must not exceed $300 monthly for a household of one, $400 for a two-person household or $500 for a three-person household.
Gov. Dunleavy’s proposed operating budget sought to cut nearly half of GRA’s funding, citing a need to cut funding for programs that obtain money directly from the state. To mitigate anticipated funding cuts, all those that are already receiving GRALH funding to pay for the cost of assisted living or nursing home facilities will be asked to reevaluate their need for funding renewal. For those that are looking to move out of assisted living, the new 811 Housing Program offers independent living with supports. If one’s needs are great enough, considering applying for a Medicaid Home and Community Based Waiver is another option to continue receiving funding for care.
Starting Mar. 1, 2019, those applying for funding through GRAHL were put on a waitlist that has grown to at least 200 applicants as of Senior Voice press time. It is unclear when or if any of those people will get into the program until funds are restored.
“The waitlist is having a ripple effect backwards,” said one industry social service worker. “GRAHL really helped hospitals as they can move people that are in between the hospital and living alone into an assisted living home. Now, without funding, these people could stay in the hospital for longer.”
“These are generally very vulnerable people that we’re trying to help and advance,” they continued. “These changes will make some of them more vulnerable as they’re living substandardly, waiting for care. The state probably needs to look at streamlining these programs so that the people in need of them are not left in a situation when funding is cut. If you pay for certain things up front, you reduce future costs in a different area -- that’s the thing that gets lost.”