Saturday, February 12, 2011

Pennsylvania needs to update Caregiver Support Law

An important bill to improve Pennsylvania’s Family Caregiver Support program was recently introduced in the Legislature as House Bill 210. This bill deserves to be enacted into law.

For years Pennsylvania has sought to rebalance our long term care delivery system away from its institutional bias in favor of care delivered in home and community settings. Care delivered at home is generally less expensive to the Government and more desirable to the recipient. It is less expensive and more desirable largely because much of the care needs of a recipient residing at home can be provided by unpaid family caregivers rather than paid professionals. 

With the nomination of Gary Alexander to be Secretary of the Department of Public Welfare, Governor Corbett’s administration has signaled its intent to emphasize this rebalancing through a implementation of a paradigm shift along the lines of the Rhode Island Global Waiver. A fundamental goal of the Rhode Island Waiver is to reduce state government expenditures by moving the setting for long term care out of institutions and into the home. This is a goal Pennsylvania has also been trying to achieve with only limited success.

Keeping people at home, with the caregiving support of unpaid family and friends, is fiscally responsible for taxpayers. According to the Pennsylvania Department of Aging, on average, services provided in a nursing facility cost 2.5 times as much as those provided in home and community settings. 

But, if we want to successfully increase the utilization of unpaid caregivers, we must be sure that we provide those caregivers with the support they need to fill that role. Effective support of caregivers is the foundation upon which the rebalancing of long term care delivery can be built.  

Pennsylvania’s Family Caregiver Support Program has long offered limited support for caregivers who have accepted responsibility for providing at home care for functionally dependent older adults and victims of chronic dementia like Alzheimer’s disease. However, the law desperately needs to be updated. Reimbursement levels have not changed since the program was initiated in 1990. And current law excludes support of caregivers who do not reside with or are not family related to the person receiving care. These limitations have prevented the Department of Aging from targeting funding in a manner that allows the most care dependent seniors to remain in their home. The ultimate result may be otherwise avoidable institutionalization.  

Each year a bill is introduced in the Pennsylvania General Assembly to modernize the Caregiver Support Program by expanding the definition of “primary caregiver” to include non-relatives, remove the requirement that the caregiver reside with the care receiver, and to adjust the amounts available to a qualified primary caregiver from the levels established in 1990. In the last session, the bill to update the caregiver support law passed the House (unanimously) but languished in the Senate. This is a typical pattern that has been repeated for years.

This year’s iteration of the update to our antiquated family support law has now been introduced as House Bill 210. If HB 210 is enacted, maximum expense reimbursement will increase from $200 per month to $500 per month and from $2,000 to $6,000 for home modifications or assistive devices for the entire duration of the case.  

Under HB 210, caregiver support will only available to caregivers who do not receive financial compensation for the care provided. And support will only be provided to caregivers who qualify under low income guidelines. 

Enactment of HB 210 will not involve any new funding nor create any new entitlements.  Services are made available only to the extent of the availability and level of appropriations made by the General Assembly. To the extent the Department of Aging is authorized to more effectively target funding, the Commonwealth is actually likely to achieve financial savings as seniors remain in their homes rather than institutions.   

Previous year's editions of HB 210 have been supported by numerous organizations including: The Pennsylvania Association of Elder Law Attorneys, AARP of Pennsylvania, Pennsylvania Association of Area Agencies on Aging, Pennsylvania Bar Association, Pennsylvania Alzheimer’s Association, The Center for Advocacy for the Rights and Interests of the Elderly, Pennsylvania Adult Day Services Association, Pennsylvania Association of Senior Centers, Pennsylvania Council on Aging, Pennsylvania Homecare Association, Pennsylvania State Nurses Association, and the National Association of Social Workers (NASW), Pennsylvania Chapter. 

HB 210 will likely pass the House again in the next few months. This year it is time for the Senate to join in the fiscally responsible action of passing this important legislation and sending it on to Governor Corbett.

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