Wolf wants 5,500 more seniors to get home care, avoid nursing homes

Gov. Wolf said Friday that he wants to help 5,500 more Pennsylvania seniors get caregiving services in their own homes rather than in nursing homes, and promised to make the approval process for home health care much faster.

Wolf said his plan, a mixture of budget, legislative, and executive actions, would offer more choices and "protect our seniors to make sure they go through their senior years with dignity."

The proposals are to be included in the budget he will release Tuesday.

Fifteen percent of Pennsylvania residents are 65 or older, the fourth-highest proportion in the nation. That could rise to 20 percent or higher in the next 15 to 30 years.

Wolf said the approach would save money. For every month a person on Medicaid receives care in his or her home or community instead of in a nursing home, the state saves $2,457, Wolf said. He said his changes would translate into savings of $162.2 million in nursing home costs.

According to a Pennsylvania Department of Health website, the daily Medicaid reimbursement at the Philadelphia Nursing Home is $230 a day, or $83,950 a year. For home care, the daily Medicaid reimbursement in Philadelphia is $76, or $27,740 a year, according to Holly Lange, head of the Philadelphia Corp. for Aging. Her agency oversees home care for 20,000 frail elderly people in Philadelphia.

To bring about the savings and improvements, Wolf proposed spending an additional $39.2 million on the Departments of Human Services and Aging, partly for workers to speed up the approval process.

If the result was 5,500 more Pennsylvanians in home care and 5,500 fewer in nursing home beds - by no means a guarantee - the net savings, he said, could be $130 million annually.

His announcement came at the AARP Pennsylvania offices at One Liberty Place in Center City.

"My actions today are just the first step in rebalancing our long-term care system and increasing opportunities for home-care workers," he said.

Experts on aging and home-care providers in the city saluted Wolf's proposals.

"We appreciate your efforts, and we applaud you and salute you," Lange told the governor.

When seniors in Pennsylvania need caregiving help to stay in their homes - and are poor enough and sick enough to qualify for Medicaid - the government will pay. But it can take up to 10 weeks to get approval, known as a waiver, and often the elderly can't wait that long.

It is easier to get admission into a nursing home, said Lange, so that is where people often go. Or perhaps they want to go home from a nursing home or hospital, but need a waiver to get that support at home.

"Right now, it takes too long to get a waiver," Wolf said, "and sometimes people have to stay longer than they should in institutions when they really want to go home and they should be home. It's a paper-based system. We're going to take new technology, and we're going to move to where we can respond more quickly."

"It is an arduous process," said Karen Kulp, chief executive of Home Care Associates, a worker-owned company of home health aides. "What he is proposing . . . would be fantastic."

There were an estimated 194,000 home health-care workers in Pennsylvania in 2013, according to the Paraprofessional Healthcare Institute. Wolf did not estimate how many new home health-care jobs would be created as a result of his proposal.

Stuart H. Shapiro, CEO of the Pennsylvania Health Care Association, which represents many nursing homes, said in a statement that he supported the governor's efforts and that nobody should be in a nursing home who does not need to be.

The city, state, and nation for years have been moving toward a "rebalancing" - allowing the frail elderly to receive care in their homes rather than in nursing homes.

But payment systems historically favored the most expensive and least desirable option for many - nursing homes. For many years, Medicaid - the federal medical insurance program for the poor - would pay for nursing homes, but rarely for workers to come into one's home and help with caregiving.

This has been changing. In Philadelphia, for instance, 20,000 seniors get care at home, compared with about 7,500 nursing home patients, said Lange.

In Pennsylvania, it is nearly even now - 53,122 (48.7 percent) in home- and community-based services, 55,934 (51.3 percent) in nursing homes.

Wolf said that with the additional 5,500 waivers for home care, more than 50 percent of residents receiving long-term care would do so at home or in their community, as adult day care, rather than in an institution.

"That's a big, big deal," the governor said. "They're going to be able to stay in their homes in ways they may not have been able to do before."

Wolf also said he would work to improve access by seniors to home improvement and modification programs, another way to help them stay in their homes as they age.