Other counties have dropped services such as home maintenance, she said. As for the use of lottery money for nursing home care, Lowe said, "there is nothing statutorily that says they can't do it. Nursing homes do support older people. But do I prefer that? No."

Kathy Cubit, director of advocacy initiatives for the Philadelphia-based Center for Advocacy for the Rights and Interests of the Elderly, said Medicaid nursing home funding "addresses the needs of the elderly, but it is not what we see as the intent of the lottery. Medicaid is an entitlement. It is a slippery slope if we continue to fund entitlements; all these programs that keep people in their homes are going to suffer."

Roy Afflerbach, a lobbyist for the Pennsylvania Association of Senior Centers and the Pennsylvania Adult Day Services Association, supports spending more lottery money on in-home care to eliminate the waiting list. "But I don't have a problem with helping out seniors in need of nursing home care. I can't take that hard of a line."

State officials said using lottery money for Medicaid helps older people receive the full continuum of care.

"There is a need to support care for persons receiving home- and community-based services and also for our citizens who reside in nursing homes," said Christina Reese, press secretary for the Department of Aging. "Both sectors will face challenges in this difficult budget year."

AARP Pennsylvania and other members of the Pennsylvania Senior Support Coalition want the state to use about $16 million of the lottery's $75 million in reserves to eliminate in-home care waiting lists. But the Governor's Budget Office said the reserves are necessary to continue funding the programs it covers in case lottery revenues fall short.

Cristina Rouvalis is a freelance writer based in Pittsburgh.

Also of interest:  Lopsided long-term care spending.