Use of Lottery Money for Costly Care in Nursing Homes Stirs Debate
Funds 'raided' from home-care programs
At a time when 3,600 Pennsylvania seniors are on waiting lists for in-home care, state lottery money that could end the wait is being diverted to less popular and more costly nursing home care — a shift that upsets some advocates.
Pennsylvania has the only lottery in the country whose proceeds exclusively benefit older people, funding adult day care, in-home personal care, meal delivery, tax rebates, transportation and other programs that help people stay in their homes. But during the past six years, the state has channeled millions of dollars in lottery funds to plug holes in the Medicaid nursing home program.
In his budget proposal for 2012-13, Gov. Tom Corbett (R) proposed increasing the amount of lottery money going to Medicaid from $178 million to $250 million. The total amount of lottery money spent on older people last year was just over $1 billion.
Money intended for home care
"The thing that is frustrating is that we have this great program paid by lottery dollars to keep people in their homes," said Ray Landis, advocacy manager of AARP Pennsylvania. "It helps people at early stages get assistance so they can delay going to a nursing home. We know nursing homes are the most expensive form of long-term care. We know people don't want to go to nursing homes."
Is the state "raiding" money from the lottery pool to pay for nursing homes? The answer depends on whom you ask. Some senior advocates say yes; state officials say no.
While using lottery money to fund Medicaid is legal, Landis said it violates the lottery's founding spirit. From 1971 — when the Pennsylvania Lottery began — until 2006, no lottery funds went to nursing homes. The lottery's proceeds originally provided property tax relief for older residents and then were used for other programs to help them continue living in their homes.
One of the most popular programs today is PennCARE, which funds personal care aides, adult day care, meal delivery and other home-based care, distributed through county Area Agencies on Aging. During the 2010-11 fiscal year, the $248 million PennCARE program helped nearly 458,000 people. The availability of services varies county by county.
"There are people who are going to die or go into a nursing home unnecessarily before they get off the [PennCARE] waiting list," said Crystal Lowe, executive director of the Pennsylvania Association of Area Agencies on Aging. "There are well over 1,000 people on it in Philadelphia County."
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.