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Shift More Lottery Money to Home Care

Some, like Martha Pangburn, have been on a waiting list for a state-funded home aide for six months

Martha Pangburn’s health took a turn for the worse in 2007 when she tripped on acorns outside her Lewisburg apartment and broke her ankle. Now she has to rely on a wheelchair. To make matters worse, the 79-year-old widow has trouble lifting her arms because she dislocated her shoulder while washing her back last year.

Still, Pangburn is fiercely determined to stay at home.

Wait-listed for a state-funded home aide since November, she’s resorted to paying $22 an hour out of her own pocket for an aide to bathe her and change the sheets.

“Who wants to go to a nursing home?” she said. “I am an independent person. I want to stay that way.”

AARP Pennsylvania thinks she should have that choice. As part of the Pennsylvania Senior Support Coalition, it is pressing the legislature to tap into lottery reserves to give more money to home- and community-based services that would help people like Pangburn. AARP is urging members to lobby lawmakers for additional home funding in the budget that will be drawn in May and June.

The desire to stay at home is overwhelming among Pennsylvanians—84 percent prefer home- and community-based services over nursing homes, according to an AARP survey of Pennsylvanians. But Medicaid long-term care spending on seniors is lopsided in the other direction—89 percent for nursing homes versus 11 percent for home-based alternatives.

“Home is somewhere we always want to be, whether we are happy or sick,” said Vicki Hoak, executive director of the Pennsylvania Homecare Association. “It boggles my mind that you are entitled to nursing home care when you spend all your savings and have nothing left. But you are not entitled to home care. You might get it but just for a limited number of hours.”

The availability of home and community services varies from county to county, and some programs are stretched to the breaking point.

“Nineteen of the 67 counties in the state don’t have adult day care services,” said Ray Landis, advocacy manager for AARP Pennsylvania. Local Area Agencies on Aging report a waiting list of more than 4,000 for home- and community-based services. Some senior centers have cut hours or closed.

Shortchanging home-based care does not make economic sense because it costs less than half of the $52,000 annual cost the state pays for nursing home care, according to the Department of Public Welfare.

Gov. Ed Rendell, D, who has pledged to rebalance the funding by 2012, has proposed coordinating long-term services under the umbrella of a new Department of Aging and Long-Term Living, absorbing long-term programs from the Department of Public Welfare.

While advocates applaud the streamlining, they said the state must boost spending on home care in the budget that takes effect July 1.

“Yes, it is a tough budget year, but lottery revenues go up in difficult times,” Landis said. “It is frustrating that there is a big reserve” of about $200 million.

The Pennsylvania lottery is the only one in the country whose proceeds exclusively benefit older people. Yet only 14 percent of lottery money goes to home and community programs. The rest is spent on property tax relief, rent rebates, transportation, prescription drug help, meals-on-wheels and other programs.

As lawmakers debate budget priorities, Pangburn and others in her apartment building are doing what they can to stay independent. Pangburn, who tries to walk most days, has hot meals delivered. She is hoping to move up on the county waiting list to get free home care like some of her neighbors so she won’t have to strain her finances.

“I’ve always been a highly independent person and I’m hanging on for dear life.”

Cristina Rouvalis is a writer based in Pittsburgh.

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