Maryland's promise to help ailing seniors remains unfulfilled

April 24, 2003|By David LaMason

REGARDLESS OF advancing years or failing health, nobody wants to move into a nursing home.

Yet like many poor Maryland seniors and their family caregivers, Wanda Smith and her daughter, Kelly (the names were changed to protect their privacy), thought they had no choice.

At 81, Wanda faced a host of medical problems, including a stroke that had severely affected her right side, which, along with hip pains, makes it difficult for her to make the slightest steps.

After living with her mother for years in their Baltimore County home, the pressures of work responsibilities and caring for Wanda took their toll on Kelly, both emotionally and financially. Kelly even had to quit her job to care for her mother.

Wanda knew she wanted to remain with her daughter in the community, and she definitely knew she didn't want to move into a nursing home. But what could be done? A lot.

With the help of lawyers at the Legal Aid Bureau, Wanda was enrolled in the Medicaid Waiver for Older Adults Program, which is designed to allow seniors to remain in their homes. As a result, Wanda is able to stay with her daughter in their home and get the right attention for her multiple needs while Kelly is given a much-needed respite from her overwhelming care-giving duties.

Provided under Maryland's Medicaid program, the waiver can prevent families from exhausting limited resources to care for loved ones. Older adults who otherwise would have to move into nursing homes can stay in the homes into which they've poured their energies and dreams.

That's not all. The Medicaid waiver program, enacted by the General Assembly in 1999, saves Maryland taxpayers hundreds of thousands of dollars per patient that would otherwise be spent on institutionalization.

People enrolled in the waiver program are eligible for services such as personal care, respite care, assisted living services, personal emergency response systems, extended home health care, home-delivered meals and more.

Political leaders recognize its importance. In his State of the State address, Gov. Robert L. Ehrlich Jr. pledged support for 1,000 additional openings for seniors to access the program.

Yet there's a problem: While there are about 2,000 seniors enrolled in the program, as of Jan. 31, another 2,935 are waiting to receive a decision on their applications. The human cost of the bureaucratic logjam is enormous as seniors wait a year or longer to be admitted to the waiver program.

As a human services associate at Meals on Wheels, I've seen clients move into nursing homes or die waiting for their applications to be approved. Yet the law says that applicants should receive a decision within 30 days.

As an intern at the Legal Aid Bureau in its nursing home/assisted living project, I've worked with lawyers who jump through unnecessary hoops to get clients such as Wanda enrolled in the waiver program, even as they negotiate with the state for systemic changes.

It doesn't have to be this way. Other states, including Colorado, Washington and Wisconsin, have well-designed Medicaid waiver programs.

So what can Maryland do? A consultant hired by the Department of Health and Mental Hygiene in February offered several recommendations to end the logjam and streamline the application process. One suggestion is to reduce the number of agencies taking applications by designating one agency or a single entry point to process waiver applications.

Today, the happy ending to Wanda's story is only a dream for thousands of other seniors and their families.

Unless Maryland commits funding to expand the program, streamline the application process and reduce the backlog, the promise of assistance offered by the Medicaid waiver program rings hollow for many frail, elderly people and their caregivers.

Maryland's Medicaid Waiver for Older Adults Program must be allowed to fulfill its goal of allowing seniors to live at home -- and not become another empty promise.

David LaMason is a graduate student at the University of Maryland, Baltimore School of Social Work.

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