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Pay no attention to the people behind the curtain

Saturday, September 29, 2007

A Few Thoughts On Family Care

by capper

With all the hubbub about the state budget, the focus has been mainly on the Healthy Wisconsin initiative and taxes. One part of the budget that hasn't received much attention is Family Care. Family Care is basically an initiative that will alter how the elderly and people with disabilities will receive funding for their services. It is an invention of Tommy Thompson, with a pilot program initiated in 2001 in five counties. Last year, Governor Jim Doyle signed it into law that every county has to go to a Family Care system.

Currently, the Democrats want to fully fund the initiative to expand Family Care state wide, while the Republicans want to scale back the funding, and slowing down the expansion of the initiative. Meanwhile, while the state keeps bickering about the budget, counties are trying to plan ahead for the expansion of Family Care without knowing how much funding, if any, they are going to receive.

There was already programs in place to allow seniors and disabled adults to receive services that would allow them to remain in the community. They are broadly grouped into a class called Medical Assistance Waiver Programs, and included the Community Option Program (COP, the Community Integration Program (CIP), the Brain Injury Waiver, and Birth To Three. They are basically convoluted ways of diverting money that would have gone to a nursing home or other institution, and using it to keep people in their own homes or community-based group homes. The programs are the result of federal lawsuits saying that seniors and disabled adults were having their civil rights violated by being forced into institutions.

The objective of these programs were two-fold. One objective was to allow more people to have more independence and freedom, thereby resolving the lawsuit. The second object was to save taxpayer dollars. These programs were based on a total sum model, in which each county was given a lump sum of money, and they used the money to help people remain in the community, or be reintroduced into the community from nursing homes, state institutions, etc. The savings could range as high as $400 per day per person, and averaged around $200 per day per person receiving these services, and at the same time, increase the quality of life of that person. The downside was that there were many more people who needed these services than could be helped with the amount of money allocated. This created waiting lists. In Milwaukee County alone, the current waiting list for disabled adults is between 2,000 and 3,000 people, and some of these people have been waiting for more than ten years to get into programming.

Family Care is supposed to eliminate these waiting lists, and save the taxpayer even more money. The premise is to base the system on an HMO type model. Each county would received a flat rate per person in that county identified as needing services. The rate would be base on the average cost of the services these people need, which can range from an area of $50 to over $300 per day. Sounds good so far, right?

But problems have already risen up in the counties already using the Family Care model, and more problems are being found as other counties are exploring it. One is that the reimbursement rates to the agencies providing services, especially in smaller counties is much lower than the waiver program. This has forced many of the smaller agencies to close as they could not afford to provide the services anymore. The larger companies also reduced services offered. This created a new waiting list, just at a different point in the system.

Another problem is that many counties are finding it too expensive to administrate the program, especially at the onset. Milwaukee County's Department of Aging had deficits of millions of dollars during the first few years. Dane County was ready to bow out of the system, stating that they would have enact a major tax hike to make up for the lost funding, before the state reached a special deal, spreading the start up costs over several years. Several counties are combining into regional units to help share the costs.

And the savings from Family Care are not clear. I have seen some reports that indicate the savings can be quite large, but Milwaukee County's savings have been negligible so far.

I think that Family Care could be a good idea, if administered properly. In an effort to make it more effective, many counties are contracting and/or subcontracting these services to private companies, which are more interested in their profit margins, than in ensuring the client's needs are being met. Unfortunately, it increasingly appears, like with HMO's, the needs of the client is being disregarded in interest of the bottom line.

For further information about Milwaukee County's progress towards moving to Family Care, one can go to http://www.planningcouncil.org/longtermcare/ . There are also going to be forums held at the following places and times:

Tuesday, October 2nd from 12:30-2:30 pm
Goodwill Industries
6055 N. 91st St.
(Park in the far west side of the employee lot)

Monday, October 22nd from 12:30-2:30 pm
Milwaukee Center for Indpendence
2020 W. Wells St.

Tuesday, October 30th from 5-7 pm
Washington Park Senior Center
1859 N. 40th St.

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