Streams

NY Medicaid Cuts Hit Home

Friday, April 13, 2012

Yolanda Phipps recently retired after 36 years working as a hospital lab technologist in the Bronx. But she still has a full-time job: taking care of her 93-year-old mother, Irene Serrano, who has advanced dementia, can barely move and can’t feed herself or talk.

While Phipps tells the story of her mother — a proud factory worker who was the granddaughter of slaves and a fashion plate at First Sharon Baptist Church on Sundays — Serrano starts to choke a little and coughs.

Phipps pats her mother’s chest. The coughing subsides.

“Sometimes the saliva doesn’t go down her tube. She tries to cough it up, but she doesn’t have the strength,” Phipps said. “Sometimes the patting works, and sometimes we have a special tool to suction out the phlegm, and then she’ll be ok.”

Phipps’ mother has had 24-hour care for the past five or six years. Even with the help, Phipps — who lives upstairs — is always on call, since home attendants have very limited certification and can’t use suction or an asthma nebulizer or administer medications.

But after a recent visit from a social worker, Phipps received notice from the city,  which runs the state- and federally funded program, saying that her mother does not require round-the-clock care, and could get by with an overnight aide who’s allowed to sleep and do minimal monitoring from 8 p.m. to 8 a.m.

Phipps will protest that decision at a hearing Monday with a state judge. She’ll try to make the case that overnight sleep-in care isn’t enough.

“You never know what’s going to happen with her. At 2 o’clock in the morning, she may have an asthma attack,” Phipps said. “She will make eye contact with you, and that’s the only way you know what’s going on. You always have to watch her, at all times.”

New York's 'Generous' Medicaid Benefits Getting Cut

Almost 100,000 elderly and disabled New York City residents receive home care through Medicaid, but only a very small number receive care at the level Serrano does. Those ranks have declined by 25 percent in the last two years, from about 1,300 people to 1,000. City officials say the drop is due not to budgetary pressures but to state and federal orders to more stringently evaluate all cases.

The average Medicaid cost per long-term care patient is around $40,000 annually in New York, but for people like Serrano who get 24-hour care, the price is closer to $150,000 a year.

New York has developed a more generous Medicaid program than any other state. Close to 20 percent of national Medicaid spending on long-term care in 2009 occurred in New York. The state spent $9.7 billion on home health care and $7.6 billion on nursing homes, according to the Kaiser Family Foundation.

New York has been trying to rein in Medicaid spending for decades — especially since Andrew Cuomo became governor in 2011. Only about 6 percent of the state’s five million Medicaid recipients receive long-term care, but services for them cost about one-fourth of the state’s $53 billion tab in 2010.

Valerie Bogart, from Selfhelp Community Services, and other advocates have received many stories of people who have been getting downgraded home coverage.

“As a society, we’re going to need to think about how we do long-term care,” Bogart said. “For most people, care at home is less expensive than at a nursing home, but the fact is for this small group of outliers, care at home is more expensive.”

She said certain conditions, like Alzheimer’s and Parkinson’s diseases, will always be expensive to cover, until there’s a cure.

“This is true throughout healthcare,” Bogart said. “Every insurance company dreads getting the person who has a brain tumor or who needs a heart transplant. But this is what insurance is: you have a lot of people who are cheaper, and then you have the outliers who cost a lot.”

Long-Term Care Needs Expected to Grow

And as the population ages, the problem is expected to get worse. There are currently about 5.4 million Americans with Alzheimer’s Disease, and that’s expected to double or triple by 2050, according to the Alzheimer’s Association. The local affiliate estimates by then one out of five New Yorkers will either have the illness or be caring for someone who does.

In the meantime, Robert Doar, Commissioner of the city’s Human Resources Administration, said his agency’s job is to make the difficult decisions, with a limited amount of resources.

“We’re talking about government assistance that over time can be very costly to people really in need,” Doar said. “The challenge is to get people the amount of assistance consistent with what they need – and sometimes that may conflict with what they prefer or want.”

Doar said personal care services are declining, not because of Cuomo’s push to reduce Medicaid spending, but because of a federal fraud prosecution, in which the city admitted to being too lax in awarding and monitoring home care.

“I wouldn’t say there are budget pressures,” Doar said. “The city was in litigation with the federal government, and we’ve been determined to make sure we make those [home care] decisions consistent with the rules and regulations."

Doar wouldn’t speak about Irene Serrano’s case or any others. But he defended how nurses and social workers determine what’s medically necessary for people. And he said in addition to clients being offered lower levels of care, they also could receive higher levels of care, too.

“You could have someone who needs to have medical attention frequently during the course of the night, and they night be better served in a hospital or nursing home situation,” Doar said. “There are situations where care in the home by a home attendant is not sufficient to care for the person appropriately.”

Long-term care advocates say the city calls nursing homes a “higher level of care” as a pretext to justify shifting its most expensive beneficiaries onto a less costly track to live out their days.

State Medicaid Director Jason Helgerson said New York does everything it can to fulfill the U.S. Supreme Court’s landmark 1999 Olmstead ruling, which says people have a right to live and receive treatment in the community, rather than institutions.

“It’s our obligation to try to make sure people have access to home- and community-based care, when possible,” Helgerson said.

But it’s not an absolute right, and the Olmstead decision gives states an ‘out’: they can limit home-care services, based on financial resources. So, there’s a nod toward Olmstead, but no all-encompassing guarantee the state will cover long-term, die-at-home services.

Keeping a Promise

Yolanda Phipps fears losing the coverage would mean either tethering her to her mother’s bedside around-the-clock or ultimately putting her mother in an institution and taking her chances that she’d do better there than with a sleeping home attendant.

“Her words to me were, ‘Please don’t put me in a nursing home, please don’t put me in a nursing home,’” Phipps said. “And I promised to her at that time, when she was aware, that I would never put her in a nursing home.”

That’s the argument Phipps will make next week before a state judge.

(Photo: Irene Serrano can’t move without help, but her daughter and a home health aide dress her up to go to the doctor’s office. Allison Wheeler for WNYC)

Even if she prevails, there could be other challenges ahead. An entirely new system is slated to arrive this summer, with Albany taking over long-term care from the city and entrusting it to private managed care companies.

Many of the details for this system are still being worked out. The state needs federal permission, and Washington has already pushed the roll-out back once.

Update: Shortly after this story ran, Yolanda Phipps met with a state judge and the city, to appeal her mother's proposed reduction in home health attendant coverage. This past weekend, Phipps learned that her mother can continue to receive around-the-clock home health aides. In a letter to Phipps, the city said the proposed reduction in services was a mistake, and should never have happened.

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Comments [16]

gail

I review Medicare and Medicaid claims for TPL (third party billing) it is disgraceful how much money NY is spending on medically unnecessary services! The article understates expenses which actually range 12,000 to 30,000 dollar per month- for beneficiaries that are not confined to home and do not need any skilled nursing. Many of these patients are able to afford repeated trips to China, Puerto Rico and Ecuador among others. This is stealing! I have seen claims for total care patients ringing in almost 60,000 per Month!! This is an average of 365,000 per patient- I review approx. 15,000 patients per year that is 5,475,000,000 in nonmedically necessary services.

Dec. 10 2013 11:23 PM
Kathleen from Texas

Recently without warning I lost my job at which my 88 year old patient was put in a nursing home by her daughter. Her mom did not even know what the power of attorney paper was but signed it and within four days was moved out with no mercy from her home of over sixty years. She was a fully functioning person, happy dressed herself, put herself to bed at night, had a life alert button, but still forced out of her home.

This was not a pretty picture and I over heard from the bathroon her mom begging her to not do this. She said, What have I dont wrong and don't you love me anymore? Please don't do this and I promise I will be good.

So without work I called a number at which the state would pay me. I was shocked to find out it would be a little over seven dollars an hour with a minimum of 14 1/2 hours a week. Just enough for gas as the drive is far. The hours were spread out though a week everyday Mon-Fri. which mean't just 2 1/2 hours three days and 3 1/2 hours two days. Why I ask? Aren't the elderly precious and don't those who care for them deserve more hours. As you know no person could work like this very long, in fact I will not be able to continue this and it is heartbreaking both for me and my lady I have already fallen in love with. My comment may be out of line but I need to vent on this matter. Can't something be done to take care of us the workers who serve the elderly?

Aug. 01 2013 08:50 AM
Sharon Bolden from Portland

The relative who works at a hospital and observes the fraud daily resonates with me because I know people who commit fraud, receive benefits, and live a life of leisure, pretending to be disabled. I am tired of supporting them with my tax dollar (have worked 47 years), and it breaks my heart that a hard worker now doesn't get the funding needed. Has anyone out there ever turned in someone for fraud? Yes, I realize that people use all sorts of issues, including emotional trauma to receive disability. But I know that plenty of people have had emotional trauma, and still work.

May. 28 2013 03:20 PM
Angi from New York NY

This speaks to much more than just the issue of cuts, it also speaks to something no one wants to discuss and that is at what expense do we preserve a life and what defines the quality of "life". I for one would NEVER want to live the life that Mrs. Wheeler is living and I would never expect my children to make martyrs of themselves in a way that would so negatively impact their own quality of life, no matter how much they love me!
I'll hopefully have enough ability left to do myself in, or make sure my DNR orders are clear.
Science and medicine is prolonging natural life spans, great, at what cost and what quality?

Apr. 21 2012 11:22 AM
d inzlicht

Good Morning NY

this is going on since this cuomo put his budget in place last year i in this field can tell hundreds of pt that were trown in the Nursing home last year because of this cuts just vote coumo

Apr. 19 2012 06:02 PM
Jazmin from Bronx, NY

Ms. Irene Serrano is my grandmother. I feel it is a utter disgrace that her benefits are even in question. I work in a hospital setting and have first handed witnessed Medicaid fraud at its finest. My grandmother is being asked to pay the cost for individuals who abuse and misuse the system on a daily bases. Individuals who can walk and complete all activities of daily living independently are freely being given hours upon hours of home care and people like my grandmother who can not do anything without assistance are being cut. This is happening on a daily bases to out sick and shut in individuals. My grandmother like many other people these cuts are effecting were taxpaying positive members of our society. WE all need to be aware of this problem and speak up for those who have no voice.

Apr. 15 2012 02:30 PM
Fiordaliza Lora

This is what we have become,restrictions, limitations, descrimination, deprivation and cuts among fellows citizens, while given away to others nations, to kill inocents and poor people around the world. It is not fair, it is an insult to the USA citizens while we continue paying taxes. I advise the young generation to focus on their education and career advacementbecause they are the future for change in our political, foreign affairs, governmental policies & procedures and the socio-economic sytem.

Apr. 15 2012 08:43 AM
VIVIAN KOFIE from BRONX, NY

I have been close to this family for some time now and I really want to commend Yolanda Phipps for her devotion and love for her mom. There is a lot she has to do in the up keep of her dear mom even in the presence of a round the clock duty of the Home Health Aids. She always has to keep an eye on what goes on with her, after all, that's her mom and this really takes a great toll on her emotionally, physically and finacially. I am sure this drain on her life will be multiplied many times, should this proposal to cut support from the city go through. Yolanda and her mom have served America to the best of their ability for so many years and therefore deserve the best from the city. It is therefore my hope that the right thing will be done and full support is maintained in order to give the necessary support to the family taking care of their loved one. THANK YOU

Apr. 14 2012 10:09 PM
kim jenkins from Ft. Lauderdale, Florida

It is about time that every american is given medical treatment. it seems that if you are poor there is no services available. To insist that someone be put in a nursing home is pure devilish. People should be able to die at home.

We are the riches nation in the world yet the poorest when it comes to spirituality and compassion towards the elderly, the poor, working poor.

Where is the humanity?

Apr. 13 2012 01:49 PM
Mariom Kozakiewicz from Coral Springs, Fl

I cared for my elderly Mother at home because I felt that the nursing homes were understaffed and my Mother would not get the quality of treatment I was able to give her at home. I feel that nursing homes are there to administer morphine and eliminate the elderly whose quality of life has declined. I think the state of NY and all the states should have programs where they can assist the families who are willing the financial aide they need to care for their loved ones at home. It is cheaper for the states to provide this service than to put the patients on medicade. The people who stole the money from Medicare should be responsible for replacing the money they took.

Apr. 13 2012 11:58 AM
lefty avenger from rockaway beach

Big Thanks to Governor Cuomo for attacking the most vulnerable while giving the biggest breaks to the Wall Street Bankers whom we the people bailed out. Universal health care is a human right and should not be sacrificed for the Exploitative Bush tax cuts to the top 1% millionaires. End the republican oil baron wars and put all that money towards universal health care.

Apr. 13 2012 10:14 AM
sherri from cooperstown, ny

First off i would love to thank WNYC for address this issue; I am also Irene
Serrano's granddaughter and would like to add along with my other family
members the extra cost it takes with regard to the care of my grandmother. Not
only do we receive a bill that is over $1,000/month that we try to pay as much as possible, we still have extra cost such as medical supplies, clothes, and other miscellaneous items that either are not covered by the issuance or we go through the supplies quickly and can't wait till the next month to get a new shipment so we have to spend out of pocket. As my mother stated in the article, we are feeling the pressure to either do the 24hr "home care" or be placed in the nursing home. We made a promised to my grandmother that we will never place her in a home, she wanted as do we that when God decides to take her, she will be at home surrounded by her family.
We ask that if you can, please write your local government official regarding this issues, there are many families like ours that are in the same situation and need help. With more voices maybe we can make a change.

Apr. 13 2012 09:40 AM
Floyd Jr

Let's not forget the financial burden and sacrifices also made by the family. Yolanda receives a bill each month that runs over $1,000 associated with her mother's care. While not being able to afford the entire bill, Yolanda does religiously send a payment each month that covers [spends down] about 70% of the monthly billing for Irene's care.

Apr. 13 2012 08:43 AM
Judy Serrano from Middletown New York

Please be informed Irene Serrano is My Grandmother and she and my Grandfather Roland Serrano worked all their lives. The pension and Social Security is being spent towards her care. She is doing a cooperative program which is referred to as a spend down. Why are we forcing our citizens into institutions when family is available to help with their care.

Apr. 13 2012 07:51 AM
Karel Boersma from Rockaway Beach

Great story ! The end game for phipps and others is a skilled nursing facility secured for altzeimer patients. The program never mentioned the cost. It is my guess that it far exceeds $150K/year.

Apr. 13 2012 07:20 AM
molly from Virgina

Fred,
What are your thoughts on the future demands facing our culture? The 78 million baby boomers aging up and a reduction of nursing home beds available? Where and how do you see our elderly being cared for in a culture where the extended family is no longer the norm and both individuals have to work to make ends meet??
I am also very interested in this "new system".
Thank you for your coverage and advocacy for our elderly.

We have developed an option for consideration: www.medcottage .com

I would appreciate your thoughts regarding our option with regard to your demographic area.
Thank you so much,
Molly
N2Care

Apr. 13 2012 07:17 AM

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