Keeping Seniors Home and Healthy
Seniors are benefiting from two new state programs — SenioRx that negotiates good drug prices from pharmaceutical companies and a plan that uses Medicaid funds for in-home care.
Sometimes a bit of lipstick makes a big difference in how you feel. It’s one of the personal touches in at-home care that Kelly McNeely, of Oxford Healthcare, provides for Jimmie Swafford.
The Alabama Department of Senior Services coordinates a variety of programs for senior citizens and people with disabilities that reach thousands of individuals across the state. For example, during the first 10 months of 2014, the state agency oversaw the serving of more than 1.5 million meals in more than 350 senior centers around the state. Nearly 2.6 million meals were delivered to seniors at home. Almost 20,000 seniors received help through the State Health Insurance Assistance Program.
In addition, programs are offered providing caregiver support, legal assistance and work skills training. Prescription drugs are provided for free to qualified individuals. And more than 9,200 individuals are benefiting from waiver programs that help them maintain their independence instead of moving into long-term care.
Help for Staying at Home
In the 1980s, Congress authorized the waiver of certain federal requirements that would enable states to provide home and community-based services for individuals who would otherwise require services in an institutional setting. Over the years, several state agencies in Alabama administered waiver programs. In 2012, during Gov. Robert Bentley’s administration, the majority of these programs were consolidated under the Alabama Department of Senior Services.
Commissioner Neal Morrison says that the department’s infrastructure — which includes 13 Area Agencies on Aging (AAAs) across the state — made it the logical choice for managing the waiver programs, thereby reducing administrative costs. “In doing so, we saved approximately $4 million in taxpayer dollars,” Morrison says. “It’s one of those unique situations that everybody agreed that it needed to happen.”
The Elderly and Disabled Waiver Program is one of those being administered by Senior Services. “The intent of this program is to allow the individual to stay in their home as long as possible,” Morrison says.
“We took a huge program that was underneath multiple departments and put it under one,” Morrison says. As a result, the department is able to provide more services at more reasonable costs. “We set the rates that we provide the direct service providers,” Morrison says. Before the waiver programs were consolidated, any of the agencies administering them would set the rates, he adds.
Individuals apply for waivers through the local AAAs. Once approved, the funds are distributed to a direct service provider who then delivers the services to the individual. These direct service providers range from large companies to small mom-and-pop operations, and all have to meet certain requirements from Medicaid. Once the provider assessment is completed, clients have a choice about which providers they want to use. Services include case management, personal care services, skilled and unskilled respite care, companion services and meals — but do not include 24-hour-a-day care.
“We have a lot of checks and balances that we’ve created at the Department of Senior Services to make sure quality is there,” Morrison says.
Oxford Healthcare is one of the direct service providers working with waiver programs statewide. “Some patients may get services every day for three or four hours a day. Some may get services three or four times a week. It’s just according to their needs,” says Deb Chambers, Oxford Healthcare’s state director. Case managers will evaluate the client and discuss the care needs with the physician. “They’ll do their plan of care, and that’s the services we provide.”
These services will go on indefinitely until a status or health change occurs.
“Our main focus is keeping them at home,” Chambers says.
Help with Prescription Drug Costs
The Department of Senior Services also offers other programs to help reduce costs for seniors and keep care more affordable. For example, during FY 2014, which ended September 30, seniors were able to save $30,635,897 on prescription drug costs through the Alabama SenioRx Program. In fact, the SenioRx program has saved $348,549,307 in prescription drug costs and served 82,490 clients since its creation by the Alabama Legislature in 2002.
Former State Sen. Roger Bedford of Russellville, who was author of the original Senate bill, points to a pilot program in Northwest Alabama as one of the early efforts in the creation of the program.
In the late 1990s, Bedford partnered with the Northwest Council of Local Governments to create a pilot program called The Elderly Medication Program, or TEMP, which served Lauderdale, Colbert, Franklin, Marion and Winston counties. As a result, seniors who met age and income criteria and had no prescription drug coverage could qualify to receive free prescriptions donated by drug companies. “That program was working in rural Northwest Alabama,” Bedford says.
Bedford was chairman of the Senate Finance and Taxation General Fund Committee at the time, and he approached Rep. John Knight (D-Montgomery), who was chairman of the House Ways and Means Committee. “I showed John how it was working in rural areas,” Bedford says. “We expanded into urban areas to see if it worked. It did.” They then worked to create the legislation for a statewide rollout.
The current guidelines state that seniors must be 55 years or older, have a chronic medical condition that requires daily medication, have an income less than twice the poverty level, and have no or inadequate prescription drug coverage. Medicare Part D works in conjunction with the program. “Just because you qualified for Medicare Part D did not disqualify you from SenioRx,” Bedford says.
“SenioRx obviously does not solve all the healthcare needs, but Alabama has become a leader in the nation,” Bedford says, noting that other states are copying the program. “I think this is another good example of using common sense while thinking outside the box. We can come up with real solutions that make a difference in people’s lives. It’s working.”
This program also is conducted through the 13 Area Agencies on Aging located across the state and serving all counties. Seniors apply through the local agencies, and a coordinator there contacts their physicians. Physicians send the prescription to the coordinator, who then writes to a pharmaceutical company that dispenses that type of medicine and makes the request for the drug. The company will often provide the drug at no cost or low cost and send it to either the client’s home or to the physician’s office.
Michael Malandro, who works in the Alabama Department of Senior Service Programs Division, points to a number of success stories since the program’s inception. In one case, a client with cancer was on disability but with an employed spouse had a household income of $50,000. The cancer medication was so expensive that his health needs were consuming their resources. “The gentleman’s cancer drug was costing him $9,000 a month,” Malandro says. “We were able to get it for him at no cost.”
As another example, Malandro says, “One guy was charging $2,000 a month on his credit card.” But once the client was successfully enrolled in the SenioRx program, he can now receive anti-rejection drugs for a liver transplant at no cost.
Information on either of these programs for seniors, as well as people with disabilities, is available online at alabamaageline.gov or by phone at 1-800-AGELINE.
Minnie Lamberth and Art Meripol are freelancers for Business Alabama. Lamberth is based in Montgomery and Meripol in Birmingham.