Coverage Quandries

Posted on Mar 1, 2011 :: Industries
Sean P. Johnson
Posted by , Insight on Business Staff Writer

Most of us at some point will go through the angst of making tough decisions for a parent who can no longer live on his or her own. But what happens when that parent can’t afford outside care and doesn’t qualify for government assistance?

As Wisconsin’s new administration under Gov. Scott Walker prepares to outline the path forward for long-term care services, organizations that provide caregiving solutions for the elderly and disabled are waiting to hear what changes are in store.

“I wish I had a crystal ball to predict how long-term care services will be delivered in the future,” says Chris Wales, vice president of communications and business development for Clarity Care, a non-profit organization in Oshkosh, serving 1,200 people on a monthly basis. “We have a large and growing number of folks who need that care, but we don’t have unlimited resources.”

Fortunately, Clarity Care had the foresight a decade ago to begin positioning itself to meet the long-term care changing landscape, and adapted a collaborative model that accepts creative and unique ideas to provide services to those who fall through the cracks.

“Our mission is to provide services for individuals with limitations or disabilities so they can achieve independent and fulfilling lives within their community,” says Wales. “Two of the more innovative ideas we’ve come up with are the Living With Assistance initiative and the Help at Home program.”
Wales points to a 79-year-old widow named Marlene as an example of how Clarity Care helps bridge the gap in home care costs for elderly and disabled residents who can’t afford to pay for outside aid, and yet don’t qualify for government assistance.

Through the Help at Home program, Marlene found a support system and assistance with transportation, household chores, meal preparation, personal care and more. She pays for services on a sliding income scale, and the program depends on grants and donations to subsidize the remainder of the cost.

“We’ve been able to help over 100 people like Marlene through Help at Home without costing the state of Wisconsin anything,” Wales says. “It’s truly and out-of-the-box idea that is working.”
In Wisconsin, the bulk of long-term care is paid for by the relatives of those receiving care. The state still pays about $1 billion each year to help those who can’t afford long-term care.

About 12 years ago, the Wisconsin Department of Health Services set out to explore and overhaul a broken and expensive system by asking the expert advice of providers, as well as taxpayers and family members. As a result, the current Family Care plan has been adopted in several counties, with plans to expand statewide by 2011.

Putting that expansion on hold for the time being, Walker has not said specifically what changes are in store for Family Care, but the program in its current state is already on thin ice.

Over the past few years a significant number of families, guardians and clients have raised concerns about how Family Care has been conducted in Wisconsin. So last August, the state Assembly voted to give Family Care a legislative audit.

“Family Care has been focused on reducing waiting lists, but in the meanwhile it has created wanting lists,” said David Boelter, executive director of The Arc of Fond du Lac Inc. “The program has, in many instances, failed to achieve its goals resulting in inefficiencies, duplication of services and a failure to address the needs of Wisconsin’s most frail citizens.”

As Boelter awaits the results of the audit expected in the next few weeks, he wonders how long Arc’s own creative funding solutions will last.

Arc-Wisconsin, a patient and provider care advocate with 33 local chapters across the state, promotes care opportunities for people with developmental and related disabilities and their families.
Boelter admits it’s getting more challenging to meet the rising costs of services while providing a decent wage to health care professionals. Understandably, he says, providers simply want their revenues at rates that sustain the cost of services.

“At The Arc, we get revenues of about 92 percent of our costs and have to fund raise to make up the shortfall. We do a great job raising those funds through the generous support of local businesses and individual donations,” Boelter says, but adds, “those donations aren’t going toward long-term investments, but to support the day-to-day operating costs. In the end that is simply not sustainable.”

Both Boelter and Wales believe that lawmakers need to take a hard look at long-term care in Wisconsin to find innovative solutions in this economic climate.

“I am optimistic that our governor can work through this if we bring a multitude of stakeholders to the table in the spirit of what is best for the people we serve,” says Wales. “We know we have limited resources, but it’s important we all work together to do the best we can with what we have.”