In Pa., a struggle to pay for some long-term care

Last June, Rene Green got the phone call children of aging parents everywhere dread. It was the paramedics, and it was about her mother.

This is part of a series on aging in the Delaware Valley called “Gray Matters: New Tools for Growing Older” from the WHYY Health and Science Desk. The six-week series features audio and video stories as well as personal essays.

Last June, Rene Green got the phone call children of aging parents everywhere dread. It was the paramedics, and it was about her mother.

“She had fallen,” Green said. “Her neighbor upstairs had found her on the floor.”

Green’s mother, Phyllis Balaban, then 83 years old, was not severely injured. But as the days went on, she drifted into a semi-conscious state.

“She would kind of talk to herself, she would grab things in the air,” Green said. “She kind of knew who she was, but she had no idea where she was, what had happened. She had no recollection of anything.”

Soon, Balaban regained much of her mental functioning. She still suffers from dementia, but knows her name and recognizes her daughter. She can dress and feed herself.

Balaban now lives in a personal-care home in Lansdale, not far from Green, where her daughter said she is relatively happy.

“It’s very calm, it’s very serene, and that’s the type of person she is. But she’s going to have to be uprooted,” Green said, “because Medicaid does not provide for assisted living.”

In Pennsylvania, Medicaid, the joint state and federal insurance program, covers long-term care for low-income seniors. For those who qualify, it pays for nursing homes and some in-home care, but it does not pay for the nearly 50,000 residents whose needs fall somewhere in the middle. Those, like Balaban, who live at personal-care or assisted-living homes.

Sometimes, that leads to tough decisions when seniors living there run out of money.

Worried about a move making her mother worse

Balaban’s care costs $2,350 a month, about $700 a month more than her Social Security and annuity bring in. Once she spends down her modest savings later this year, Green said she will not be able to afford to stay where she is.

Green is already picking up the tab for her mother’s supplemental health insurance, medications and incidental expenses, and said she could not afford to pay the difference.

Green is appealing to the Department of Veterans Affairs for financial help, but if that does not come through, she said she will have to move her mother to a Medicaid-covered nursing home.

“It’s a level of care that she doesn’t need at this point,” Green said. “I just think she would become into a shell and just not participate in anything. I’m just worried about it making her worse.”

Situation ‘extremely common’

Montgomery County elder law attorney Michelle Berk said Balaban’s situation is very common.

“I was just discussing a similar situation with a geriatric-care manager,” Berk said. “We have another woman of around 85 years old who is in exactly the same situation, living in a personal-care home, and her savings have all been depleted and yet her income is less than half of what the monthly pay rate is. So we were thinking that we would also have to move her.”

Berk said some veterans or their spouses — like Balaban — can get help paying for assisted-living facilities through the VA. And, she said, some religiously affiliated personal-care homes have benevolent funds for people who have run out of money.

But generally, for the Pennsylvanians who seek Berk’s help, she said options are few.

“I think that’s the majority of the cases, are that there isn’t another source of funds available, and people just have to move,” Berk said.

Changes to coverage possible

In 2007, Pennsylvania passed a bill defining assisted-living facilities and requiring them to get certified. It was a move Berk and others hoped would eventually allow Medicaid to cover these homes — as it does in more than 30 other states, including Delaware. In New Jersey, Medicaid will cover the cost of care in these homes but not room and board.

The Rendell administration said it planned to pursue a Medicaid waiver to get assisted-living facilities covered, but it never did. A spokeswoman for the Corbett administration said it would be unfair to expand benefits for this population now, when benefits are being cut for so many others.

Still, Department of Public Welfare Secretary Gary Alexander said the issue is on his radar.

“We have a commitment to work with assisted living. It’s a viable option that should be an option under the Medicaid program,” Alexander said.

He said keeping an individual in assisted living could save Pennsylvania money. Those facilities cost about half as much as nursing homes. But the picture is not quite as clear on a macro scale.

“Any time that you have anything from a step down from an institution, it’ll save money,” Alexander said. “Certainly, assisted living won’t save as much money as home care, or as shared living, but it’s a viable option that certainly is not as costly as institutional nursing home care.”

The long-term care group LeadingAge PA, which represents more than 350 not-for-profit nursing homes, assisted-living facilities and other senior service providers, said after the current state budget is passed, lobbying for this change will be a top priority.

For now, for Phyllis Balaban and others like her, the market will remain private pay.