AS Health and Humans Services Commissioner Nick Valis says, IT’S A TOUGH DECISION, BUT sometimes YOU have to drown some puppies.
Track 9
:15 there's nothing in our budget that isn't painful. We look at it as drowning puppies, so that the litter can thrive, the department can thrive, other services can thrive. We have to make some very difficult decisions and there are some issues in adult day care, that may be lost.
In a recent meeting with the Senate Finance Committee, Commissioner Valis more than once used this graphic metaphor to underscore two points:
FIRST, the department is willing to live with whatever budget LAWMAKERS APPROVE.
But SECOND, if LAWMAKERS COULD APPROVE MORE, maybe fewer puppies would be sacrificed.
Under the House plan, HHS's Division of Elderly and Adult Services will see about a six million dollar cut over the next two years.
If those cuts happen, HHS HAS PROPOSED ELIMINATING Medicaid FUNDING FOR SERVICES LIKE adult daycare, transportation to adult daycare, and ambulance services.
AND THE PROSPECT OF CUTTING ASSISTANCE FOR ADULT DAYCARE SERVICES HAS DRAWN A GREAT DEAL OF ATTENTION.
CRITICS OF THE PROPOSAL CALL IT PENNY SMART AND POUND FOOLISH.
THEY SAY IF FAMILIES DON’T HAVE THE OPTION TO SEND AILING ADULTS TO DAY CARE…..THEY’LL HAVE TO BE PUT IN NURSING HOMES.
THE DIFFERENCE IN COST, THEY ARGUE, IS SIGNIFICANT.
Republican Representative Fran Wendelboe LED THE HOUSE meetings on the HHS budget.
Track 4
:00 a lot of this is just like in school budgets when they say they are going to cut the budget they always pick the thing that will raise the most ire in the community like football...and everybody makes the biggest display of outrage, and I think the department in identifying in saying they are going to cut payments to physicians, and hospitals, and day care, they know that is a very vocal constituency. I don't know if those cuts are ever going to happen.
Representative Wendleboe says if people want a loved one to remain in adult daycare, there are options.
5:54 I think they could look at getting private donations, they could look at the seniors paying part of the daycare costs, family members paying some.
Republican Senator (FIRST NAME) Green chairs the Senate Finance Committee.
HE agrees that people NEEDING CARE would find someone to pay for them.
That's the problem.
Track 4
1:48 ... they are going to go to emergency rooms, and they are going ot go to local welfare offices, and they are still going to get those services, we are just going to downshift it to the local communities, it will show up on the county and the local tax rate, and it could be at a much higher rate than we are paying now, and that's why it's not a good idea.
THEY COULD ALSO END UP IN NURSING HOMES….PUBLIC OR PRIVATE.
The state PAYS $45 A DAY IN MEDICAID FUNDS FOR adult day care.
THE STATE PAYS about $130 A DAY TO SEND THAT SAME PERSON TO a nursing home.
Catherine Keane runs HHS’S Division of Elderly and Adult Services.
SHE says she can't think of another service where the state can contract five hours of professional medical service for THE $45 IT PAYS ADULT DAY CARE CENTERS.
But in addition to the financial consequences, the human ones, KEENE SAYS, may be even greater.
Track 3
4:57 If I have an adult that needs supervision and I need to work, I am able to bring my parent to a program and have peace of mind my parent is safe, and is interacting with peers, and is getting the care he or she needs. If that care is unavailable it throws my life into disarray. Can I still work, can I still keep mom or dad at home, and those are heart wrenching and agonizing decisions.
TO Keith Blessington KEENE’S WORDS HAVE MEANING.
THANKS TO THE CONCORD ADULT DAYCARE CENTER, TLC, HE’S BEEN ABLE TO KEEP HIS DAD OUT OF A NURSING HOME.
Fade up...
Track 5
1:28 alright dad, sit up dad...sit up, sit, we are going to put these on, we are finished, sit, come on we are going to put these on.
EVERY MORNING, Keith Bleesington GOES through his ritual.
Wake up.
Wake up his Dad.
Take DAD to the bathroom…. check and change DAD’S diaper.
Get him dressed.
Feed him.
And finally drive DAD, who has Alzheimer's to TLC.
THEN KEITH drives himself to work in Portsmouth.
Track 5
:27 he couldn't stay home. He needs attention all the time. My mother is in her 80s. She isn't that healthy herself. He just needs attention, he just needs to be watched. It's when someone isn't watching him that he's going to get busy trying to do something. We have had a few cases in the house where he's started fire on top of the range, he got up in the middle of the night, he accidentally knocked my mother. She was trying to put his sock on two months ago. He pushed her and she ended up falling into the armoire. And broke her finger.
Terry, Keith's mom, handles the finger gently, explaining how her husband didn't understand what he was doing.
She has lived with Tom and his Alzheimer's for 13 years.
Track 13
:00 ...it's horrible. The person is not there anymore, you understand? TheIR mind is gone. And they don't understand anything, and you try to be patient, but you are only human...I am not mother Teresea, but you want to scream, you want to yell, you want to run away.
Track 12
:40 (big sigh) I've had all kinds of troubles here, seems every day, if we don't have any troubles I say thank you god. Just to get through the day, but it's getting worse now.
That's where TLC comes in for Keith and his mom.
WHEN HE’S THERE THEY GET A break from playing cop.
THEY DON’T HAVE TO WATCH TO MAKE SURE Tom ISN’T EATING lipstick, cat food, crayons (CRAY-YONS)
1:06 they are very good there. They shower him. They cut his hair, and they are trained, and much more patient. He's better with them.
Fade this up...
Track 46
Sfx: calisthenics
2:10 that's an everyday thing, that's their excercises that goes from 9-10. they sit down in the chairs and move all their body, then after this tape, there are these exercise, these little dice...there's two dice, there's a number, and the other dice says five or four times...and they look forward to that everyday.
That's Jean Fisk, the owner of TLC.
SHE’S GOT 30 PATIENTS ON ANY GIVEN DAY.
Track 48
1:02 Medicaid pays TLC $45 dollars per day. With that money our clients receive breaksfast, a snack, a full noon meal, we also give them when necessary medication administration, wound care, physical therapy, speech therapy. We monitor their vital signs, lung sounds, they have showers, foot care, nail care, and most of all being with other people.
Fisk says if LAWMAKERS CUT MEDICAID FUNDING FOR ADULT DAY CARE she WILL LIKELY LOSE ABOUT 60% OF HER CLIENTS.
She SAYS SHE WOULD ALSO HAVE TO CUT HER STAFF.
And she worries that TOO MANY OF HER CLIENTS WOULD HAVE BE TO SENT TO NURSING HOMES.
She says the nursing homes STAFFS ARE already overworked.
AND FROM HER EXPERIENCE THEY JUST DON’T HAVE THE TIME TO SPEND WITH PATIENTS.
AND WHILE SHE MAY HAVE A DOG IN THIS FIGHT, SHE DOESN’T THINK IT SERVES ANYONE’S INTEREST TO DROWN THIS PUPPY.
Track 57
:00 they are going ot go to nursing homes earlier than they have to, b/c the families aren't going to be able to afford anything but, and then if there is a shortage of staff now, and then you have figure 30 of my clients, and 30 of the others, what is going to happen to them?
THAT’S A QUESTION HOUSE AND SENATE LAWMAKERS ARE GOING TO HAVE TO ANSWER.
For NHPR News I'm DG.
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