Know the law: 12 million dollars in funds to provide services to frail elders go unused in Florida

Gema G. Hernández

For the last three years elders and caregivers throughout the state have been told that there is no money for services. They have also been told that there was no point in completing a full assessment on their situation or in getting their information to be placed on a waiting list because there was no money to deal with the waiting list. This information is in direct contradiction to the policies and procedures governing community care for the elder programs, Medicaid waiver programs and family caregivers’ initiative programs.

The frequent answers elders and caregivers receive when they call their local Area Agency on Aging or their local Community Care for the Elders Lead Agency are designed to discourage elders from seeking services while quietly lowering the number of elders and caregivers in need of help. This conscious attempt to lower the number of individuals in need is designed to justify lower budget request and cuts to social services programs. This approach silently imposes a self rationing of services while artificially reducing the need to expand or even maintain at the present levels the Medicaid and the Older Americans Act budgets.

What those elders and family members do not know is that the policies and procedures governing both the Area Agencies on Aging and the Department of Elder Affairs mandate that employees of those agencies collect, manage and monitor the name and demographic information of every single elder that calls for help. Furthermore, it also mandates that once an elder is assessed and his or her level of frailty is established those elders must be re assessed every 90 days and their new condition reported promptly. In cases where those elders suffer a hospitalization or the loss of their caregivers a complete evaluation is to be done at that time. To cut corners Area Agencies and Lead Agencies have not been re assessing elders and by not doing this mandatory reassessment they are also artificially minimizing the number of frail elders in our state, justifying lower budget requests to state and federal officials.

Because these policies and procedures are not generally known, no one is collecting data in reference to the number of elders that are dying prematurely due to lack of help or are going to a Nursing Home months if not years ahead of schedule because they were strongly discouraged to register in the system. Some Area Agencies, including the one here in Tallahassee, have justified their behavior by saying they don’t want to call people on the waiting list because they don’t want to give them false hope that soon services will be given. This is not only an excuse but it is in violation of the regulations that mandate such calls be made as a way of monitoring and prioritizing cases.

This month the office of the auditor general has uncovered the fact that the department of elder affairs has been holding 12 million dollars in its coffers, money that should have been used to provide services to elders. The response given by the department for holding that money is again in direct contraction to the law in three ways:

1) Medicaid laws clearly indicate that the Medicaid funding is to be allocated on a first come first served basis. This means that if a 75 year old frail elder in Daytona Beach with a frailty level of 3 register on the waiting list on May 2002 and another elder in Miami with the same frailty level registered on July 2002, Daytona Beach should receive an allocation of dollars to support that elder because he or she was registered in the waiting list first. This is not what the Department of Elder Affairs has been doing. Instead, the department is giving the excuse that they are mandated to allocate money based on population when in reality they have been allocating money based on the political clout of the area, not the frailty level of its residents.

2) As far as I know, no legislation or congressional act has changed the frailty level an elderly person must have to qualify for services. The rest of the nation with the exception of Florida uses a frailty level of 3, 4 and 5 to consider those elders a priority to receive a variety of in home and community based services. Under the leadership of Secretary White, Florida began to focus on frailty levels of 4 and 5, eliminating from the potential waiting list all those elders with a frailty level of 3. This artificially rations services in a way that has been undetected to the public and eliminates from the waiting list an estimated 15,000 elders and their caregivers.

3) For the last four years the Department has been moving money around from one area to another, preventing any given area the opportunity to fully address its needs. The constant moving of money between programs, among districts and between providers, coupled with the lax monitoring practices and the advocacy in favor of service providers and not frail elders has led to a creative accountability practice that has generated the 12 million of unused service funds. This creative accounting has nothing to envy the creative accountability of Enron and World Com.

If you are an elderly person in need of services you need to know your rights. Next time you call your Area Agency on aging or your Lead agency and they tell you about the waiting list, insist that they take your information, and most importantly, ask them about what number you have on that waiting list. Get the number, the time and date that you called and the name of the person that took your information. Within 30 days of that call someone from the agency should visit you to complete your assessment. Get copies not only of the assessment but insist in getting your frailty score. If your final score is a 3, 4 or 5 you should be eligible for services on a first come first served basis. Once that assessment is completed, every 90 days you should be re evaluated, and if your condition changes before those 90 days are over you should get a new frailty score. Report to your elected officials and to the media if these procedures are not being followed.