By Gema G. Hernández

Soon the official State of State of address of elder affairs will be presented and as the Department of Elder Affairs has done every year the focus of the presentation is going to be how better off elders and the agencies, which provide services to elders are today versus three years ago. Beautiful graphs will be presented merging together what was accomplished from 1999 to 2001 with what has been done since then. However, this year there are changes that may detract from the euphoria traditionally built for that presentation.

I have therefore taken the liberty to bring to the attention of Floridians some of the real issues that would not be discussed in any graphs. Issues that if openly discussed could change the title of the presentation from the State of the State to the State of Disarray of elder programs.

1. Although this is public knowledge, few individuals would mention that the bulk of the Department of Elder Affairs’ budget does not belong to the Department any longer. As a matter of fact, the only piece that has been left under the complete control of the Department is approximately 58 million dollars that comes from the Administration of the Older Americans Act programs. Unless other Agencies like the Agency for Health Care Administration allows the Department to use their budget in the presentation, the total “real” budget of the Department is quite different this year.
2. While programs that are truly helping elders have received serious budget cuts, those budget cuts will never be mentioned. I am referring to the Nursing Home Diversion Program whose payment rate per client per month has been reduced this year by $500 per client per month and is scheduled to be further reduced next year another $500 per client per month, making the delivery of quality services and the preservation of the patient’s safety almost impossible. While the argument has been that the capitation rate per client was too high, other organizations have increased their unit cost with no penalties.
3. On the other hand, programs like PACE, the famous all inclusive service for elders established as a pilot, has been expanded despite questionable showings. PACE was created in Miami in 2001. While the idea of PACE is excellent and the benefit to the elders and caregivers is great, for reasons unknown to anyone dealing with the project, at the present time the enrollment rate has been a disaster. To put this disaster in numbers PACE was given financial support to enroll approximately 125 frail clients to receive all inclusive care and despite four years of operation and tremendous marketing efforts PACE has only been able to enroll a maximum of 40 clients, and this just happened recently because before this year the enrollment was 8, 10 and 15 elders. It really does not make sense to expand PACE to Ft. Myers and Martin and St. Lucie Counties until such a time as the mystery connected with the poor enrollment is uncovered. PACE’s poor enrollment and wasted resources will not be part of the presentation.
4. Historically, Area Agencies on Aging, Lead Agencies and some community based providers have not been poster agencies for financial effectiveness and control. Still today the accounting “errors” and over expenditures prevail. The fact that two Area Agencies are on “probation”, one of them for overspending $1.5 million, are not good reasons to give them “more” contracts and are not a good reason to adjudicate the total control over the clients’ lives to these agencies. Until these agencies show control over their budgets, giving them a type of Managed Care contract with no assurances from them that the money will be there two years or five years into the future is irresponsible. Imagine for a second that after collecting millions of dollars in capitated payments these Lead agencies declare bankruptcy. This will leave hundreds of elders with no services and will leave the State of Florida in a financial crisis because the money for services has already been allocated to these providers. Of course, three years from now new legislators will be there to hold the torch and new personnel to save the day, but for the elders the scenario will not be pleasant.
5. The legislative changes that have happened and the physical collocation of the Department of Elder Affairs and the Agency for Health Care Administration signals the beginning of the end for Elder Affairs. The process has begun. If they are collocated there is no need to have two different program monitors, no need to have two different offices of evaluation and research, two different office of communication, and so on and so on so. The next budget cycle which coincidentally starts in August will take this to the next step by “consolidating” positions, jobs and responsibilities and at the end and after the election Florida will lose its uniqueness of having a Department of Elder Affairs as a cabinet level Department and become like Texas where elder affairs is a unit of a bigger Department with 35 employees to deal with all the elders in the State.
6. While meetings are taking place around the State to create a new “vision” for long term care, no elders to my knowledge have been asked to comment on these and other changes that are going to eventually impact the types of services and options they have available to them. As a matter of fact if you reside in the Tallahassee, Jacksonville, Daytona or Pensacola unless you have the financial resources to travel the meetings are hundred of miles away from you.
7. The State of the State presentation will not elaborate on Clients’ assessments and evaluations. Who will do it? One reason for that is that the “private agencies” that are going to accept a Managed Care type contract would like to assess the client this way they can select the least frail and get the most dollars. As we see this topic unfold we should remember that the argument we have heard from professionals is that to prepare an effective care plan that meet the needs of the frail person the frail person must be assessed by an objective independent professional, otherwise unmet needs will remain unmet. Leaving the assessment to the frail person via a phone interview or to the agency that is accepting a capitated rate is too risky.

As you can see from the above, The State of Disarray has replaced the State of the State address on elder affairs..