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Changes in Minnesota senior care cuts some out of services
by Dan Gunderson, Minnesota Public Radio
November 11, 2003

Last year Minnesota spent $65 million on a program to help senior citizens stay in their homes. To recover some of that money, a new law requires seniors who own a home to sign a lien agreement. That means the state gets paid back when the home is sold. But some elderly are refusing to sign the lien agreement, instead opting out of the alternative care program. Caregivers say that is putting some seniors at risk.

Moorhead, Minn. — Lucille, lives in a small bungalow on a busy Moorhead street. She's wheelchair-bound and has diabetes. She's been on the state funded Alternative Care Program for several years. A nurse stopped to check on her every couple of weeks and she had help getting groceries and cleaning her house.

"Now I just kinda let things go. 'Cause if you can't do them you can't do them," says Lucille.

It's more important for me to leave my house to my children than it is for me to have the services, so I just said, 'Okay, that's the way it's going to be.' - Lucille, Moorhead resident

Paying for a nurse and housekeeper would take most of Lucille's monthly income of $700. If she signed a lien agreement, she would continue to get Alternative Care services. When she dies, or sells her home, the state would recover the cost of any services she's received. Lucille refused to sign a lien.

"It's more important for me to leave my house to my children than it is for me to have the services, so I just said, 'okay that's the way it's going to be,' Lucille says. "It (my home) is my most important thing. I worked all my life for this home. It's where my children grew up. I love this house."

More than a dozen Clay County seniors have opted out of the Alternative Care program since the new rules took effect in July. Others have declined to even sign up for the program after hearing about the lien requirement.

A few seniors have family to look after them, says Clay County Social Services Supervisor Pat Boyer, but most will be on their own. Boyer believes people who refuse Alternative Care services will likely end up on the counties list of vulnerable adults.

"(That means) either someone has reported them as abuse, neglect, self neglect, or financial exploitation," says Boyer. "All of those vulnerable areas (mean) frail seniors may end up where someone may take advantage of them or they may just neglect to care for themselves."

Boyer says she expects some of the seniors will be forced to go into a nursing home. An official with the state Department of Human Services agrees the changes may "accelerate some nursing home placements."

Ironically, if those seniors end up going to a nursing home, they'll be required to sign a property lien to get government assistance with nursing home costs.

The Minnesota Department of Human Services expects to save $20 million by requiring seniors with assets, to pay for in- home care. Some seniors may also be shifted to a similar program that gets federal funding. The Alternative Care Program is entirely funded by the state.

In fiscal 2002 the state spent nearly $65 million providing Alternative Care services to about 12,000 people.

Cost saving is only part of the reason for the changes, according to Department of Human Services Aging and Adult Services Director Jim Varpness. The other goal is fairness. The state has long required a lien agreement from people who qualify for medical assistance programs. Varpness says people on the Alternative Care Program should be held to the same level of accountability.

The Department of Human Services recently asked Minnesota counties to track what happens to seniors on the alternative care program. There is concern some will make poor choices, according to Jim Varpness.

"We do know that with any kind of change there will be some consequences you'd rather not see, so we are going to monitor and see what that means for the program," says Varpness.

Some caregivers estimate hundreds of Minnesota senior citizens will choose to go without nursing visits and help with things like housework and bathing, rather than agree to a lien on their home.

Rep. Fran Bradley, R-Rochester, says it's a difficult but necessary change. Bradley says the state shouldn't be paying for personal financial obligations. He authored the legislation requiring seniors with assets to pay for their care. People don't expect the state to pay for their homes or cars, says Bradley, and they shouldn't expect the state to pay for long term care. He thinks seniors are over reacting to the lien agreement provision.

"We have not kicked anybody out of their home," says Bradley. "Typically we work out arrangements when people liquidate the property, and we're pretty darn reasonable in the way we do it."

The state doesn't collect on the lien until a person dies or sells their property, according to a state official, and there are exemptions to protect spouses and family members who share a house with someone who's on a state funded program such as Alternative Care.

Rep. Bradley says it's time to change what he calls a culture of entitlement when it comes to paying for long term care.

Sitting in her wheelchair in her Moorhead home, Lucille says she understands the need to cut state funding. But she's frustrated and disillusioned as a result of the choice she had to make, leaving her home as a legacy for her children and not getting the help she needs.

"I think it's wonderful when they do try to help us, it's a community kind of thing, it makes me feel warm and safe," says Lucille. "But, I feel much less safe. I felt kind of protected before. Now I feel scared."

The Department of Human Services expects to evaluate changes to the Alternative Care Program early next year.

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