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A proposal to save the state money on independent living services could mean dire consequences for as many as 34,000 people.
Gov. Bruce Rauner wants to decrease the number of people in Illinois who receive in-home care, a move disability advocates say could put people on the street. The proposal appears unlikely to clear two major hurdles for approval, and its acceptance could even cause the state to run afoul of a longstanding court order.
Among Rauner’s many other proposed cuts to social services is a plan to raise the threshold for elderly people and people with disabilities to receive home services, a pair of state-funded programs which offer qualified people help with basic tasks like laundry and paying bills. Home services allow recipients to live independently, instead of living in nursing homes or other institutions. In order to qualify, an individual must undergo a “determination of need” assessment, which scores each person’s needs on a scale of 0 to 100. Currently, anyone who scores 29 or above qualifies for home services, and a higher score means more hours of service. Rauner, who campaigned for governor as a compassionate conservative, wants to increase the threshold from 29 to 37.
Amber Smock, director of advocacy for the Chicago-based disability group Access Living, estimates that the change would knock 10,000 people with disabilities out of the program, along with 24,000 senior citizens. […]
[Springfield disability advocate Tyler McHaley] says most people who receive home services are low-income, meaning they won’t be able to hire outside help if they lose their state assistance. That could result in more people being sent to nursing homes or other institutions, he said. McHaley says the tightened eligibility would have a ripple effect even outside of those directly affected. As clients lose services, the people who provide those services would be put out of work.
posted by Rich Miller
Friday, Aug 28, 15 @ 8:47 am
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Probably cheaper to house them in IDOC custody….according to the Bruce P&L!
Comment by Jack Stephens Friday, Aug 28, 15 @ 8:56 am
As usual, a “money saving” policy change which will actually result in shifting those expenses to nursing homes which rely on Medicaid (which itself is being cut) and therefore shifting the costs somewhere (but not eliminating them). And the kicker is the home care workers who will now be unemployed, which further hurts the economy. That’s not even the worst part- look at the people who can no longer stay in their homes. The Rauner policies are mean-spirited. Perhaps we need a dual governor structure; the rich people have their governor, where is ours?
Comment by illinoised Friday, Aug 28, 15 @ 8:57 am
“That could result in more people being sent to nursing homes or other institutions”
And prepare to see an uptick in elderly homelessness. People in need of these services don’t typically have a lot of outside support. There’s no alternatives for them, no soft landing. It’s gonna be harsh.
Comment by Politix Friday, Aug 28, 15 @ 8:58 am
#Arduinitwrong
Comment by PublicServant Friday, Aug 28, 15 @ 9:00 am
I’ve never been a fan of Mike Madigan until this year.
Comment by anon Friday, Aug 28, 15 @ 9:04 am
Please raise my income tax. It is okay, raise it and stop this. (Never thought I would say that)
Comment by burbanite Friday, Aug 28, 15 @ 9:06 am
illinoised to be clear it is actually worse than that. The DON score is the same for nursing homes and in-home care described here. SO what would happen is a person would lose their in home care and then go through a cycle of health deterioration to the point where their score goes up and likely only be able to be treated in a nursing home not their home. Just shifting to a nursing home is one thing but what this does is force people to get sicker quicker in order to receive certain care. This is more troubling than it appears on the surface and is bad all the way around.
Comment by Hoping for Rational Thought Friday, Aug 28, 15 @ 9:06 am
Some wouldn’t find their way into a nursing home. They’d simply stay in their apartment or home, unable to care for themselves. What happens then? Malnutrition. Living in filth? Medical issues go untreated? Once people fall through the cracks, tragedy happens.
Is that the Illinois we want?
Comment by Aldyth Friday, Aug 28, 15 @ 9:08 am
Any more “savings” like this and the FY16 deficit will be pushing $10 billion.
But if your model for an ideal society is Dicken’s London, then perhaps it’s worth the fiscal disaster.
Comment by Wordslinger Friday, Aug 28, 15 @ 9:08 am
Penny wise and pound foolish.
Comment by CharlieKratos Friday, Aug 28, 15 @ 9:13 am
“Please raise my income tax. It is okay, raise it and stop this.”
Mine too. How can we be a first-world state and country if we allow this to happen when we can mitigate or stop this?
Comment by Grandson of Man Friday, Aug 28, 15 @ 9:20 am
Just cruel, and it doesn’t even make sense from a strictly dollars-and-cents perspective. Trying to puzzle out the economic motivations for this. The only thing I can figure–from the angle of those who see value only in money–is that it’s an attempt to influence the poor and disabled to leave Illinois. But these populations usually have the least wherewithal to move, so how would that work? None of these proposed policies make sense from an economic or public policy perspective; maybe you have to be a sociopath to get the logic?
Anyway, totally wrongheaded, and will have dire human consequences if implemented. This is not how Illinois is supposed to be.
Comment by Crispy Friday, Aug 28, 15 @ 9:29 am
But if your model for an ideal society is Dicken’s London . . .
Or perhaps Barbados
Comment by Bill White Friday, Aug 28, 15 @ 9:33 am
The immutable truth about social services is this. If you don’t pay for it upfront you will pay double on the back end. The ignorant and cruel strategy of many conservatives is to push the cost to the back end and to hide it so no one sees it. It gauls me that many who profess Christian faith advocate this strategy. It is both immoral and does not make fiscal sense. Address poverty FACE FORWARD!
Comment by Honeybear Friday, Aug 28, 15 @ 9:38 am
http://www.skillednursingfacilities.org/directory/il/
If the current rate of full beds is about 77%, do we have 34,000 beds? Surely superstar math can make this work./s
Comment by Anon221 Friday, Aug 28, 15 @ 9:44 am
Don’t lose sight of federal laws here either. The Americans with Disabilities Act requires services in the most integrated setting and that’s been interpreted to mean the home, not a nursing home. So not only will we see the horrific personal health crises so well discussed in earlier posts, we’ll see lawsuits against the State and of course, massive legal fees that will grow when the State loses, and it will lose.
Another poster said penny wise and pound foolish. That’s true in spades.
And yes, please raise my income tax rate now. And no I am not a government employee, I am private sector. Hurry before this gets worse.
Comment by Mongo Friday, Aug 28, 15 @ 9:51 am
Can the superstars not do simple math. Please check the cost of in home service vs nursing home care. Or is this just another slap in the face to the have not’s?? Why doesn’t granny just get a job as superstar Donna has suggested for the homeless? I’m becoming ashamed to say I live in Illinois.
Comment by Flynn's Mom Friday, Aug 28, 15 @ 9:58 am
What was the $ threshold before and what is it changing to?
Comment by Toure' s Latte Friday, Aug 28, 15 @ 10:00 am
“Home services allow recipients to live independently, instead of living in nursing homes or other institutions.”
Rauner is in the nursing home business. Maybe he plans to fill some beds by moving people from home health care to nursing homes.
Comment by Mama Friday, Aug 28, 15 @ 10:19 am
To make things worse, DHS is proposing rules to curtail the due process rights for consumers such as the 10,000 persons with disabilities noted in the story. It’ll be harder than ever to file an appeal. Some will be forced to travel hundreds of miles to a hearing that isn’t even guaranteed to be held that day. Plus, the burden of proof would shift from DHS to consumers, which is outrageous considering DHS doesn’t have the best kept, most easily accessible records, much less policies that are completely transparent and easy to understand.
And yes, please feel free to tax my income more, and for God’s sake close corporate tax loopholes and pass progressive revenue taxes while you’re at it.
Comment by Sick & Tired Friday, Aug 28, 15 @ 10:50 am
So the “assessment of need” doesn’t include income and net worth, nor owning long term care insurance, just how much help is needed? Anyine know the threshholds for receiving free services from the state for this?
Comment by Arizona Bob Friday, Aug 28, 15 @ 10:53 am
Durkin? Radogno? What are you accomplishing that makes it acceptable to do this to 34,000 people? How does it fit into a scenario that balances the budget, or does anything else worth doing?
Comment by Langhorne Friday, Aug 28, 15 @ 11:01 am
http://www.illinoislegalaid.org/index.cfm?fuseaction=home.dsp_content&contentID=178
Here you go AZ.
Comment by Anon221 Friday, Aug 28, 15 @ 11:02 am
Sigh. A solution for this problem is nationally-backed long term care insurance paid for through payroll deductions, similar to the Medicare system. The Obama admin considered it but backed off because of the costs. Maybe Hillary will take a run at it. A elderly relative who is terminally ill has it and it is a godsend for the family; you don’t have to go through some massive (and badly run and overpriced) government agency to get the service, the patient or guardian simply buys the service and the insurance pays for it. Of course, if this were a widespread solution, the massive government agency would have to slim down, fewer patronage jobs and so forth, so maybe our political masters across the country aren’t advocating very hard for it. They need these massive bureaucracies in order to employ relatives, friends, campaign contributors. It’s the Illinois way.
Comment by Cassandra Friday, Aug 28, 15 @ 11:09 am
To answer a couple of questions raised by commenters:
The current DON score threshold is 29. That means you must score at least 29 in order to secure services through either the Home Services Program, or the Community Care Program. The state’s proposal is to raise that threshold to a score of at least 37 to qualify. In doing so, that would knock out the 10,000 HSP clients and the 24,000 CCP clients who currently have scores under 37. As I and others have repeatedly testified in General Assembly hearings, those with scores of 29-36 DO have significant need for in home help.
Assessment of need does not include income level. However, in HSP there is an asset limit of $17,500 or less. CCP does not have this, but the state has proposed an income limit. However by far and away, CCP clients are majority lower income.
There are no private long term care insurances that provide the level of support that HSP does (personal care assistance, like toileting, bathing, etc). Few cover what CCP does (home maker services). Even for just home maker services, if a person paid out of pocket, on average that would come to about $800 or so a month, which is totally unaffordable for seniors on fixed incomes.
There are some people who work who have HSP, but only BECAUSE they have HSP are they actually able to get out of bed, dress, toilet, go to work and in general contribute to their communities. They do not make enough to pay for such personal assistance on their own, and do not have assets beyond $17,500. One of the greatest tragedies of this proposed DON change is these people, if they score 29-36, will lose their jobs.
It would be nice if private insurance covered these things and allowed people to actually accrue assets. but that is not reality. HSP and CCP literally save lives every day.
Some asked how/why people would be forced into nursing homes. It is true some people, if cut off, would hold out without support until they became so ill they would meet the new threshold of 37. But really why people would enter nursing homes is because they will hit crisis mode and be admitted to nursing homes under the 30 day emergency admission rule. Nursing homes do not regularly administer DONS and offer community transition services. This is how people get stuck in nursing homes and why Illinois leads the nation in nursing home residents who are defined as “low need.”
I would urge the House to adopt the preservation of the DON score at 29 in HB 972 HFA 1, given that the state has made no commitment to preserve it in policy. The Senate has already done so.
As others stated, this situation has gone on far too long and is beyond the pale. As a state we should do better and invest in community-based long term services and supports that save taxpayers from paying more in hospitalizations and nursing home costs.
Comment by Amber Smock Friday, Aug 28, 15 @ 11:16 am
AB, although this is not my area of policy, I’m 100% sure that assets and earned/unearned income are part of the assessment. I don’t know the income/asset thresholds but I can tell you that with AABD (Aid the Aged, Blind, and Disabled) they nickle and dime the old folks. It’s awful how little goes to them. A perfectly able non working 25 year old can get 194 in SNAP and a 100 year old great great grandmother is lucky to get 16 bucks after the unearned income and asset tests. This will be addressed in OCT when I’m sure the work requirement for SNAP will come back on. Then that 25 year old will need to find work to get help. I actually agree with that. It kills me to tell little miss simpson she’s only getting 16 dollars.
Comment by Honeybear Friday, Aug 28, 15 @ 11:16 am
It’s not reality (more comprehensive care insurance) because we the citizens don’t demand it. We seem to prefer to continue to hurl ourselves at a failing state political system that has proven over and over in recent decades that it cannot manage resources effectively.
Comment by Cassandra Friday, Aug 28, 15 @ 11:47 am
== 34,000 fewer disabled and elderly receiving home care ==
Just another step in making Illinois the most compassionate state in the Union.
Comment by nona Friday, Aug 28, 15 @ 11:48 am
woops my bad, thanks for clarifying about the income policy. That’s shocking that it is not in the assessment. Although asset limit is really low.
Comment by Honeybear Friday, Aug 28, 15 @ 11:55 am
Bruce does not care about these people. He. Does. Not. Care. They are not in the realm of his idea of governance. The only thing that matters to him is making sure working class people get set back as far as possible.
Comment by Cheswick Friday, Aug 28, 15 @ 2:39 pm