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The governor shored up some care programs, but others sagged under the demand, which will only increase.
By STEPHEN NOHLGREN, Times Staff Writer
© St. Petersburg Times, published October 7, 2002
The baby boom began in 1946, a year after Bill McBride was born. Jeb Bush, 49, arrived right in the thick of it. For the first time, a governor's race foreshadows one of Florida's scariest demographic challenges.
In about two decades, the Bush-McBride generation will need long-term care. They will suffer strokes, have heart attacks and lose their memories. Absent dramatic changes, Florida's nursing home bill should skyrocket.
Democrat McBride, who focuses doggedly on education, rarely addresses long-term care -- not on the stump, not on his campaign Web site.
Bush campaigned four years ago on keeping people out of nursing homes and still discusses it from time to time. More important, he has a track record voters can examine. How did he perform? What were his priorities?
For starters, payments to nursing homes have taken a huge jump in the past four years. After discounting for inflation, state spending has risen 41 percent, even though the number of people served went up only 2 percent. Insurance and labor costs rose; the Legislature required homes to hire more staff. Industry officials say state payments still don't cover their costs.
Spending also increased 21 percent on programs that help frail people stay in their homes. But there's a twist. Every year, Bush and the Legislature funneled more and more home-care money into Medicaid programs for poor people. The federal government picks up most of Medicaid's tab, so every dollar that Florida spent generated more than $2 for the programs.
"We were really pleased," said Sally Gronda, Area Agency on Aging director for Pinellas and Pasco counties. "We had heard candidates promise things (about home-based programs) before, but he really did it."
If advocates like Gronda have a concern, it's that non-Medicaid programs have suffered by comparison.
Under Bush and the Republican-dominated Legislature, funding has stagnated for Community Care for the Elderly, a popular program that serves people of any means.
When he ran against Buddy MacKay, Bush promised voters he would eliminate the CCE waiting list, which he did, in a way. The 11,000 people waiting for services either received help or left the list for other reasons. But now, with CCE funding languishing, 14,000 new people are waiting.
Some need help with baths, others with cooking and cleaning; some need a ride to Publix.
"When the frailest are not receiving aging intervention services, they will simply become more frail," said Margaret Lynn Duggar, executive director of the Florida Council on Aging. "We have to have those general revenue dollars to provide services to a lot of needy, deserving people."
Consider Jean Branvall, who lives in a public-subsidized apartment in Holiday. She is 86 and blind with a hereditary illness. She moves around her apartment all right, bathes herself and cooks frozen dinners in the microwave or an occasional pot of soup.
Her problem lies outside her door.
"I need transportation. I have no way to get to the doctor. I need somebody to shop for me or take me shopping. I have a granddaughter in Holiday, but she has the same thing with her eyes and can't drive."
Branvall, a retired beautician from New Jersey, receives $692 a month in Social Security, well under the $1,635 limit for receiving services from Florida's Medicaid waiver programs. But she also collects interest on a little nest egg, money she banked after selling a house. The nest egg keeps her going, but also disqualifies her from Medicaid, because it's more than $2,000.
So Branvall lingers on the CCE waiting list, knitting afghans, listening to talking books and begging her young neighbors or relatives to take her shopping.
Up the road in Bayonet Point, Anna Moors, 77, welcomes a state-paid aide into her home every day at 9 a.m and another at 4 p.m.
Moors, a retired computer operator from Massachusetts, lost her right leg eight years ago in an accident. She functioned pretty well on her own until wrist surgery weakened her hand. Now she can't attach her artificial leg by herself, or get into the bath tub. The aides help her and clean the house while they're at it.
Moors receives Social Security and a pension, but has no savings. So she qualifies for aides courtesy of Medicaid.
"Without them, I don't what I would do. They are so good to me."
The Department of Elderly Affairs has prioritized its waiting lists, said Secretary Terry White. People most likely to go into a nursing home are rated 4 or 5 and go to the top of the list. People rated 3 or below can probably gut it out by themselves, or with help from federal programs like Meals on Wheels.
Branvall, for example, is rated a "high 3."
"In tight budget times, we compare it to a ship going down with 100 people and lifeboats that fit 10," White said. "We are going to take the sickest, the poorest, the frailest."
Medicaid takes, on average, almost six months to process a client's application, White said. People who are in desperate straits sometimes get CCE services while they wait for Medicaid. Others get by as best they can while case managers pray they don't deteriorate.
Lt. Gov. Frank Brogan gained praise from advocates two years ago when he chaired a commission to study long-term care. The nursing home industry was lobbying hard for damage caps on lawsuits. Trial lawyers complained about abuse and neglect. Advocates and academics pushed for bigger nursing home staffs and more home-based programs. The commission included representatives from all these factions.
Brogan kept the meetings reasonably civil and, after a year, the Legislature imposed some lawsuit caps, passed quality measures and required nursing homes to hire more staff -- giving something to everybody.
More staffing is one reason nursing home spending has risen so dramatically, 20 times faster than the growth in patients. For years, the industry complained that Medicaid didn't begin to cover the cost of treating residents. Bush and the Legislature listened.
Last week, Brogan said home-based programs also will get the attention they deserve. "Those programs are essential services to people who are borderline," he said.
Brogan questioned how McBride proposes to pay for home-based programs when he also plans to spend more general revenue on schools. "That's writing a check I'm afraid he never wants to cash," Brogan said.
McBride spokesman Alan Stonecipher counters that Bush would have had more money for CCE and other home-based programs if he hadn't reduced taxes when Florida had a surplus.
"He returned $100-million in tax reductions for corporations and for those at the top," Stonecipher said. "In the meantime, there is a blind woman who can't be served by state government and a 4-year-old child in Miami who can't be served in a quality preschool."
Stonecipher acknowledged that long-term care financing grew as much, or more, under Bush than under any previous governor. But he questioned how that money was spent.
"We think substantial increases actually have gone to price increases to providers in private agencies, rather than to provide services," Stonecipher said. "Bill McBride is going to take a good hard look at that."