Personal care strains state's budget

More elderly and disabled people choose in-home care; Medicaid picks up tab

They're called personal care services, offering North Carolina's elderly or disabled hours of help bathing, eating, changing clothes or carrying out other activities of daily life without having to enter long-term, live-in care.

They're also a growing taxpayer expense. Personal care services delivered to North Carolina homes are projected to cost Medicaid more than $315 million next budget year, and that has some legislators saying enough is enough.

"With this personal care, more and more people need more and more time," said Sen. David Hoyle, a Gastonia Democrat. "We put caps in place, we try to get a handle on it, but once they approve a program, there seems to be an endless supply of money."

The expenditure could easily grow under a federal mandate that North Carolina provide the same levels of taxpayer-funded care to people in adult-care homes that is supplied to those at home. Currently, people in adult-care homes qualify for just over an hour a day of personal care service, compared with as much as hours daily, or 60 hours a month, for people in home settings.

Hoyle and others concede the need for personal care services, because they keep some people out of more expensive long-term settings. But he thinks the use of in-home aides is growing too fast.

"I would say it can't grow fast enough," said Kelly Woodall, 24, a Raleigh resident who gets help for about 2 1/2 hours a day with tasks she can't handle because she has cerebral palsy. "Group homes shouldn't be the only options. People with disabilities should have the same choices about where to live."

Medicaid's expense for personal care services in the state has more than quadrupled since 1999, when it cost about $74 million, according to the Kaiser Foundation. In the 2007-08 budget that's being completed in the legislature, it's likely to surpass the tab for adult-care homes, which include assisted living centers and group homes that have been the traditional mainstay for the state's elderly and disabled.

"I'm not saying that they should get less or that consumers who are served in their homes should be treated unfairly," said Lou Wilson, who lobbies for assisted living at the General Assembly. "I am just saying that people who are in adult care homes shouldn't be treated unfairly. There is evidence all over this state that they have been treated unfairly."

Wilson says everyone, whether in a rest home or their own home, should be entitled to the same level of personal care service, paid by Medicaid.

Advocates for in-home care said there are differences in who qualifies and the kind of care they get, making it difficult to apply a single equation. Still, federal regulators have told the state that it must figure out how to equalize care by this fall.

"Clearly this is an area of support that we recognize is needed," said Dr. William Lawrence Jr., senior deputy director of the state Division of Medical Assistance, which oversees Medicaid in the state.

Less dependent

At Kelly Woodall's apartment Wednesday, certified nursing assistant Christine Eddins spent time helping Woodall with daily activities, then fixed her lunch and fed it to her. Medicaid pays Eddins' employer, Good Health Services of Raleigh, more than $14 an hour for help that Woodall says keeps her in a subsidized apartment near downtown and out of an institutional setting.

"At college, I had an apartment and I learned that I could do that," said Woodall, who lives with two roommates. "I'm too independent for a group home."

Growing numbers of North Carolinians say they'd rather live in a place of their own, with help if necessary, than go into long-term care. About 53,000 received Medicaid-funded personal care services in 2006, up from about 9,000 in 1999. Earlier this decade, the cost grew so quickly that legislators made it harder to qualify and are considering adding another level of physician approval.

"We are providing more services to people than we did years ago," said Jim Edgerton, a lobbyist for the Association for Home and Hospice Care of North Carolina. "To my way of thinking, that's a good thing."

People who speak for adult-care homes and those who represent in-home care made frequent visits to the legislature during recent state budget negotiations, vying for Medicaid dollars along with mental health providers, hospitals and others.

And competition in personal care services could easily get more intense as three different task forces try to come up with a solution to satisfy Medicaid that North Carolina is treating everyone the same.

"I don't know if it will become a heated discussion; it will become a complex discussion," said Sherry Thomas, senior vice president of the state Association of Home and Hospice Care.