State may cut off caregiving spouses

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Posted by Del on December 09, 1999 at 23:36:41:

In Reply to: Re: YAY !!! posted by Kay on December 09, 1999 at 14:14:59:

Here's the article Kay talked about. The article is also linked below thanks to the Wimpster

State may cut off caregiving spouses
More than 200 Oregonians may soon lose their reimbursement for nursing disabled loved ones

Thursday, December 9, 1999

By Erin Hoover Barnett of The Oregonian staff

Bruce Foster steps back to look at his wife, Sherryl, after lowering her into her wheelchair near the softly glowing fireplace.

Sherryl mentions her hairbrush.

"Oh, I forgot to fluff you a bit," says Bruce, darting to the counter.

Gently, he brushes her short, graying hair. Sherryl peers up at her bangs, hanging in her hazel eyes. Bruce moves in, remembering now to part her hair and sweep her bangs to the left.

"That's another thing I've learned -- about parts," Bruce says in his eternally cheerful way.

Bruce and Sherryl Foster have learned a lot about each other since he began caring for her full time five years ago, soon after returning from work one afternoon to find that her multiple sclerosis had stranded her in her wheelchair, unable to get on the toilet alone.

Now the Fosters are learning about budget politics.

And unless something unexpected happens during a legislative Emergency Board meeting today and Friday in Salem, the effective caregiving balance they have achieved will be disrupted.

Bruce Foster is one of 217 Oregonians paid by the state to care for their severely impaired spouses. Many of these spouses have progressively debilitating conditions and cannot even get out of bed without help.

Last summer, the Legislature cut this innovative, 12-year-old program that allows willing spouses to take on some of the most difficult caregiving jobs. The cut yielded a general fund savings of $3.4 million over the next two years.

For a Legislature faced with more demands than money, the math was clear. The state foots the bill to pay each of these spousal caregivers, on average, $1,200 a month. Caregivers who aren't spouses are paid $1,525 a month to care for similarly impaired people. But the state pays only about $610 of that bill; federal Medicaid dollars pay the rest.

Medicaid does not pay spouses or other "legally responsible relatives" to be caregivers. "You have to look at where do you draw the line," said Tom Flavin, a spokesman for the Health Care Finance Administration, which administers Medicaid.

So legislators decided that even though it is more expensive overall to pay outside caregivers, it is less expense to the state.

Yet people who choose to care for spouses are often more stable and effective caregivers than outsiders, say state officials. And without stable care, the ailing person can wind up in a nursing home -- at more than $2,000 a month.

Sen. Eileen Qutub, R-Beaverton, chaired the legislative committee that made the cut. She said it was a hard one. But she thinks the cut may push the federal government to approve proposals from the state that could resuscitate the spousal pay program.

Yet the fate of those proposals is still unknown, and one of the proposals would initially serve just four counties, not including Clatsop County, where the Fosters live.

And so today, Dan Kaplan, deputy administrator for the state Senior and Disabled Services Division, will sit before the Emergency Board. He will explain how his office intends to stop paying spousal caregivers and make other arrangements -- from bringing in outside caregivers to moving people to assisted living or other facilities.

Kaplan says that the state may be able to keep paying perhaps 20 of these 217 spouses.

The Emergency Board staff has recommended that the board cut spousal pay but has encouraged Kaplan and his staff to push the federal government for alternatives.

A lot is riding on Oregon to work out this problem.

"Oregon is the most progressive state on home- and community-based care. They're the national model for encouraging independent living," said Janice Jackson, executive director of the National Association of Area Agencies on Aging in Washington, D.C. "If you chip away at it, then you don't have that stature any more."

For Bruce and Sherryl Foster, all the bureaucratic maneuvering came down to an oversized, official-looking white envelope.

The Monday after Thanksgiving, Bruce had driven his Ford Ranger through the rain-soaked alder and cedar trees, down the chuck-holed gravel road and over the three single-lane bridges to the mailbox.

He noticed the return address from the state Senior and Disabled Services Division.

He brought the envelope back to the dream home that he and Sherryl were able to buy just this year with their son as a co-signer on the loan. The home on the little north fork of the Nehalem River had been repossessed and sold for $135,000. The home where Sherryl can sit outside in her wheelchair on nice days and decide what flowers Bruce could plant. The home where Bruce can take a breather watching the salmon spawn in the river below.

"Dear Spousal Pay Program Participant," the letter began.

After a few paragraphs came the zinger: "In general, payments to spouses for care will end March 31, 2000."

Bruce said he looked at Sherryl, sitting in her wheelchair by the fire that heats their home.

"These people are trying to put you in a nursing home, warehouse you," Bruce said to her.

The Fosters know how hard it would be to get a caregiver to their home in the Coast Range, particularly when the storms come.

Bruce knows he could return to work. For 25 years, he worked for Safeway as everything from night foreman to manager of the grocery checkers. He was making $1,800 a month when he left to accept $968 a month to care for Sherryl, increasing over five years to $1,671 a month.

But Bruce knows he would be distracted, worrying about whether Sherryl was getting the kind of care he gives her. And what would they do when caregivers quit?

They know how high the turnover rate is when the job includes using a lift to move her from bed to wheelchair, emptying her catheter, helping her use the toilet and feeding her.

"It would just be a job to them," Bruce said. "It's not a job: It's just part of life for us."

Sherryl told Bruce she would consider getting a divorce so that she could hire Bruce as her nonspousal caregiver.

"If that's what it takes," Sherryl says. "I would feel awkward having someone else care for me."

You can reach Erin Hoover Barnett at 503-294-5011 or Send Erin Hoover E-Mail

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