pennsylvania’s family caregiver support program
DESCRIPTION
Pennsylvania’s Family Caregiver Support Program. Initiation of program as demonstration (1987) Passage of legislation Statewide implementation (1990) Addition of Federal Funding (2001). PROGRAM HISTORY. Funding and Organization. Funded from state general fund & O.A.A. - PowerPoint PPT PresentationTRANSCRIPT
Pennsylvania’s Family Caregiver Support Program
Initiation of program as demonstration (1987)Passage of legislationStatewide implementation (1990)Addition of Federal Funding (2001)
PROGRAM HISTORY
Funding and Organization
Funded from state general fund & O.A.A.Current budget: $17.8 million/yearAdministered at state level by PA Department of Aging (state unit on aging)Administered locally by statewide network of 52 area agencies on aging
Program Eligibility
Care receiver must be 60+ years of age or have chronic dementiaCare receiver must have at least one ADL deficit
Core Program Benefits
Assessment and care managementBenefits counselingCaregiver education and training (including caregiver support groups)Core program benefits are available to all eligible participants as needed with no cost ceiling and no consumer cost sharing
Financial Reimbursement Benefits
Up to $500 per month for services and supplies (caseload average must not exceed $300/mo). Up to $2,000 during the life of the case for home modifications and assistive devicesRelatives (including primary caregiver) may be reimbursed for expenses, but NOT paid for services renderedFinancial reimbursement benefits are subject to a sliding reimbursement scale
Sliding Reimbursement Scale
Families with incomes at or below 200% of poverty may receive full benefits (if needed)Families with incomes between 200% and the eligibility ceiling of 380% of poverty receive declining reimbursements in 10% decrements as income increases in increments of 20% of poverty
Examples of Sliding Reimbursements
A family at income of 298% of poverty falls into the 50% reimbursement range. Maximum reimbursement is half of actual expenses, OR $250 per month for services and supplies and $1,000 for life of case for home modifications and/or assistive devices, whichever is lessA family with income of of 302% of poverty receives the lesser of 40% of actual expenses or $200/month and $800/case
Actual Utilization Patterns
Program serves about 4,500 families at any given time, and about 8000 unduplicated families per yearProgram costs an average of about $3,000 per family for a full year of stay in the programAverage length of stay in the program is just above 8 months
Actual Utilization Patterns (Continued)
Most care receivers have multiple ADL deficits and some are nursing facility clinically eligibleMost caregivers are advanced in age and female, and some have IADL deficitsMore than 80% of participating families have incomes below 200% of poverty and are therefore fully eligible for benefits
Program Strengths
Ideal for functional families and other strong, voluntary caregiving relationshipsAllows the family autonomy to structure the caregiving environment with public $$$ merely supporting and filling gapsCosts run about 10% of nursing home care, about 20% of our Medicaid waiver, and about 1/2 of the cost of standard aging in-home services for consumers with similar needs
Program Limitations
Low benefit ceilings unsuited to families unwilling or unable to provide the bulk of care informally“Niche” program which can be an important part of the HCBS continuum, but not the entire answer
Program Impacts
Allows more efficient use of public resources for a sub-set of the service population, leaving more for consumers in less supportive living environmentsMinimizes public interference into the affairs of functional families, while meeting consumer needsServes as a laboratory for consumerism which has been gradually incorporated into traditional aging home and community based services
Interface Issues
Many consumers have formal service needs that go beyond the FCSP benefit ceilings, yet live with very supportive caregiversThe availability of primary in-home care providers using traditional models is diminishingMedicaid waiver standards tend toward traditional models which can restrict who provides care and when it is provided
The 21st Century Challenge
Demographic trends predict the financial necessity for maximizing the use of informal supports in community based long term care Flexibility in program design which respects family autonomy will be crucialPennsylvania’s Family Caregiver Support Program is demonstrating concepts that may contribute to the design of the larger system