By Hillel Aron
By Joseph Tsidulko
By Patrick Range McDonald
By David Futch
By Hillel Aron
By Dennis Romero
By Jill Stewart
By Dennis Romero
You won’t ever see a much happier crowd than the hundreds of nattily dressed people who sat in sunny Plummer Park late last month, celebrating a victory of a sort. The people were home health-care workers, and they were hearing our governor, Gray Davis, exultantly proclaiming how he was bringing them into the gladsome realm of the decently waged and benefited.
Davis saluted the people who have long been handling the home personal-care needs of the elderly and otherwise convalescent. It‘s a hard job, a messy job and, as of now, a minimum-wage-plus-peanuts job, minus any health benefits.
Davis called the work of those present ”the dignity option: caring for your parents in their own home, not in the nursing home.“ The governor announced, in effect, that home health-care workers, whom his administration stinted in the first draft of his fiscal year 2000-2001 spending package, were part of a new, $371 million program in the budget’s Ides of May revise. The program is called ”Aging With Dignity,“ and it addresses many medical needs for a maturing population. It includes more nursing-home inspections and harsher discipline for homes not meeting legal standards, but focuses on keeping senior (and other) convalescents out of nursing homes.
The aging package includes $100 million to raise the wages of home-care workers -- now officially (if awkwardly) known as ISSPs, or In Home Supportive Services Providers -- to a minimum of $7.50 an hour, plus 60 cents an hour for long-sought health benefits.
”They give us so much,“ Davis said, ”that it‘s time for us to give something back to them.“ The governor pointed out that paying caregivers to give care in homes saves the state a great deal of money it would otherwise have to pay to keep those same people in nursing homes, where such care costs more. It therefore makes fiscal, as well as moral, sense to encourage them with better (if scarcely adequate) pay.
All this was wonderful to hear. Last February, you may recall, this column berated the governor for offering the state’s total 200,000 home caregivers a nugatory $6.25 wage and no detectable benefits -- derisive, considering that these caregivers are themselves key health providers. Since then, it seems, key officers of the Service Employees International Union have spoken to Davis, as did certain members of his own staff, about getting the caregivers into the new aging program. And there we were. Happy End. Oh, but there‘s just one thing -- the program can’t work without county cooperation. And at the moment, that isn‘t going to happen. At least not in this county: It’s the old problem of who pays what.
Wait a minute. What about all that state surplus money? And the county‘s tobacco-settlement boon? What is our governments’ problem?
There are two problems, actually. One of them -- the predictable one -- has to do with how the county and state split the costs of care-worker pay. That issue‘s not new. In the recent past, the county’s picked up 20 percent of the home health-care costs, while the state paid the rest. At this rate, according to Supervisor Zev Yaroslavsky, the county saves itself about $6 million a year over the costs of treating the same invalids as inpatients.
Now Davis‘ new plan wants the county to up its share to 35 percent of the costs. At which point, instead of saving, the county gets to pay nearly $35 million a year to keep the program going.
But the other, larger problem is a three-way intergovernmental health-care-funding train wreck not directly related to the home health-care issue. This is the expiration this month of the billion-dollar, five-year federal fee-waiver program instituted back in 1995. This special funding concession to the nation’s most populous county followed said county‘s near bankruptcy; it’s probably the main reason that there still are Los Angeles County health services.
The waiver, painstakingly negotiated by former state legislator Bert Margolin, allowed the county to keep health-care money that would have otherwise gone back to Washington. This boon was allowed, however, under the condition that the county‘s Department of Health Services would have, by this year, transferred a third of patient treatments from inpatient hospitals to more effective and less costly outpatient care. The county so far has managed only a 28 percent transfer, yet it’s hoping for a waiver renewal until 2005 to balance its upcoming health-care budget. This may yet happen. But the omens are mixed, and, on the possibility that the waiver won‘t be renewed, the DHS is already cutting back long-planned expansions of its critical outpatient programs. It would make a lot of PR sense -- considering Al Gore’s lag in the presidential polls -- for the Democratic administration to finance the DHS‘s shortcomings for another five years. But the feds may also think that it would make even more sense for the DHS not to be in this mess in the first place.
Regardless, the county’s attention probably isn‘t going to be focused on resolving the health-care-worker problem in the near future. And if that waiver isn’t renewed, any further form of county health expenditure is going to be a very hard sell.