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Bracing for the Silver Tsunami

In-Home Care Program for S.B.’s Elderly Faces Funding Crisis as the County Gets Older


The Santa Barbara County Board of Supervisors recently got a look at how the area’s elderly are doing and what should be expected, with regard to their numbers and needs, in the coming years. Warning of an impending “silver tsunami” — the unavoidable increase of aging adults as the area’s baby boomers reach 60 to 65 years old — representatives from county aging agencies submitted a report on what has been done, and what needs to be done, to properly look after the county’s geriatric citizenry.

The June 22 presentation comes just three months after the Grand Jury released a study about possible cuts to a statewide program — In-Home Supportive Services (IHSS) — that’s designed to assist low-income elderly and disabled people with day-to-day living, allowing them to remain home and retain an element of their independence. To be eligible for IHSS, a person must be 65 or older, blind or disabled, and have an income at or below $845 a month through federal or state grant programs. Currently, Santa Barbara County budgets $31.2 million for IHSS offerings.

According to the report, California’s IHSS program — and therefore Santa Barbara’s, as state funding trickles down to individual counties — stands on a dangerous precipice: Proposed legislation from 2009-2010 that would reduce funding for IHSS programs statewide (which was stayed by a federal court decision but may be reinstated), combined with Governor Schwarzenegger’s suggested 84 percent slashing of IHSS programs for 2010-2011, could leave the critical program in dire straights. Even if just the 2009-2010 legislation goes through (and taking into consideration the proportional reduction of federal funding), total IHSS funds would be drop by 8.62 percent or approximately $2.69 million in Santa Barbara.

There are currently around 3,000 IHSS recipients in Santa Barbara County, the majority of whom are assisted by family members, the rest by nurses. These folks — about 2,000 of them — are paid $10/hour by the county’s Department of Social Services (DSS), which administers IHSS funds. But, said the report, should last year’s proposed legislation come into play, 1,200 of the elderly or disabled recipients would be “impacted,” 640 would be “substantially affected,” and 200 would lose all benefits. If the 84 percent suggested cut happens, even more people would be directly affected one way or another.

Yet another challenge for DSS is its inability to begin planning ahead should the dreaded cutbacks come down. Because IHSS recipients are ranked on a scale depending on their needs, and because money is allocated to both individuals and services, the program can’t just take an across-the-board downsizing that most departments would be able to. Delfino Niera, DSS deputy director, said, “It’s difficult for us to plan to downsize since there are different ways to scale back. It’s tricky. They can say this type of person is no longer eligible. But they can also say this type of service is no longer eligible … Those are two completely different things and it would impact what we would do in two completely different ways.”

The Grand Jury report goes on to say that IHSS currently spends around $9,600 per recipient per year for an average of 80 hours of service a month. If the program goes under, these people who completely depend on direct care and supervision would be forced to leave their homes and enter institutional care. This would require the expenditure of $59,495 in MediCal money (plus a federal Medicaid supplement) per year per person. So, if the 200 people mentioned lost all of their IHSS benefits, the cost of taking care of them all would jump from $1,920,000 per year to $11,899,000.

During their recent presentation to the supes, representatives with the Area Agency on Aging and Adult Aging Network stated there are currently about 55,000 adults in the county over the age of 65, and that by 2050, there will be 110,000. They also pointed out that while the county’s total population has increased by 8 percent in 10 years (1990-2000), the population of adults 85 years old and above has increased by 34.7 percent in the same period of time. Alzheimer’s cases, they said, are “growing enormously,” with 8,000 cases documented in the county at the moment and 13,000 expected by 2030.

Lastly, the representatives said that hospitalizations due to falls is a major issue that will only get worse if preventative measures aren’t taken in the coming years. In 2005, there were 1,027 hospitalizations due to falls, and the average treatment cost was $35,683. By 2030, they predict, there will be 37,581 hospitalizations due to falls, the total cost of which would be upward of $13.5 million. While the reps acknowledged that the county has done a fine job recently in caring for its older generations, staff are advised to increasingly consider the needs of older adults in County Strategic Planning process.

Should potential cutbacks become a reality, the Grand Jury report states that Board of Supervisors should direct the County CEO to “identity funds to maintain the current level of services for IHSS recipients.” It also goes on to say that the board should “develop a definitive plan, which could include public and private partnerships, to seamlessly assist the low income frail elderly and disabled should prior and/or proposed budget cuts be implemented.”

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