Meeting the Demands of the Growing Senior Population
NY State Office for the Aging (NYSOFA) has drawn down over $19 million federal Balancing Incentive Program (BIP) dollars to provide support to disabled and/or elderly NY residents that require long term care services to remain in the home preventing more costly care.
The Wayne County Department of Aging and Youth has been allocated BIP funding in the amount of $207,965 for 2017. This funding is designed to provide for information services and assistance in obtaining long term care supports in order for an individual to remain at home or in the community as opposed to institutional care.
Providing community based preventive services is a very sound return on the investment to prevent or delay a nursing home placements or hospital admissions. Approximately 60% our clients meet the eligibility criteria for nursing home care and would likely need alternative placement if we did not provide these valuable support services in the home. The Department of Aging and Youth has calculated the annual cost for a client to receive four of our core services (home delivered meals, personal care aid services, a personal emergency response units and case management is approximately $10,000 per year and opposed to $130,000 annual cost for nursing home care.
Another primary component to keeping health care costs down for individuals is to have appropriate health insurance to cover the growing costs of medical and pharmaceutical expenses. Over the past several years as Medicare options have become more complex, our health insurance counseling referrals have soared, as you can see in the chart below.
Seniors have come to count on our experienced health insurance counselors to help them navigate the complex health care coverage. We provide unbiased information about Medicare, supplemental insurance, Medicare Advantage policies, Medicaid, Medicare buy-in programs, EPIC, and long term care insurance. We also help with understanding billing questions, filing claims and appeals, and comparing policy coverage. Information is provided both in the format of monthly 101 classes or one-on-one individual sessions with a trained insurance counselor.
The open enrollment period gears up in September and ends in December. In 2016, we served 813 clients and had 2,325 contacts, an increase about 20% over 2015. We have four staff that dedicate all or a portion of their time to this process. Once all the Health Insurance appointments slots are completely filled, we have to refer the remaining Wayne County clients to the state office or a Medicare call center for assistance with selecting the most appropriate health care coverage that will best suit their medical and prescription needs. This is a difficult way to determine the ins and outs of all the health care coverage that is so critical for the health and well-being for our older adults. Phone counseling is difficult for many of our people with hearing deficits and they don’t have the luxury of having visual aids or written material in front of them to refer to.
To help address the demand for this service last year we piloted some changes in our process. We reorganized the intake, counseling and enrollment process and it worked well but still could not meet the growing demand of consumers. The Department had the reception staff complete a quick intake screen as the calls come in, the referrals with some of the demographic information were entered into a data base for the Health Insurance Coordinator to assign to a counselor. The counselor scheduled the appointment. In some instances, before the client come in for their appointment, the support staff helped research the web based prescription formularies to have some of the materials available for the actual appointment. After the client has talked to the counselor to review their choices, they will be called by the support staff offering enrollment assistance if the client has selected their option. If the client has additional questions they are referred back to their counselor.
The Department has already designated $157,000 BIP revenue in the 2017 County budget to cover salary and fringe of staff conducting health insurance counseling and long term care information and assistance (NY Connects) functions. With the balance of the funding we have requested authorization to create another support position that will allow the service workers to provide more information and assistance and direct services to our growing client population in the future.