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Elder services providers are warning about major budget shortfalls for state-funded home care and case management. (Cade Martin/Unsplash)
Alison Kuznitz | SHNS
Thousands of older Bay Staters could lose access to home care services this spring or see support scaled back due to looming funding shortfalls totaling millions of dollars, elder advocates and providers say.
Elder services organizations are urging Gov. Maura Healey and the Legislature to appropriate more money to ensure continued services, calls for help that come at a time when state budget officials are concerned about softening tax collections and myriad spending demands.
One organization anticipates running out of money for its state-funded home care program in February, while others are bracing for their home care programs to be tapped out around March or April, said Betsey Crimmins, executive director of Mass Aging Access, which represents nearly 30 so-called Aging Services Access Points and Area Agencies on Aging across the state.
If left unaddressed, the funding woes could lead to home care staff layoffs, lengthy waitlists for Bay Staters looking to enroll in care, increased hospitalizations among older adults, and heightened pressure on nursing homes, according to elder services providers.
"We're hoping in a supplemental budget we can get this covered. We don't want to go into a managed intake that can harm people," said Crimmins, referring to a process in which the state could end up triaging or reducing services to elderly residents depending on needs.
She added, "One of my big fears is breaking apart this really valuable direct care workforce because if they have to start getting laid off, I don't know how long it would take to rebuild that workforce."
Asked whether the administration is concerned about funding shortfalls for elder home care programs and if more money will be allocated in a supplemental budget, a spokesperson for the Executive Office of Elder Affairs indicated officials are evaluating how to handle costs exceeding expectations.
"Throughout this Fiscal Year, a variety of factors have resulted in costs being higher than expected — home care caseload has returned to pre-pandemic levels, efforts to increase hiring and retention have been successful to address workforce shortages, and more residents are aging," the spokesperson told the News Service Tuesday. "The Executive Office of Elder Affairs is working to address this to ensure that older residents continue to get the high-quality service they need and ensure that workforce has the support they need."
The Healey administration is already planning to file a supplemental budget to seek more than $400 million for the emergency family shelter system, which will likely run out of funds in January. Lt. Gov. Kim Driscoll said the administration would submit that spending request once the fiscal 2024 closeout budget, which the Legislature sent to the governor's desk Monday, is finalized.
Home care programs help older residents maintain their independence, and avoid more expensive care options, including moving into nursing homes, Crimmins said. Home care staff assist with daily tasks like bathing and meal preparation, laundry services and grocery shopping, in addition to providing medical care.
Providers say the surging demand for home care, compounded by the commonwealth's growing population of older adults and the aftermath of the pandemic, has fueled the budget squeeze. Meanwhile, the fiscal 2025 budget funded the Chapter 257 reserve for human services workers at $390 million, which health care advocates previously celebrated as a record investment.
Crimmins and other providers say they are working closely with the Executive Office of Elder Affairs to resolve the financial shortfall for fiscal 2025, plus meeting with top lawmakers to raise awareness of the issue. More than 9,600 older adults could be denied home care services in the "very near future" without state action, Mass Aging Access warned.
"It's very scary because the last thing you want to do is to try to figure out a way to prioritize consumers because everyone has a need for different reasons," said Kim Nahas, clinical services officer at Elder Services of Cape Cod and the Islands.
The organization has experienced a "huge spike" in demand, said CEO Maryanne Ryan. At the start of the year, there were about 300 to 310 new home care referrals each month. That figure has climbed to about 370 to 380, said Ryan.
"There's more demand out there coming to us every day," Ryan said. "And budget-wise, we count on state home care dollars."
The fiscal 2025 budget steered nearly $237 million to elder home care services, but Crimmins said the line item is underfunded and based on outdated information for how many older people use the services. Crimmins said an additional $35.2 million is needed to maintain home care services, though the amount could be closer to $46.1 million should more people seek services.
Providers are also concerned about home care case management, which helps older adults navigate available services and resources. The budget allocated more than $95 million, but at least another $4 million is needed for case managers to support Bay Staters, Crimmins said. If the caseload demand continues to grow, Crimmins said closer to $8.6 million may be needed to shore up the account.
The EOEA spokesperson did not say whether the administration agrees with those budget shortfall estimates.
Lisa Gurgone, CEO of Mystic Valley Elder Services in Malden, said providers will be in a "crisis" this spring without additional state support to keep pace with demand.
"Eventually, we're going to run out of money if we don't start either cutting back on services or waitlisting people that aren't as needy as others," she said. "If the state doesn't give us the money, we're not going to be able to afford new people at all."
Mystic Valley Elder Services had 4,180 people enrolled in home care in June 2023, compared to 4,524 in September.
Nahas said reducing services, such as providing only one shower a week instead of two, could result in more medical problems. Without a funding injection, limited services could also translate into more elderly adults becoming hospitalized or homeless, ending up in protective services, or turning to nursing homes that are ultimately more expensive for them and the commonwealth, Nahas and Ryan said.
Older adults might also be forced to rely more heavily on strained family caregivers, said Justin Lees, CEO of Coastline Elderly Services in New Bedford. Lees said he wouldn't be surprised if his organization runs out of money for home care, or comes close to it, in February.
Coastline is grappling with record monthly enrollments for home care, Lees said. About 20 to 40 people are being enrolled each month, though sometimes monthly enrollment has surpassed 100. Before the surge this spring, new enrollments hovered around 10 to 15 people.
"If we keep going on this trend, we're going to need more staff, but we can't hire them not knowing if the money will be there," Lees said. "I've already had to eliminate other programs that are not funded through these lines but typically run at a loss."
