A state plan to cut services for the elderly and adults with disabilities is likely to result in thousands of Oklahomans being forced into nursing homes, and will worsen the state's fiscal crisis in 2018, according to information provided by Oklahoma Health Care Authority (OHCA) and Oklahoma Department of Human Services (DHS).
Jeff Wagner, DHS communications manager, said the agency is preparing to eliminate services under the ADvantage Waiver Program, a service that provides frail adults with in-home assistance, due to a $69 million gap in the department's budget.
If the Legislature doesn't fill the department's budget gap, Wagner said the ADvantage Waiver Program will end Dec. 1, and would save DHS $36.44 million for the remainder of the fiscal year.
But, the costs — both human and fiscal — are projected to be much greater than those savings.
The fiscal fallout
Wagner said each of the program's current enrollment of 17,034 people would be eligible for Medicaid funding through SoonerCare for nursing homes if the ADvantage Waiver assistance ends.
DHS estimates about half of the 17,000 people currently in the program would need nursing home placement.
That would shift the cost of their care to OHCA, which administers the SoonerCare program for low-income seniors' nursing home care.
Jo Stainsby, public information director for OHCA, said the fiscal impact over the next year would be $124 million if half the ADvantage Waiver enrollees move to nursing home care, or about $247 million if all of them required resident care. That cost is about three-and-a-half to almost seven times the amount projected to be saved in the DHS budget.
According to OHCA figures, there would only be nursing home beds available in the state for about half the ADvantage Waiver enrollees, based on census figures from January.
There also likely would be a significant number of jobs lost if the program ends. Wagner said OHCA estimates about 450 provider organizations that hire nursing aides for the program would be impacted.
Lola Edwards, owner of Complete Home Services, a company that provides in-home care across the state through the ADvantage Waiver Program, said she expects to lay off about 1,100 employees if the program ends. That would include about 95 employees managed out of the company's Enid office.
She said as many as 10,000 nurses and aides could expect to lose their jobs across the state.
"We won't have anywhere else to use them," Edwards said. "The overwhelming majority would lose their jobs, and a lot of these are single mothers that are working, so a lot of them will be back on the state payroll as far as unemployment or food stamps or other assistance. It's going to be a much bigger impact back to the state than it is now."
She estimated the back-end costs to the state would be four to five times as much as maintaining the ADvantage Waiver Program.
The local impact
Pam Singer, supervisor for the Enid office of Complete Home Services, which oversees personal aides, clients and case managers in a 17-county area, said ADvantage Waiver aides help seniors with medical appointments, home health equipment, bathing and dressing, prescription medication, housekeeping, errands and meals.
She said clients have been calling since the state announced plans to end the program last week, especially clients who rely on ADvantage Waiver to receive daily meals.
"The members are very upset," Singer said, "because some of them have been told they've received the last of their meals."
Adrian Janzen, staffing coordinator for Complete Home Services, said the employees also have been calling.
"The aides are calling scared," she said, "asking if they need to get a new job, and we don't know what to tell them."
Jan Snapp, R.N., has been working with ADvantage Waiver clients for 10 years — some of them since the day she started work. She said most of them are scared, and don't have a plan for where they'll go if the program ends.
"A lot of these people will have no alternative but to go into the nursing home," she said. "For people who do have family that can help, it's going to be a huge burden on them."
The human cost
Elda Jones, of Enid, is well aware of the benefits of the ADvantage Waiver Program, and the likely outcome of its termination.
Jones, who now resides in an independent living apartment at Golden Oaks Village, has been enrolled in the program for 14 years.
Her active life as a 20-year assistant professor of health and physical education at Northwestern Oklahoma State University underwent a dramatic change after she was diagnosed with multiple sclerosis (MS) at 53 years old.
"I need help with getting in and out of bed, a little bit of help dressing, with my range of motion, bathing, and light housekeeping," Jones said.
But, she's still able to fix most of her own meals, and regularly takes public transportation to volunteer at Loaves & Fishes of Northwest Oklahoma and Enid Symphony Orchestra, to attend an exercise class at Senior Life Network and to participate in various MS fundraisers and a support group that meets at 6 p.m. the second Monday of each month at Christian Church of the Covenant, 1205 S. Cleveland.
Jones said she's able to maintain that active lifestyle because ADvantage Waiver aides come in the morning and again at night to help her get in and out of bed.
Without that assistance, Jones said there will be few options.
"If I did not have their help I would probably be in the nursing home and very depressed, because that's not my lifestyle," she said. "I try to stay very active and contribute to the community."
Jones, like OHCA and DHS, took a dim view of the notion the state's going to save money by increasing the nursing home population.
"It's just going to be a fiasco," she said. "Expecting to put these people in nursing homes to save money isn't going to work."