Missouri families struggle with in-home care cuts
By JASON HANCOCK, RICK MONTGOMERY
Aug. 18, 2017
KANSAS CITY, Mo. (AP) — The state of Missouri just cut Kevin Pickett's reimbursements for in-home health care by a third.
But he's still getting all-day help from his parents, which he needs. They've been tending to Pickett, 47, since he was born with a congenital defect called arthrogryposis, a destroyer of joints.
When the funding cuts took effect, Kevin's father Morrill, 73, spent 10 minutes strapping to his son's legs the braces with big boots that allow Kevin to take a few steps, feet splayed.
Ten minutes just for that. According to a notification to the Northland family, the reduced benefits for Kevin's in-home care cover no more than 15 minutes of "dressing/grooming" for the entire day.
That includes putting on his clothes — before and after baths — brushing his teeth, undressing him and removing his leg braces at night.
"I feel I constantly have to prove I'm disabled or that I'm worthy of some help," Kevin Pickett told The Kansas City Star . "I'm not a number on the spreadsheet. I have a voice. There are others affected by these cuts who can't communicate, who can't self-advocate. . I'm not going to lay down and take it."
He may have to take it.
Lawmakers approved a one-time funding fix aimed at avoiding cuts to the in-home care program in May, but it was vetoed by Gov. Eric Greitens. The bill passed the House with 83 votes — 26 votes shy of a two-thirds majority needed to override a veto.
Without the $35 million funding fix, the $27 billion state budget approved by lawmakers and signed by Greitens changes eligibility requirements for Missourians to qualify for in-home and nursing care services through Medicaid.
Essentially, people are now required to display more severe disabilities to get state-funded care, a change that could eventually affect more than 8,000 Missourians.
Disability advocates have said that in many cases those needing round-the-clock care will get it for little to no coverage — from relatives, neighbors and visiting nurses who can't turn away from a person in need.
"I think that's what the state is banking on: Someone will take care of these people," said Julie DeJean, chief executive of The Whole Person, a Kansas City nonprofit that assists the disabled.
While that may be what the state is banking on, Emilio Vela Jr., CEO of Southwest Center for Independent Living in Springfield, said, "That's not real life for most people."
Many don't have neighbors or family members to look after them, Vela said. No longer able to live in their homes, many disabled Missourians who lose state aid will rack up costly hospital visits and eventually land in a nursing home, Vela said, which will cost the state more in the long run.
Greitens had originally called for an even deeper cut to the program that would have caused 20,000 elderly and disabled Missourians to lose state assistance.
The Missouri House reversed that cut in its version of the budget, paying for in-home and nursing care by ending a property tax credit for low-income seniors who rent their homes.
But Democratic resistance in the Senate to ending the property tax credit forced legislators to come up with another plan. So instead they passed a bill that would have authorized a review of special state funds to find $35.4 million in excess money and avoid the cuts to in-home and nursing home care.
But Greitens vetoed the bill in June, calling it "an unconstitutional, one-time, fake fix to a real problem."
"This gimmick was pushed through in the middle of the night with no public hearing," Greitens said when he vetoed the bill.
State Rep. Crystal Quade, D-Springfield, said that while the bill vetoed by Greitens was not a long-term funding solution, it would have given legislators time to design one without eliminating critical services for Missourians who most need them.
"When seniors and folks with disabilities are able to afford support in their homes, it saves the state money and empowers these Missourians to live independently," Quade said. "It provides them the freedom to work and the ability to participate in our communities and economy. It allows people to maintain their dignity."
Greitens' office did not respond to a request for comment for this article.
James Stowe, director of Aging and Adult Services at the Mid-America Regional Council, said the impact of the cut will not be felt all at once. Individuals' eligibility for assistance will be determined during their annual re-assessment by the state.
For Gary Sallee of Oak Grove, the reductions begin Sept. 1.
A quadriplegic, Sallee pays a personal care attendant $9.75 an hour to get him out bed, bathe and feed him and return at night to help him back into bed.
Five years ago the state covered 6 ½ hours of his in-home care. Then it fell to 5 hours 45 minutes. As of next month the support will drop to 4 hours — meaning a payment of less than $40 for a day's worth of care.
"They keep attacking it and attacking it," said Sallee. "It's bad for the disabled and bad for taxpayers" because the alternative to in-home care is a pricier nursing home paid for by Medicaid.
He's not going into a nursing home if he can help it. To maintain the care he now receives, Sallee said he'll pay more out of pocket from his Social Security and small retirement benefit.
As for the Picketts in Kansas City, North, the loss of state money isn't the real issue, they said.
"Who's going to care for Kevin Pickett when we're gone?" said mother Sharon Pickett, 70. "This is about respecting the lives of people who need the help of others. Are the politicians making these decisions taking salary cuts?"
A checklist sent to the Picketts by the Missouri Department of Health and Senior Services itemized the care eligible for state support effective Tuesday: 10 minutes a day for washing dishes, five minutes for cleaning the bathroom and an hour for preparing meals and helping Kevin Pickett eat.
Thirty minutes for bathing, down from 45 minutes. "It takes 15 minutes just to get him situated," Morrill Pickett said. "What do they want me to do — splash a little water on him and take him out?"
But, of course, Kevin Pickett's parents will care for him morning, noon and night, even though the state now will cover only 3 ½ hours.
"I wish I could jump up and grab a glass of water on my own. But I can't," said Kevin, whose wheelchair allows him to take regular strolls to chat with neighbors.
"This is my home. It means everything to me," he said. "At a nursing home, I'd just be marking time."
Information from: The Kansas City Star, http://www.kcstar.com