TESTIMONY OF CATHERINE EDWARDS, PhD - EXECUTIVE DIRECTOR
MISSOURI ASSOCIATION OF AREA AGENCIES ON AGING
JANUARY 22, 2013
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Mister Chairman, members of the Committee and guests - good afternoon.
My name is Catherine Edwards. I am the Executive Director of the Missouri Association of Area Agencies on Aging. Collectively, we represent the 10 Area Agencies on Aging that exist throughout Missouri. On behalf of ma4 and the seniors across Missouri we represent, thank you for the opportunity to speak with you today.
Our public face is best known by the 244 Senior Centers that we maintain throughout the state. But, our responsibility, as established by the Older Americans Act, is much broader.
The Area Agencies represent the front line in providing vital services, programs and information to Missouri seniors and their caregivers, including home-delivered meals, disease prevention, transportation, public benefits counseling (like Medicare), and in-home services. In 2012 the AAA’s provided over 9 million units of service to Missouri’s seniors.*
Today, however, I want to focus once again on the nutrition program. Two years ago, I testified before you on the impact of the $1.4 million cut in meals funding the AAA’s experienced in 2010. Because of your efforts over $900,000 was restored to the program last session, and we thank you for that.
This partial restoration helped to prevent cuts to the meals programs for thousands of older adults across the state and provided approximately 160,000 additional meals to seniors statewide.
However, since I appeared before you two years ago and we began this conversation, there have been two major changes: 1) the cost of the program is rising at an even more rapid rate and 2) the numbers of seniors in Missouri are increasing on a daily basis. Based on those two factors alone, to replenish the level of service lost, it would now require $1,000,000.
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*The unit depends on the service. Examples:
For meals, it is a meal served or delivered.
For transportation, it is a one way ride.
For I & A, it is a contact with information and follow up provided.
Case management is one hour of service.
INCREASED COST OF MEALS
Over the past five years, the area agencies have experienced a steady increase in the cost of meals as each of us are very aware every time we go to the store or fill up with gas. The impact of meals funding cuts will be magnified as the cost of meals continues to increase.
FUNDING TRENDING DOWNWARD
As you can see from the funding trend charts in your background materials, in general, funding for the AAA’s has been trending downwards for the past five years. Federal funding is fairly flat, with the exception of the infusion of ARRA funds in 2010 on a temporary basis. State funding has been steadily decreasing through budget cuts in the General Assembly and through Governor Withholdings.
EROSION OF PROGRAM
What is the impact of this funding trend? We have examined the data gathered by the state’s National Aging Program Information System (NAPIS) and we are seeing a downward trend there too in the number of people served in the home delivered meals program. Between 2007 and 2012 the number of people served has declined from 34,241 to 31,683.
This downward funding spiral is eroding the program and the safety net it provides for seniors most likely to enter a nursing home without them. And, it is threatening the program’s ability to serve the emergent senior population who will need this service. We know from the latest census, for example, that the fastest growing age group within the senior population is those 80 and above and those 90 and above, in other words those who tend to be the most vulnerable. We also know that over half of the seniors we serve live alone--we are often their only resource. As the number of people who reach the age of eligibility jumps (i.e. the baby boomers), even more pressure will be placed on this program. The number of seniors in Missouri is expected to increase 87% between 2000 and 2030.
COST-EFFECTIVENESS
Researchers from Brown University found that states who invest in the home-delivered meals program under the Older Americans Act are more successful in helping seniors remain in their homes.
Even after taking into account state spending on Medicaid-sponsored home and community-based services and other long-term care market factors, the researchers found home-delivered meals provided through the Area Agencies on Aging were the only statistically significant factor that influenced differences in the number of low-care nursing home residents.
The researchers also calculated that states could reduce their percentage of low-care nursing home residents by one percentage point for every $25 spent per senior, per year above the national average.
The study is published in Health Services Research.
The study also noted drivers who deliver meals are able to observe and monitor the environment in which the seniors are living as well as the seniors themselves. If seniors do not respond to a delivery, they can be checked on, which serves as an additional safety measure.
SOURCE: Brown University, news release, Dec. 4, 2012
In Missouri, if only 90 seniors (less than one person per county) enter a nursing home because of the loss of the home-delivered meal service, the state will spend MORE in MO HealthNet (Medicaid) general revenue match for their nursing home care than the state would have spent if it provided the full $1.4 million (lost in 2010) in general revenue for the home-delivered meals. **
On average, services (e.g. case management, meals, transportation, and in-home) provided by the AAA’s are approximately 1/5 the cost of nursing home care.
We thank you for your confidence in our programs over the years and we ask again for your support now when cost effective, outcome based programming is most needed.
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**Average MO HealthNet cost for a nursing home bed is $132.00 per day. Medicaid participation rates are variable – MA4 assumed a 40% state match rate for this calculation.
BACKGROUND INFORMATION
ABOUT THE HOME DELIVERED MEALS PROGRAM
The home delivered meals program is designed to deliver a nutritionally balanced meal that represents one-third of a typical adult’s Recommended Daily Allowance of nutrients to homebound individuals. Participants must be 60 years of age or older and physically or mentally unable to leave their homes. Priority is given to people who have no immediate family members available to assist in meal preparation or delivery; individuals in greatest economic and social need; and people who are in the protective services program of the Missouri Division of Senior and Disability Services.
A high percentage of these meals are delivered by local volunteer drivers. State funding for this program is combined with federal funds, client contributions and other private and public donations to expand the reach of the program.
During 2012, the 10 Area Agencies on Aging delivered approximately 5 million meals to Missouri seniors in their homes.
When the Older Americans Act established the nutrition (meals) program, it was because America’s seniors were living in poverty and going hungry. Over the past five decades the program has helped turn that situation around -- but we must remain watchful and not slip back. Despite our advances, 9% of Missouri’s seniors continue to live in poverty with a median income of about $27,000. The meals programs help people live independently for as long as they can by keeping them strong – and that goal becomes more difficult every time we ratchet back on our ability to serve them.
ABOUT FUNDING
In FY 2010 the Missouri General Assembly cut the home delivered meals program by $1,421,354. Policymakers stated at the time that although it was a core cut, it was their intention to restore the cut in the next fiscal year. (A core cut is a permanent cut to the budget versus a one-time cut). When this cut occurred, ARRA funds were used to “back-fill” this GR loss for FY10, but still resulted in a net loss of approximately $200,000.
In 2010 the General Assembly did not restore the funding for FY11. For FY11, there were no ARRA funds resulting in a GR decrease of approximately $1.4 million for the home-delivered meal program with no amelioration. In FY 2010 federal stimulus dollars filled the gap. Moreover, the area agencies took several measures to protect the meals for seniors programs -- they cut staff, cut other services such as transportation or legal services, increased local fundraising -- all to protect this core program. In FY12 the General Assembly partially restored the funding by allocating $941,620.
State Funding for Home Delivered Meals Program
Ongoing State Funding
2008-2013
ONGOING STATE FUNDING2008 / $12,466,573
2009 / $12,096,784
2010 / $9,335,053
2011 / $9,041,042
2012 / $9,555,884
2013 / $10,026,694
Missouri Funding Trend Chart
2008-2013
TOTAL FUNDING / ONGOING FEDERAL FUNDING / ONGOING STATE FUNDING / TEMPORARY FUNDING2008 / $39,482,230 / $27,015,657 / $12,466,573 / $0
2009 / $40,389,158 / $27,928,107 / $12,096,784 / $364,267
2010 / $39,068,898 / $27,744,977 / $9,335,053 / $1,988,868
2011 / $36,825,485 / $27,751,941 / $9,041,042 / $32,502
2012 / $37,172,904 / $27,617,020 / $9,555,884 / $0
2013 / $37,813,177 / $27,786,483 / $10,026,694 / $0
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