[Congressional Record Volume 154, Number 114 (Friday, July 11, 2008)]
[Senate]
[Pages S6600-S6601]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         STRENGTHENING MEDICARE

 Ms. STABENOW. Mr. President, I wish to share with my 
colleagues a disturbing report about the challenges

[[Page S6601]]

home health professionals are facing while delivering service to our 
Nation's seniors. Too many home health providers have seen not only 
declining reimbursement but also increasing fuel costs.
  Last week, the New York Times highlighted how these challenges are 
affecting several Michigan families and home health providers. Sadly, 
this is a problem facing the entire Nation. The National Association 
for Home Care & Hospice's, NAHC, Foundation for Hospice and Homecare 
released a study finding that nurses, therapists, and home care aides 
who serve chronically ill elderly and disabled patients drive nearly 5 
billion miles each year. But escalating gasoline prices threaten their 
ability to reach their patients, particularly in rural areas. NAHC 
reported that, in Michigan, home health providers drove over 161 
million miles to make nearly 12 million visits to seniors and other 
patients in need of homebound services.
  As a short-term solution, I urge my colleagues to join with me in 
calling for the Medicare rural home-health add-on, which expired in 
2006, to be reinstated. The rural add-on bonus will have a huge impact 
on the ability of home health providers to serve seniors, particularly 
in remote, rural locations.
  I ask that a copy of the New York Times article be printed in the 
Record.
  The material follows:

                [From the New York Times, July 5, 2008]

              As Gas Prices Soar, Elderly Face Cuts in Aid

                            (By John Leland)

       South Haven, Mich.--Early last month, Jeanne Fair, 62, got 
     her first hot meals delivered to her home in this lake town 
     in the sparsely populated southwestern part of the state. 
     Then after two deliveries the meals stopped because gas 
     prices had made the delivery too expensive.
       ``They called and said I was outside of the delivery 
     area,'' said Mrs. Fair, who is homebound and has not been 
     able to use her left arm since a stroke in 1997.
       Faced with soaring gasoline prices, agencies around the 
     country that provide services to the elderly say they are 
     having to cut back on programs like Meals on Wheels, 
     transportation assistance and home care, especially in rural 
     areas that depend on volunteers who provide their own gas. In 
     a recent survey by the National Association of Area Agencies 
     on Aging, more than half said they had already cut back on 
     programs because of gas costs, and 90 percent said they 
     expected to make cuts in the 2009 fiscal year.
       ``I've never seen the increase in need at this level,'' 
     said Robert McFalls, chief executive of the Area Agency on 
     Aging in Palm Beach, Fla., whose office has a waiting list of 
     1,500 people. Volunteers who deliver meals or drive the 
     elderly to medical appointments have cut back their miles, 
     Mr. McFalls said.
       Public agencies of all kinds are struggling with the new 
     math of higher gas prices, lower property and sales tax 
     revenues and increases in the minimum wage. Some communities 
     have cut school bus routes, police patrols, traveling 
     libraries and lawn maintenance. The St. Paul Police 
     Department is encouraging officers to use horses and bikes. A 
     number of state agencies, including those in Utah, are going 
     to four-day workweeks to save energy costs and reduce 
     commuting expenses for their employees.
       But older poor people and those who are homebound are 
     doubly squeezed by rising gas and food prices, because they 
     rely not just on social service agencies, but also on 
     volunteers.
       In the survey of agencies, more than 70 percent said it was 
     more difficult to recruit and keep volunteers.
       Mrs. Fair, who has limited mobility because of diabetes, 
     lives on $642 per month in Social Security widow's benefits, 
     and relies on care from her son, who often works odd hours, 
     especially during blueberry season. ``He says, `You belong in 
     a nursing home; I can't take care of you,' '' Mrs. Fair said.
       The delivered meals allowed her to eat at regular hours, 
     which helped her control her blood sugar levels, she said. 
     Last year she lost her balance during a change in blood sugar 
     and spent a month in a nursing home.
       With no meal delivery in her area, Mrs. Fair said her home 
     aide, who comes three times a week, must pick up frozen meals 
     from a center in the next town.
       ``If my aide can't get the meals, maybe I can get my pastor 
     to pick them up,'' Mrs. Fair said. ``I can't travel even to 
     the drop-off center.''
       Val J. Halamandaris, president of the National Association 
     for Home Care and Hospice, said that rising fuel prices had 
     become a significant burden for the 7,000 agencies 
     represented by his group, with some forced to close and 
     others compelled to shrink their service areas or reduce 
     face-to-face visits with patients.
       A recent survey by the group concluded that home health and 
     hospice workers drove 4.8 billion miles in 2006 to serve 12 
     million clients. ``If we lose these agencies in rural areas, 
     we'll never get them back,'' Mr. Halamandaris said.
       The agencies, which have suffered from Medicare cuts in 
     recent years, are lobbying Congress to account for fuel 
     inflation in reimbursement rates and to reinstate special 
     increases for providers in rural areas, a program that 
     expired in 2006.
       In Union, Mich., a town among flat corn and soybean farms 
     near the Indiana border, Bill Harman, 77, relies on a home 
     aide to take care of his wife, Evelyn, who is 85 and has 
     Alzheimer's disease. Mr. Harman has had to use a wheelchair 
     since 2000 because of hip problems.
       But the aide, Katie Clark, 26, may have to give up the job. 
     She lives 25 miles away and drives 700 miles a week to 
     provide twice-daily visits, helping Mrs. Harman dress in the 
     morning and get to bed at night, feeding her, doing chores 
     around the house. ``And putting up with a grumpy old man,'' 
     she said jokingly to Mr. Harman. Her weekly income of $250 is 
     being eaten up by gas expenses, which come to $100 a week.
       ``Some weeks I have to borrow money to get here,'' said Ms. 
     Clark, a single mother of two, adding, ``They're just like 
     family to me.''
       Agencies say they are facing a shortage of home aides, 
     because the jobs have low pay and often require long drives 
     for a few hours of work. ``They can't make any money,'' said 
     Laurence Schmidt, administrator for the Oswego County Office 
     for the Aging, in rural northwest New York. ``So they'll get 
     jobs in nursing homes, where they can drive to one place and 
     work a full shift. That is a statewide problem.''
       Mr. Harman said that he thought a previous aide might have 
     abused his wife, but that Mrs. Harman was comfortable with 
     Ms. Clark. On a recent afternoon, Mrs. Harman called Ms. 
     Clark ``honey''; Ms. Clark, walking Mrs. Harman to the 
     bathroom, kissed her nose. Mrs. Harman said she was going 
     home. Ms. Clark said, ``You are home, silly.''
       For her work, Ms. Clark receives $9 an hour. If she leaves, 
     Mr. Harman said, he could not care for his wife.
       He said that when they married, she raised his five 
     children as if they were her own. When Mrs. Harman started to 
     develop Alzheimer's 8 or 10 years ago, he said, ``I promised 
     her, `Don't worry, I'll take care of you as long as I can.' 
     ''
       Without an aide, he said, he would have to put his wife in 
     a nursing home, and probably need to live in one himself.
       For many isolated older people, home delivery of meals 
     provides not just nutrition but also regular contact with the 
     outside world, said Elaine Eubank, president of CareLink, a 
     nonprofit agency that serves elderly people in six counties 
     in Arkansas, delivering 480,181 meals to 18,000 people last 
     year. Because of gas prices, Ms. Eubank said, one center in 
     Monroe County had closed its kitchen, and others were 
     delivering frozen meals two days a week.
       Mary Margaret Cox, executive director of Meals on Wheels in 
     Greeley, Colo., which serves meals to 300 people a day, said 
     that her agency was trying to avoid shifting to frozen meals, 
     but that it was getting hard to recruit students and teachers 
     who volunteer during the summer.
       ``Most don't have anyone else checking up on them daily,'' 
     Mrs. Cox said of her clients. ``If we do more frozen meals, 
     they'll lose that daily contact.''
       Many agencies said their revenues--which come from state, 
     federal and private sources--were not keeping up with their 
     increased expenses. ``We've had one increase from Medicaid in 
     11 years,'' Ms. Eubank said. ``But home care and Meals on 
     Wheels keep people at home for a fraction of the cost of a 
     nursing home. The state pays for care once they're in a 
     nursing home. So our cuts may cost more than they save.''
       Sandra Prediger, 70, who still drives a car, said higher 
     gas prices hit her every time she needed to go to the doctor. 
     From her senior apartment in South Haven, she was barely able 
     to pay her bills before gas prices rose.
       ``I try to help some of the ladies around here, driving 
     them to doctors or to the store,'' Miss Prediger said, but a 
     round trip to her doctor or the beauty shop now costs $26 in 
     gas. She has had to ask her friends to pay half. ``I hate to 
     ask,'' she said, ``because they have less than me.''
       Her Social Security check arrives on the third of the 
     month. For the few days before, her local gas station lets 
     her write a postdated check to fill up.
       On July 2, Miss Prediger had no money and owed money to the 
     gas station. ``In a few minutes,'' she said, ``my friend 
     Shirley will probably call and say, `Can you take me to Wal-
     Mart to get needles for my diabetes?' What else can I do?''
       Barbara Blumka, 67, of Buchanan, Mich., said she would 
     continue delivering 15 or 16 meals a week though she could 
     not afford it. She is driving a Dodge Caravan, a ``gas 
     guzzler,'' she said.
       ``I see these people's faces,'' said Ms. Blumka, who gets 
     her meals at a senior center. ``They're so appreciative. I 
     think of all the people who took care of my mother in the 
     nursing home. This is my way of giving thanks.''
       Christine Vanlandingham, development officer for the three-
     county Area Agency on Aging, said that in three to six 
     months, the agency would have to start cutting meal 
     deliveries to clients who get them now.
       But Ms. Blumka will continue to help the homebound. Her 
     nieces and nephews were buying her an adult tricycle for 
     other travels. ``It's neon blue,'' she said. ``I'll ride it 
     to the senior center.''

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