Jon Sannes used to spend his days caring for his elderly mother.
Because his mother qualified for in-home services, Sannes received $1,200 a month to provide her care such as meal preparation, bathing and transportation to medical appointments.
But in September that funding was cut nearly in half. Sannes returned to a 60-hour a week job and now pays somebody else to care for his 11-month-old son and to help prepare meals.
"My mom still gets good care," Sannes said. "But I'm not able to spend much time with her."
Sannes and his mother, Shirley Hopewell, are two victims of recent state budget cuts for services that allow low-income people to postpone moving into a nursing home.
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Cuts are necessary because demand has outpaced the budgeted funds, said Linda Wright, director of aging services for the state. As a result some home-based programs receive less funding and others accept fewer clients.
After the cuts were made, Sannes' mother worried she would become too much of a burden. "She won't say it, but she worries I'll send her to a nursing home," he said. "I won't, but she worries about it."
Home- and community-based services range from someone coming in once a week to do light housework to 24-hour care.
"Most elderly clients don't complain" about the cuts, said DeLana Duffy-Aziz, Cass County adult services supervisor. "They take it in stride. They don't want to make waves."
Nearly 130 cases in Cass County have been affected by the cuts. Some clients receive fewer hours of homemaker services, others are placed on waiting lists to receive services for which they qualify.
Sylvia Renfrew, 80, of Fargo waited about a month after a fall before somebody was assigned to help her get ready in the mornings and to do light housework around her home. Before that, her children took time off work to assist her.
"The (home-based) services have been a life-saver," Renfrew said. "My kids all have jobs so they can't be here every day. I'm not so bad that I need to go to a nursing home. I just need help off and on."
The state Legislature's recent promise to appropriate emergency money so nursing homes don't have to face reimbursement cuts left advocates for home-based services frazzled.
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A recent survey by AARP found that 86 percent of its North Dakota members want to remain in their own homes as long as possible.
In-home care usually costs less, too. A client in a nursing home cost Medicaid an average of $2,815 per month in 2001, according to the North Dakota Department of Human Services. Services for that same client, if he or she chooses in-home care, cost $1,333 per month.
"When you look at the numbers, it's so obvious," said Chuck Stebbins, community services coordinator for Freedom Resource Center in Fargo. "When you cut funding to in-home services, you eliminate the service that keeps the person independent. As a result, a lot of people are forced to move into nursing homes. People shouldn't be faced with just one choice."
The North Dakota County Directors Association recently released a statement asking state policymakers to consider how limited access to in-home care could result in an increased demand for nursing home services and significant increases in state costs.
Right now the state commits 21 percent of DHS' budget to nursing home care. About 3 percent of the budget is designated for home-based services.
For the 2003-05 biennium, DHS has requested about
$3 million more for in-home care than it did in 2000-02, Wright said. If approved, the amount will allow the state to keep pace with demand, but it won't allow any growth, she said.
That isn't good enough for people like Sannes and his mother.
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"I think the government has forgotten about her," Sannes said. "Just because she doesn't pay taxes, they think there's no more need for her.
"It just doesn't make sense to cut reimbursement for services that help her stay happy and healthy."
Readers can reach Forum reporter Erin Hemme Froslie at (701) 241-5534
