Mayor Marion Barry will propose doubling city funding for personal care aides for low-income elderly and disabled patients from $1 million to $2 million for this fiscal year, but the number of patients in the home-care program is being frozen at the current level, city officials said yesterday.
"This program has been chronically underfunded" in past budgets, said Elizabeth Reveal, Barry's budget director. The increase for fiscal 1983, to be submitted as part of a revised budget later this month, will be just enough to fund it at current caseload levels, she said.
The D.C. public health commission has decided that it cannot add to the number of patients it will provide with personal care aides, who help bathe, clothe and feed patients in their homes, because of a lack of nurses to supervise the aides.
In the past, the city has not limited the caseload, and it started growing "much too fast" as the elderly population increased, said Dr. Ernest Hardaway, D.C. commissioner of public health. New patients now will be added to the caseload only as current ones leave, he said.
"We had gotten spread too thin with fewer RNs registered nurses " than were needed, Hardaway said. "I have been concerned about the quality of care those people are getting."
At the same time, the city is trying to negotiate an agreement with private home health care agencies, such as the Visiting Nurses Association, to supervise personal care aides, said Paul Lavigne, long-term care administrator. The city would supplement Medicaid payments, and this system could be in place as soon as next month if negotiations go well, Lavigne said.
Involving the private sector is a better long-term solution than hiring more nurses for the city program, another option for dealing with high demand, Lavigne said.
About 700 Medicaid-eligible D.C. residents currently have personal care aides, who are paid $3.50 an hour by the city. A nurse is required to visit each patient regularly to make sure that proper care is being given.
Some patients have not been visited by nurses as often as they were supposed to be, city officials acknowledged. If the quality of care is not maintained, federal Medicaid payments for the program could be jeopardized.
Hospital social workers said limiting the program could mean that some people will have to stay in hospitals who otherwise could go home if they had a personal care aide to help them. If this happens, it will cost the city more in Medicaid payments than for the aides, the social workers said.