As someone who advocates for seniors everyday, I was disturbed by the Associated Press article running in many Florida papers February 24-25, 2013:  “DCF: Medicaid paying nursing home bill for wealthy.”  The article carried only information from a Department of Children & Families (DCF) spokesman and failed to provide an accurate picture of what DCF told the reporter was fraud, including that the contract given to the reporter and referenced in her article paid the caregiver less than 25% of what DCF claimed the caregiver had been paid. The article also failed to mention that the caregiver was providing far more services than DCF claim were being provided.

The article states that through Personal Service Contracts “patients are allowed to hire a relative or friend to oversee small aspects of their care, such as hair styling or room decorating,” and that some caregivers are paid up front for many anticipated years of service. According to the DCF spokesman, personal service contracts are used to “hide” so a “wealthy” individual is “poor enough” to qualify for Medicaid. Hiding money would indeed be abuse of our system and is fraud. DCF officials are proposing legislation to get rid of this kind of abuse.  This proposed legislation would be in addition to the laws already in place that DCF can enforce to weed out the alleged fraud described by DCF officials in the article.

We must be careful when we make new laws. While there is no doubt that a few always take advantage of the system, the great majority of seniors and their families legitimately benefited from legal Personal Service Contracts.  Based on DCF’s one-sided point of view, Senator Evers and Representative Nunez have introduced into the Florida legislature Senate Bill 1748 and House Bill 1323, which would severely limit if not eliminate payments to family members for care of the elderly because they believe it should be provided out of “consideration of the individual.”

To give personal service contract a context, Floridians must understand Florida’s nursing home staffing ratios require only about 3 hours of individual patient care per day per patient.  This means in that limited time, nursing home staff must help a patient bathe, dress, groom, eat, drink, get in and out of bed, clean up incontinence accidents or take restroom breaks, check vital signs, turn them in their beds to prevent bedsores, administer medications, monitor and prevent injuries, and provide social interaction. Staff does not decorate rooms, cut hair, shop for clothing, or mark clothing to prevent loss or theft.  Without significant monitoring and outside assistance to a resident, even in the best facilities, care can become inadequate and patients suffer.  Active family caregivers benefit facilities by monitoring and assisting patients, improving patient care.  They also benefit Florida taxpayers by filling care giving gaps tax dollars would have to be used to close.

The monitoring and care undertaken by family member caregivers present hard choices for families. Families must choose to take time off work and in some instances leave their jobs to devote the time necessary to care for that relative. There is ample research on the financial, physical and emotional stress suffered by caregivers.  Their own marriages and families suffer.  If the care DCF claims done only for love and affection, then there would be no need for businesses like Home Instead or Hopewell, who provide the services families get paid for under Personal Service Contracts.  Legitimate Personal Service Contracts allow caregivers to be paid reasonable fees for services, which eliminates some of the financial stress and sacrifice.

Nobody, except a few who intentionally exploit the system, wants anyone to abuse Medicaid and our elderly, and live unjustifiably off taxpayers. It results in a system that doesn’t work. However, that does not mean we should overreact and destroy a system that sincerely helps our most vulnerable citizens and their families while saving Florida money in the long run.