The D.C. Department of Health failed to offer a home care option to frail or elderly residents receiving Medicaid, an option that could have saved $34 million in nursing home costs, according to a critical audit released yesterday.
The audit found that the average yearly cost of nursing home care was $75,600, compared with $10,000 for annual in-home care costs for comparable services. The report, which covers 2002 through 2005, said the city had the right to offer waivers for home care to 1,684 residents who were not given that option. Medicaid is supported by 70 percent federal and 30 percent District funding.
"Some people would like the advantage of having the option," an official in the inspector general's office said. "Medicaid would help pay for accommodations in [your] home. It cuts costs all around."
If the Medical Assistance Administration, responsible for managing the city's Medicaid program, had taken advantage of the Medicaid waivers during the period, the city could have saved up to $33.8 million, the report said.
Gregg A. Pane, director of the Department of Health, responsible for the administration, responded that it is common for states to have waivers that are not filled to capacity. He said in the past two years, the Medical Assistance Administration has doubled the number of people in the in-home nursing program to more than 1,100.
The inspector general's office did find an improvement this year, but said the city could have done a better job. "The purpose of maintaining the elderly and adults with physical disabilities in their homes is . . . two-fold," the report said. "First, many people maintain a higher quality of life in their homes with assistance from direct care providers. Second, the cost of home health care is much lower than the cost of nursing home care."
Pane said one of the major problems in providing in-home nursing care is the shortage of affordable housing for elderly Medicaid patients.
"The primary reason that more persons are not diverted from nursing homes is that there is not adequate housing for this population," Pane said. "Older persons and persons with disabilities cannot participate without a place to live."
The inspector general's office also criticized the health department for trying to use contractors instead of government employees to administer the nursing home program. The audit said city officials did not prepare a cost-benefit analysis to compare the benefits of using District government employees with private contractors.
The inspector general's office also released a report yesterday on the city's foster care program. The audit was intended to determine whether the Child and Family Services Agency, which is responsible for placing neglected and abused children in new homes, is managing the program in an "efficient, effective and economical manner."
The audit found that the agency was able to account for 99 of the 100 foster children in the sample. The remaining child had a history of running away and in June was picked up by the police, the audit said.
"In our opinion, based on our visits to each child's foster home, most of the children appeared to be satisfied with their foster care providers and living in safe and stable environments," the auditor wrote. "Many of the foster parents interviewed appeared to be committed caregivers and supporters of the children."
While the audit found that many of the social workers knew the children and had good relationships with the families, the agency's records contained mistakes. The addresses of nine of the 100 children were incorrect, and two of the incorrect addresses were for post office boxes, which is unacceptable for foster care providers, the report said.
