Editorial: Medicaid waivers real roller coaster

It is easy to have a plan. It’s a little harder to assemble it.

It is a lot harder to make it function the way it should.

Kennywood can speak to that. The idea of the Steel Curtain roller coaster has been a hit from the beginning. It’s been months in the making. And it’s been a lot of starts and stops along the way with long lines, unexpected glitches and delays.

But the implementation of Pennsylvania’s Medicaid waiver program is a lot less fun and a lot more important. And the wait? That’s so much longer.

The program is supposed to be a money-saving, reassuring alternative to expensive nursing home care for the elderly. In a Sunday article by Deb Erdley, the Tribune-Review found that, instead, many end up in a winding queue waiting for promised help.

The blankets of red tape are complicated by a drastic shortage of people to provide the care that eligible seniors need.

“Staffing of direct care has been a problem for a long time. It’s a problem in nursing homes and in home care. It’s hard work,” John Lovelace, UPMC’s president of government programs, said.

But part of the problem is just the way the pieces are assembled.

Providers like UPMC’s Community Health Choices receive a flat fee for care. The more expensive and time-consuming the care, the less profit is made.

Direct care workers make about $10 an hour — more than minimum wage but less than you can make pouring lattes at Starbucks or stocking shelves at Target.

Yes, the providers could make more, but if costs go up, would they be able to afford to provide any care?

It just shows that the whole operation is like the old joke about a moose being a horse made by a committee. But it’s not funny, because this wasn’t supposed to be a horse.

It was supposed to be a train that would get you safely through your last days, like Vilma Morgante, 100, of Lower Burrell, who had dementia and contracted infections that led to approval for 24-hour home care but a one-year wait to find it. Her journey ended July 4 when she died still waiting.

Instead of a train, we get a roller coaster, all steep drops and whiplash curves that can be scary and intimidating. And that’s just the line to get on.

Everyone involved in laying out these plans and snapping them in place should do so with this thought:

If the only thing your mother had in the world was the home she wanted to die in, rather than spending her last days in a nursing home, is this the system you would design for her?

Didn’t think so.