People seated in a ballroom, listening to a woman on stage.

Foundation report examines dual-eligible elderly in Montgomery County

Panelists discuss their views during the Planning a Better Future for Dual-Eligible Elderly in Montgomery County seminar at the Blue Bell County Club in Whitpain Friday, Nov. 7, 2014. Photo by Gene Walsh, The Times Herald.

By Carl Rotenberg

WHITPAIN, PA - A 78-year-old Norristown woman, a widow with no children, has lived alone in a rowhouse for many years.

The retired, dietary worker has suffered through a series of medical issues including diabetes and congestive obstructive pulmonary (lung) disease. She sleeps in a hospital bed on the first floor because the stairs have become impossible.

A series of hospitalizations supported by both Medicare and Medicaid (for the elderly poor) makes the woman a prime example of why greater coordination between the two government health care systems would benefit both the woman and the health care systems, said Carol Irvine, the CEO of the Abramson Center for Jewish Life.

“Medicare serves her after a hospitalization only for a short period of time. She is on a three-year wait list for home care under the Medicaid waiver service. The issue is that (elderly) hospital patients are being referred to a nursing home for short-term rehabilitation but they fail when they are discharged home without the proper supports. It becomes a cycle of short-term hospital stays followed by brief periods at home and they start to unravel. She can become a long-term Medicaid patient in a nursing home.”

“It breaks my heart,” said Irvine. “We need stronger supports for home-based care. We need to do evaluations before they leave a nursing home or hospital and they get discharged to their home.”

Irvine also wants embedded primary care services for the elderly frail that would serve them at home rather than requiring office visits.

More than 120 care providers for the elderly, administrators and managers from Montgomery County gathered Friday to hear the recommendations of a workgroup to better serve the elderly in Montgomery County who are “dual-eligible,” meaning they qualify for both Medicare and Medicaid services. An October 2014 report called, “Planning a Better Future for Dual-Eligible Elderly in Montgomery County” was presented at the meeting at the Blue Bell Country Club.

“It is always about dignity,” said Montgomery County Common Pleas Court Judge Stanley Ott, the Orphans’ Court administrative judge. “It is the easiest thing to lose. Your work is important work. Your clients are looking for a person with a smile and a soft heart.”

Brian Duke, the Pennsylvania Secretary of Aging, said Alzheimer’s Disease affects many Pennsylvania elderly.

“Dual-eligible persons (Medicare & Medicaid) totaled 450,000 in Pennsylvania in 2012 and that includes 16,505 in Montgomery County. They are the most vulnerable elderly,” Duke said. “We need to address the gaps in coverage.”

“Pennsylvania has over 333,096 full dual-eligible individuals enrolled in its Medicaid program,” he said. “About 7,833 dual-eligible elderly live in Montgomery County.”

According to the report, they are poorer and sicker than the rest of the Medicare population. Fifty-eight percent have incomes under the poverty level compared to 10 percent on non dual-eligible Medicare participants. Twenty percent of dual eligible individuals are in hospitals or nursing homes compared to only 2 percent of non-dual eligible Medicare participants.

One man in the audience suggested a joint Medicare/Medicaid program in Montgomery County would help reduce total costs. “If we did a demonstration project it could improve care and reduce costs,” he said.

“The support of the family care givers is important. We have a competent and knowledgeable workforce. We have to support research on Alzheimer’s Disease,” Duke concluded. “The long term care report to the governor is due Dec. 1. It will go to Gov. Wolf and his team.”

Barbara O’Malley, the acting Director of Montgomery County Aging and Adult Services, said that her mother was a dual-eligible senior citizen.

O’Malley described the county’s waiver program that provides home-based services to allow sick elderly to remain in their home.

The department serves 947 elderly in the county. They are concentrated in Norristown, Lansdale, North Penn and Abington.

“Senior support centers in the county are not just bingo anymore. The county supports these centers with $1.9 million a year,” O’Malley said. “Some have WiFi Internet cafes. If you haven’t been there, you should check them out.”

Russell Johnson, the CEO of North Penn Community Health Foundation, described how the challenges of caring for an elderly relative remotely complicates the task.

“My grandmother lived in Florida. The sad reality for her was she suffered from dementia and she was unable to advocate for herself,” said Johnson. “She was treated for pneumonia at a hospital and was waiting on a gurney to return to a nursing home, but she died on that gurney alone.”

Johnson said a national survey ranked Pennsylvania 42nd of 50 states in long term care support services.

Alissa Halperin, a principal at Halperin Butera, said the rules of Medicare and Medicaid prevented the systems from coordinating care.

“The patients are likely to be more illiterate. The support programs are complicated,” Halperin said. “For years there have been new initiatives to tackle these issues.”

A follow-up meeting will be held Dec. 12 at the North Penn Community Health Foundation office. Information is available at

Montgomery County Commissioners’ Chairman Josh Shapiro was the final speaker.

“My personal passion is in delivering human services. Having a voice at the table works best when we work together,” Shapiro said. “The ‘Your Way Home’ program is an example of what the county is doing to house the homeless. We have increased that program to 55 persons a month.”

“We have one department now that deals with everything we own,” Shapiro said. “Before we had five departments. Human services should be no different. We are exploring whether we should do that for human services in a study. That study will conclude in early 2015.”

“Unless we partner with all of you, none of us will be successful,” he said. “I am focused on making those relationships work together.”

From Carl Rotenberg. (2014, November 7). Foundation report examines dual-eligible elderly in Montgomery County. The Times Herald. Retrieved from: