Council on Aging ends waiting list for in-home care program

Tuesday, June 14, 2016

Elderly Services Program logo

Exactly three years after starting a waiting list to manage demand for the Hamilton County Elderly Services Program, Council on Aging has eliminated the list and is once again able to quickly enroll seniors who are eligible for in-home care services.

“I am really excited about this,” said program manager Kim Clark. “We have worked very hard to make this day happen.”

The final push came on May 25 when the number of people on the list had dropped to 92, a number low enough to allow Clark to assign each of them to one of her 28 care managers.

“That left no one on the list and I will now be making additional daily case assignments (to care managers),” Clark said. “It’s a lot for staff, but we are committed to enrolling people as quickly as possible. It is very hard when seniors and their families are forced to wait for services when they are in great need.”

The Hamilton County Elderly Services Program (HCESP) receives 90 percent of its funding from a county property tax levy. The five-year, 1.29-mill levy has enjoyed strong support – renewing in November 2012 by nearly 75 percent of voters. But a straight renewal (no increase) combined with high demand meant that Council on Aging had to begin the waiting list in June 2013, only seven months into the new levy period (2012-2017). Enrollment and financial projections showed the program to be at risk of incurring a deficit.

HCESP helps older adults remain independent within the familiar surroundings of their own homes for as long as possible. In 2015, the program helped 5,449 people age 60+ with long-term care services such as home-delivered meals, transportation, home care assistance (such as housekeeping and personal care), medical equipment, home accessibility modifications, and more. The program supplements care provided by family members, but also serves many people who have no family nearby to help them.

For a person with chronic illness or aging-related impairments, the services often make the difference between remaining at home and moving to a nursing home. For taxpayers, the cost of care in the home is a fraction of the cost for a stay in a nursing home.  It costs about $378 per month, per client on HCESP compared with more than $4,000 a month for Medicaid nursing home care.

Council on Aging manages the program via contract with Hamilton County Commissioners and also provides intake and care management.

At its peak in January 2014, the HCESP waiting list included more than 1,400 people. A triage system allowed one person to enroll for every four who went off the program (typically because they had died or declined in health and entered a nursing home). People inquiring about enrollment were told the wait would be indefinite, although enrollment was possible for people who met certain emergency criteria. At one point, the program even closed for several months.

Council on Aging took several measures to gradually reduce and finally eliminate the waiting list. They included cost reductions and contacting each person on the list to eliminate any who no longer needed services.

For the past year or so, the wait was reduced to a few months. Now, without a wait, most eligible seniors can be enrolled in about a week. The process includes an in-home assessment for eligibility, assignment to a care manager, development of a care plan, and initiation of services.

While an end to the waiting list is good news, so-called managed enrollment remains an ever-present reality for the program, Clark said. Demand remains high and funding is limited.

According to the U.S. Census, nearly one-fourth of Hamilton County households contain at least one person age 65 or older and more than one-third of the county’s older residents report having at least one disability, indicating a need for care.

More information about the program and its 2015 annual report are available at