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Minnesota Opinion: On cost cutting nears diminishing return:

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opinion Willmar, 56201
West Central Tribune
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From The Associated Press

Excerpts from recent Minnesota editorials:

On cost cutting nears diminishing return:

Almost everyone these days has had some belt-tightening experience. Either at home or at work, the quest for efficiency never ends -- and in that quest for maximum results at minimum expense, there are times when we go too far. Occasionally, cost-cutting strategies can cross the line of diminishing return.

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Right now, the cash-strapped state of Minnesota has little choice but to see how close it can come to that line. That's why it is changing the way disabled people are evaluated for the level of state-funded, in-home care they receive from personal care attendants.

Most of us, fortunately, will never need such care. But more than 11,000 Minnesotans depend on it to maintain their independence and quality of life, at a cost that now tops $200 million per year. More people are enrolling in the program each year, in part due to the fact that modern medicine helps people survive injuries that years ago would have proven fatal, or totally debilitating.

When public programs grow, so too does the likelihood of inefficiency and inconsistency. The personal care program is no exception, especially given that it depends on the judgment of public health care nurses across the state who assess disabled peoples' needs and determine how much assistance they require.

The state is taking steps to standardize this system. All counties must now use the same assessment tool, which is supposed to reduce or eliminate the "judgment calls" that in the past have resulted in some patients receiving more care than others who have similar needs.

The problem, of course, is that this new system has the potential to cause inconvenience and potentially life-changing results for people who've already endured more than their share of suffering. Saturday's Post-Bulletin described the plight of Randy Krulish, a 56-year-old quadriplegic from Lyle who could lose 10 hours per week of care under the new system. He says that this reduction could force him out of his apartment and into a nursing home, where the cost of meeting his basic needs would be much higher than the current $77,000 the state spends to help him lead a remarkably full life.

Obviously, it's in everyone's best interests to make sure that doesn't happen. In recent years, there has been a strong push to keep the disabled and elderly out of nursing homes as long as possible -- and it isn't just a matter of cost. People who retain at least some of their independence are healthier, happier, more-productive members of society.

State health officials know this. They are aware that if changes to the Personal Care Assistance system force some people into full-time care facilities, we will indeed have reached the point of diminishing return.

So we're not going to condemn the new assessment system before it's had a chance to work out the kinks. We'd like to think that in most cases, those who lose a few hours of in-home care will find a way to maximize the help they're still receiving, or to better combine that help with the assistance they receive from family members.

The bottom line is that as more people require this type of care, the state is duty-bound to make sure every dollar is spent effectively and fairly.

-- Rochester Post-Bulletin

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