By Stephen Smoot
Last week Jason Parsons, the President and CEO of Blue Ridge Care, penned an opinion piece published by the West Virginia Press Association. Virginia-based Blue Ridge Care provides health care services for the elderly who wish to remain in their home. Two of the services are for chronic health problems and also hospice services, available in many parts of West Virginia.
One option they offer, however, is not. That service is known as the Program for All-Inclusive Care of the Elderly, or PACE. The Medicare.gov website states that “PACE helps eligible older adults who need nursing home-level care meet their health care needs in the community, by giving them coordinated care and support services” in their home. It adds that “PACE covers all Medicare-and Medicaid-covered care and services.”
Parsons shared a story of a Berkeley County daughter who once traveled almost daily to and from her mother’s Winchester home. Her mother “lives alone, with diabetes, heart disease, and mobility challenges that make daily life difficult” and needed daily “help with medications, meals, and bathing.” After being accepted into PACE, the last now receives these services plus “coordinated medical care, transportation, therapy, meals, and social support through one program.”
Loosely stated, the program has many of the coordinated aspects of hospice programs but for seniors whose health conditions have started to make living at home difficult or dangerous. Hospice provides end-of life care in the home or in specific facilities.
In March 2023, the National Advisory Committee on Rural Health and Human Services released a report entitled “Programs of All-Inclusive Care for the Elderly in Rural America. It states that “the model was developed in the early 1970’s by staff at On Lok Senior Services (a nonprofit corporation) in San Francisco to meet the LTSS needs of older adults who immigrated from Italy, China, and the Philippines.” The report, intended as an information presentation to the Secretary of Health and Human Services, explains many of the problems that make PACE-type care a challenge for a state like West Virginia. The Mountain State’s sparsely populated counties and also the mountain, hill, and hollow extended drive times create identified boundaries in providing these services.
“A 2021 study conducted by the University of Minnesota found that State Offices of Rural Health (SORHs) cited transportation as the greatest barrier to older adults successfully aging in place in rural areas,” but not in the fashion most may think. Seniors with health care problems often have significant difficulties tolerating long vehicle rides.
Overcoming such problems to make PACE a viable option for West Virginia requires analyzing an urban model to see how it can adapt to the rural environment “Flexibility is needed for rural PACE organizations to maximize partnerships and resources. Additionally, the Committee thinks that there is potential for more partnership with existing safety net providers including Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs), Community Health Centers (CHCs, and Local Health Departments (LHDs)” West Virginia has a number of agencies and services, both professional and volunteer, that, if coordinated, could provide more help to caregivers, better care to patients, and improved outcomes from both a health care standpoint and possibly also the taxpayers’ as well. It is well known that in most cases seniors living safely at home need a less costly slate of services than those in residential facilities.
Adopting PACE will provide immediate relief for rural volunteer rescue squads. Currently, many residents will call 911 for EMS assistance in moving a senior from his or residence to a car, or to take a senior to a doctor appointment. With rural EMS all over West Virginia operating with dangerously limited resources, in many cases these calls may leave a patient with a life-threatening emergency waiting for the first available transport.
The number of those providing care at home for beloved family is staggering, but not widely known because those who do so usually provide this care quietly within their own households. AARP estimates that 250,000 West Virginians provide unpaid senior care in their homes, accounting for approximately $3 billion that taxpayes would otherwise cover.
It is quite possible that an investment in rural-appropriate PACE services could keep more seniors at home where they usually live longer and happier lives, while also lowering the barrier for families who want to care for their senior loved ones with both compassion and safety. The State Legislature should take the next year to study the issue and, if it could work, run a bill that lays out a thoughtful and well considered program so West Virginia can join the many participating states offering this.
Another thing to discuss is Civil Asset Forfeiture.
One of the originators of the legal concept of Civil Asset Forfeiture, West Virginia Circuit Judge John Yoder, eventually became one of its biggest critics. Civil asset forfeiture, through a complex legal maneuver that Yoder helped to develop, allows for law enforcement to use the civil system to seize property of suspected drug criminals. The key word is suspected, not convicted, not even charged, but suspected. Often times the only “suspicious” action lies in carrying a large amount of cash on ones person.
Even the innocent find it difficult or almost impossible in some jurisdiction to recover their property.
Yoder and his colleagues developed CAF as a weapon against major drug cartels and American organized crime. It was meant to allow law enforcement to quickly dismantle an organization’s capabilities. Yoder stated on Fox News before his untimely passing that he believed it would only be used against well-monied organizations, not poor suspects who had no wherewithal to protect themselves if not guilty of a crime.
The federal government also said in 1913 that the federal income tax would only apply to the top two percent of wage-earners.
In 2012, a number of Delegates from Berkeley and Morgan counties gathered to discuss with a panel their plans for the next Legislative session. They pledged to support repealing state laws that permitted CAF seizures, despite the opposition of law enforcement agencies whose budgets had come to rely on funds seized and never reclaimed. That movement fizzled, but Delegate Chuck Horst (R-Berkeley) has picked up the issue.
He sponsored House Bill 4049, which “ends civil forfeiture in West Virginia and replaces it with criminal forfeiture only.” No property can be seized without a criminal conviction coming first. The bill would also mandate “prompt post-seizure hearings, allowing owners to quickly challenge unlawful seizures.”
This also puts forfeitures under the highest standard of proof, “beyond a reasonable doubt” as opposed to “reasonable suspicion” or less reason to seize.
The current “act provides that ten percent of the forfeiture proceeds must be given to the prosecuting attorney’s office that filed the forfeiture proceeding. The balance is placed in a law enforcement investigation fund to be used by the law enforcement agency that seized the forfeited property.”
An interesting point to note, the West Virginia State Constitution, Article 12, Section Five, reads “the net proceeds of all forfeitures and fines accruing to this state under the laws thereof and by general taxation of persons and property or otherwise. It shall also provide for raising in each county or district, by the authority of the people thereof, such a proportion of the amount required for the support of free schools therein as shall be prescribed by general laws.”
The section is entitled “Support of Free Schools.” In other words, the verbiage of the State Constitution leaves little doubt that “forfeitures” go not to law enforcement, but to the school system.
Chief Justice Menis Ketchum echoed these concerns in a dissent on a State Supreme Court of Appeals case, Tricia Dean v. State of W. Va. and Jefferson Co. Sheriff’s Dept. (Separate) 2012.
There is no doubt that too many law enforcement agencies around the nation rely on CAF to meet their budget. According to the Cardinal Institute, “between 2000 and 2019, West Virginia police agencies generated an additional $70 million” from federal sharing of their seized asset caches. Jessica Dobrinsky of the Cardinal Institute, however, wrote that the policy “is an explicit denial of the fundamental American principle ‘innocent into proven guilty’” and those caught in it “face a severe deprivation of due process.”
West Virginia long ago had offices of “Justice of the Peace” as opposed to Magistrate. The old “J.P.s” received their pay out of fines collected, but the State Legislature eventually saw this set up as a conflict of interest that incentivized the minor judges to fine more and/or more often. CAF provides too much incentive to “police for profit.” It’s not that state and local agencies are necessarily abusing the system, but it’s time to remove the potential for said abuse.