For many Tristate seniors who fall into the so-called “Medicaid gap,” aging in place isn’t at all easy.

Older people who are mostly independent, but who require some light supportive services to stay safe and well, often don’t qualify for in-home care coverage through Medicaid, which has strict income guidelines.

Luckily, lower-income seniors here in Cincinnati, who might otherwise fall into the care gap, have for many years been able to rely on the Elderly Services Program (ESP) to receive the help they need.

What is ESP?

The Elderly Services Program supports over 12,000 Hamilton, Butler and Warren County seniors who do not qualify for Medicaid, but who also cannot afford to hire help on their own.

More than 90 percent of the program’s costs are supported by senior services tax levies in each of its constituent counties (Clermont and other surrounding counties have their own, tax-supported senior services programs).

“A typical ESP client,“ per the Council on Aging of Southwestern Ohio, “is a woman in her 80s. She lives alone on a modest income of between $1,400 - 1,700 per month, from which she pays between $240 - 320 in out-of-pocket medical costs.”

That income level is too high to qualify for Medicaid, but too low to allow such a client to hire in-home care on her own.

Hamilton County’s senior services levy expires in 2017 and will be up for a no-increase renewal on the ballot this November, placing in jeopardy ESP’s ability to continue serving the Tristate’s elderly.

Although renewals have typically passed without significant controversy, poll outcomes are never certain — particularly in off-election years, when voter turnouts are usually lower. A grassroots push by even a small number of levy opponents could be enough to deny critical services to thousands of our most vulnerable, senior neighbors.

With subsidy assistance from the ESP, she was able to bring in a personal care aide, who comes to her senior apartment once a week for two or three hours at a time.

Given that the futures of Medicaid and, indeed, of our nation’s health care system are increasingly uncertain, many seniors in our region are justifiably worried about recommendations Hamilton County’s Tax Levy Review Committee recently made to county commissioners.

The group recommended reducing the senior services levy renewal period from its current five years to three years. It also urged a comprehensive review of the Council on Aging — which administers ESP on behalf of the participating counties — to look for cost-cutting opportunities.

Some local seniors fear that such calls could lead to reductions in service. And some are speaking up.

Making the case for continuing to support seniors’ independence.

In June, four Affordable Living by ERS residents, from Maple Knoll Meadows and St. Paul Village, spoke at the Tax Levy Review Committee’s public hearing about the importance of the county’s Elderly Services Program and about how the program allows them to stay independent in their own apartments.

Nancy Knott, 72, has lived at Maple Knoll Meadows for seven years.

“I really like it here,” she emphasized. “I have a lot of friends here.”

Knott told the Tax Levy Review Committee that, in 2009, when she was first diagnosed with Parkinson’s and began receiving Social Security disability income, she was no longer allowed to work. That severely limited her ability to hire her own in-home care providers.

Knott can no longer drive and has great difficulty performing some household chores.

“I have a problem bending down to clean the shower, and toilet and sink,” she explained. “Changing the sheets would be very difficult.”

With subsidy assistance from the ESP, she was able to bring in a personal care aide, who comes to her senior apartment once a week for two or three hours at a time.

The aide does laundry, cleans, and goes to the grocery store for her every other week. Having an assistant who can help her with those tasks, she told the committee, has been, “a big help for me.”

Knott and her peers all noted that ESP services are essential supports that enable them to continue living independently in their apartments. This assistance keeps residents like Knott and others out of  Medicaid-funded nursing homes which is more costly to taxpayers. They urged the Tax Levy Review Committee and Hamilton County commissioners to preserve funding for ESP and for the Council on Aging.

The senior services levy, as well as levies for indigent care and for mental health care, will be listed on Hamilton County’s November ballot. If you’re a voter here, we urge you to research beforehand all the services that these levies provide, so that you’ll be well-informed about their impact.

And if you, like we, believe that in-home senior services and meal deliveries should be protected and appropriately funded, we hope you’ll consider voting in favor of renewing the Hamilton County senior services levy later this year.