LifeSpan Resources says PathWays transition has been 'devastating' for agency

SOUTHERN INDIANA — LifeSpan Resources Chief Business Development Officer Lucy Koesters said the state’s PathWays for Aging program has been “devastating” for the organization and other Area Agencies on Aging in Indiana.

The state rolled out the managed care program for seniors in 2024, causing a major shift for LifeSpan Resources. The change included the transition of case management away from local AAAs under the Aged & Disabled Medicaid waiver and directed it to coordination by three large insurance companies, including Anthem, Humana and UnitedHealthcare.

Koesters said these changes have been detrimental to the agency’s clients, and the agency lost two-thirds of its previous case load. The agency serves Clark, Floyd, Harrison and Scott counties.

“We were at about 3,000 case-managed clients before PathWays, and we are under 1,000 now,” she said. “So we have 2,000 clients out there loundering. They are calling us in a panic because they don’t know who to call.”

LifeSpan Resources has been around for 50 years, and it is known in the community, Koesters said. But with the switch to PathWays, clients have had to pick an insurance company for managed care, and it has been difficult for many to navigate.

“The communication from the health insurance companies has been really minimal at best,” she said. “And a lot of our former clients, they’re very low income. They’re on Medicaid. Many of them have multiple disabilities or maybe low education, and it’s just a lot of hoops to jump. And we’re trying to help them to the best of our ability, but they don’t know who to call. They don’t know who their service coordinator is.”

When PathWays first began, LifeSpan Resources contracted with two out of the three insurance companies involved. However, the state no longer requires them to contract with AAAs for managed care, and all of those contracts have ended.

This has been a “nightmare” for the agency, Koesters said.

“We’ve lost half our staff,” she said. “This devastated us. We have had to lay off a lot of our case managers because we had no contracts.”

The Medicaid waiver program allowed LifeSpan Resources to “shore up money” from programs where it was losing funds, she said. This includes transportation, which is “so important and critical to so many people in the community and always comes up as one of their largest unmet needs.”

The agency’s transportation programs helps clients get to doctor’s appointments and medical care such as dialysis and cancer treatment, as well as allowing them to run errands such as grocery shopping.

“But transportation never makes any money,” Koesters said. “It loses money. Look at what’s happening with TARC. I mean, everybody’s losing money on it. It just threatens those critical programs that the waiver – the successful running of that business – helped shored up programs like that.”

The transition has also negatively affected the agency’s Meals on Wheels program, creating a waitlist for the home-delivered meals provided to homebound individuals in the community.

“We did not have a waitlist for eight years because we had running profits off other businesses… we didn’t have to put anyone on a waitlist,” Koesters said. “Well, we started a waitlist this year. This first month, we put 20 people on it. The second month, it jumped to 47, and the last report, it’s over 80.”

“I am so upset [and] beside myself that we have this many people so quickly just waiting for the basic necessities of life, which is a meal, and that meal is so important to these folks that are homebound with disabilities.”

The Meals on Wheels service helps keep people in their homes instead of going into a nursing home, which is much more costly, Koesters said. A news release from LifeSpan Resources states that providing “one home-delivered meal costs the state only dollars per day (or average of $2,500 per year,” whereas a “nursing home placement costs the state and taxpayers hundreds of dollars per day (or average of $82,000 per year.”

The news release quotes Debbie Andre, a 71-year-old former LifeSpan Resources client who was on the Medicaid waiver program. The Jeffersonville resident lives alone and has life-threatening disabilities that require in-home supports, and she was upset that she would no longer have local representation through LifeSpan.

“I built a great relationship with my case manager and she understood my needs,” Andre said. “She knew how important it was for me to have care at home – without it, my health would quickly deteriorate. Now, under this new PathWays thing, they keep changing my case manager. I’ve had three different ones since the change.”

She voiced concerned about losing a service called Integrative HealthCare Coordination that provides a nurse to help her with tasks ranging from scheduling appointments to managing medications. According to the news release, it is “being challenged as a duplication of services under PathWays and in danger of being cut completely.”

“There is no feasible way that any PathWays case manager will spend the same amount of time (about 16 hours per month) addressing and assisting me with my needs when they have at least 60 other people to help,” Andre said. “And that’s if I can even find out who my case manager is. I don’t know who to call for help.”

The move to PathWays has also caused challenges for local businesses that provide home care. Koesters mentioned the difficulties for PurposeCare, a home care agency in Jeffersonville. Nicole Minton, a patient advocate with PurposeCare, is quoted in the news release stating that the new managed care coordinators “have cut hours of service drastically for our Pathways clients, or they are not getting approved for services at all – those at home and those residing in assisted living facilities.”

Koesters also noted that although PathWays was intended to save money, it is actually over budget by more than $300 million this year.

“This was supposed to save money, and instead It’s costing the state a lot of money,” she said.

The agency is reaching out to elected officials to raise awareness of the issues caused by the new long-term care program.

“It’s just wrong on so many levels, and people are suffering,” Koesters said. “People are suffering because of it. Our clients are suffering.”

Koesters said LifeSpan Resources is participating in the Angel Tree program, and “donations are pouring in like never before” due to the needs in the community.

“There’s been so much in the news about funding programs being cut,” she said. “Nonprofits are suffering. Clients are not getting what they need. And just like all that stuff with SNAP being cut – people are very generous in this community, and our boardroom is filling up with donations right now. We’ve wrapped over 100 boxes already. So that’s good, but that’s just a once-a-year delivery.”

She emphasizes that LifeSpan Resources continues to serve as the local AAA, and it is looking into developing different business models that could help it care for its clients.

“Our mission is promoting independent living for people of all ages,” Koesters said. “We’ve been here for 50 years. We have no intention of leaving. The community is stepping up with lots of donations. We’re looking for people to make planned gifts, which would be critical to the sustainability to help us serve thousands of Southern Indiana residents.”

“Until you have cared for an aging person in your family, you don’t realize how critical these services are. And no one wants to say, I want to live in a nursing home when I’m 90 years old.”

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