At the center of Lawrence’s second homicide of 2013 were, allegedly, a man’s concerns over his wife’s ongoing health problems.

Larry L. Hopkins, 67, is scheduled to return to Douglas County District Court on Wednesday for a hearing that will determine whether a mental health evaluation will find him competent to stand trial in the Nov. 5 shooting death of his 61-year-old wife, Margaret.

For years, Margaret Hopkins suffered from arthritis, diabetes and nerve damage before knee problems further immobilized her. Neighbors recalled Larry Hopkins serving as her primary caregiver despite his own health history that includes heart problems and at least one recent stroke.

Area health care service providers say the Hopkinses fit a not uncommon profile of a caregiver reluctant to ask for help and a patient who fell into an age gap keeping her from some services. Though providers describe this area as rich with health options, they also describe waiting lists — mostly due to depleted funding — and age and income requirements as obstacles for some in need.

Falling into a gap

Along with Douglas County Senior Services, the Jayhawk Area Agency on Aging is among the most-referred providers of caregiver support in town. The JAAA’s caregiver support specialist, Michele Dillon, said services are typically for those 60 and older. But in many areas, those below the 65-year-old threshold are “kind of really stuck in a gap.”

Provisions such as the Senior Care Act, which is a non-Medicaid program that offers in-home care for residents 60 and older, have wait lists caused by low funding. And to receive Medicaid, Dillon said, one has to first apply for disability if the person is younger than 65.

“Yeah, it’s a struggle,” she said.

That leaves as one of the few remaining options for those above 55 but younger than 65 the Program of All-Inclusive Care for the Elderly, which expanded into Douglas County in January.

To become eligible, PACE Lawrence site director Beth McKenzie said, applicants must first participate in an evaluation to be declared “nursing-home eligible.” If they’re not overly dependent, patients will then work with the program and their caregiver to tailor attention to the types of care required. Those on Medicare or Medicaid can use PACE with a monthly co-pay a possibility based on the patient’s income.

One of the largest hurdles, Dillon said, is still the relative newness of the program — and the deluge of often dense health care news.

“People are just so overwhelmed with health care information in general,” Dillon said. “But we are definitely out there.”

The waiting game

Cynthia Lewis, the Visiting Nurses of Lawrence’s chief operating officer, said most insurance companies are able to cover home health service, typically short-term care. Often, she said, a patient must be deemed unable to leave the home. For those on Medicaid, she said, there is no such requirement but reimbursement is very limited. Meanwhile, Dillon estimates that there is a three-year wait list for the Physical Disabilities Waiver for Medicaid-eligible residents ages 16 to 65 who meet the criteria for nursing home placement because of a disability.

Lewis cited cuts in state funding as having spawned such long waiting lists — not uncommon for such services.

“As belts tighten at the state and federal level the ability at the local level to serve the people we want to becomes a challenge,” Lewis said.

It is still unclear what resources may have been available to the Hopkinses. Larry Hopkins retired from Kansas University Libraries in 2010 after 19 years, but Margaret’s work history — aside from accounts that she had a history in social work — is less clear. Jill Jess, a KU spokeswoman, said retirees are eligible for the state’s retiree health insurance plan if they were enrolled in the state’s program at the time of their retirement. Spouses, meanwhile, can be added to the plan during any open enrollment period.

Some low-income Kansans can qualify to receive care in their homes to be paid for with Social Security income — with a catch. In Kansas, those receiving Social Security income can keep only $747 of it to pay for food, shelter and other living expenses. That gives the state the eighth-lowest personal income allowance in the country, according to a 2010 AARP Public Policy Institute study cited in a Journal-World story last month.

“I don’t know a lot of people that can live on $747 a month,” Dillon said. “I think a lot of people have difficulty meeting that. Anything above that you have to pay some out of pocket for those services. If there are other expenses, they just may not choose (the services).”

Asking for help

Then there is the need for more caregivers to ask for help in the first place: Lewis said many who are most in need of services are the least willing to request them.

“We have those sad circumstances where people need these services but don’t let people in to help,” Lewis said. “Those scenarios present themselves on a somewhat regular basis.”

Others maybe don’t know how to make the initial connection, or don’t have anyone to reach out on their behalf. Lewis said family, friends or services like Meals on Wheels do often reach out to the VNA, but the proper care for people needing help while living in isolation can be delayed for years.

“If people are more isolated, then no one may know,” Lewis said. “That’s a tragedy, but how do you identify all the many needs?”

At the JAAA, Dillon often encounters caregivers reluctant to ask for help. A lot of time, she said, they think they should be performing the task alone — something she constantly works to convince them isn’t the case.

“Otherwise, I get a call from them in a crisis saying I can’t do this anymore,” she said.