Community Based Services Key But Can We Pay For Them?

A new report from the AARP shows that nursing home residents, beds, and occupancy rates have remained nearly constant in the last five years, even though the older population has increased. Specifically, the report finds that spending for long-term care services is not a primary force behind escalating Medicaid costs. Medicaid funds spent on home and community-based services (HCBS) can serve three older people or adults with disabilities for each resident in a nursing home.

And that is the shift that is slowly taking place – home and community based service programs. I am all for the shift though I believe as a country with a World Health Ranking of 37th, one plagued with chronic disease conditions, and a boomer onslaught approaching that we will need nursing homes like it or not. So first issue we can‰Ûªt duck away from the fact that some will need care in nursing homes and that care has to be planned for and paid for differently in the future.

Sure everyone wants to stay in their homes and community based programs are key. However here is an issue. Medicaid covers a specific segment of the population not all. So while community and home based care may be paid for by people who qualify the fact is there are many more people that need community and home based services and can not access them because they can not afford them. For those people they face the same fate as many others ‰ÛÒ spending down their assets until they do qualify for Medicaid. For some reason it doesn‰Ûªt seem right that you have to become poor and destitute before you can be served.

The report emphasizes, however, that family caregivers remain the main providers of long-term care services in all the states and nationwide. By providing personal care and even health care, family caregivers help to contain costs by delaying or preventing the use of nursing home and hospital care. But that says nothing about the personal cost to the caregiver. Those costs are financial costs, worsened health, emotional distress and more. Many caregivers die before the one they are caring for.

So health care reform can not just be about acute care hospital reform. It must address the whole continuum. More about this study here.