Reducing the Cost of Long Term Care
Kenneth R. "Ken" Plum
 
        Government at all levels is facing two challenges that conflict with each other:  scarce resources exacerbated by the economic recession and an aging population requiring new and sometimes costly services.  Medicaid that provides health care funding for those in need is the fastest growing segment of state budgets.  With rising health care costs and an aging and growing population requiring assistance, states face difficult choices.  People are living longer than ever before, and their end of life care is more expensive when it can involve many years in a nursing home.
 
        A recent Insight on the Issues report, "Taking the Long View:  Investing in Medicaid Home and Community-Based Services is Cost-Effective" (March, 2009), by the AARP Public Policy Institute (www.aarp.org/ppi) found that states that promote home and community-based services over institutional care have had the effect of slowing the growth in Medicaid long term care expenditures while at the same time improving consumer choices.
 
        Individuals of all ages prefer to stay in their homes and their communities for medical services.  Appropriate counseling for individuals and families can make clear the choice of receiving care at home rather than in a nursing home when the option is feasible.  Programs can also provide services and support for family caregivers whose unpaid assistance is a major factoring preventing or delaying nursing home care.
 
        While consumers want the option to stay in their homes as long as possible, the AARP study found that there is an institutional care bias in the rules that govern Medicaid spending.  In fact, home and community based care is an option under current Medicaid rules.  The AARP report raises an alarm that in the current fiscal crisis there may be a tendency to cut optional services such as home and community based care.
 
        The report offers compelling reasons why home and community based programs should not be reduced.  Evidence in the report shows that states that invest in home and community based care realize real savings in the long run over states that depend primarily on institutional care.  Medicaid monies are actually saved with the use of this option.  Reducing home and community based care reduces consumer choice and leads to an increase in nursing home use.  I will be working in the state legislature to maintain the home and community care option as a way to reduce the cost of long term care and to preserve consumer choice.