As published as an editorial in The Hartford Courant, April 27, 2008.

Care Can Be Best At Home

By Stan Kosloski and Brenda Kelley

The recent widespread concern about the quality of care in state nursing facilities is certainly important and the response by the governor and General Assembly has been appropriate.

But another important aspect of long-term care isn't receiving the attention it deserves, raising serious quality of life, consumer choice and cost concerns. Referred to as "in-home support" or "rebalancing the system," it is both cost-effective and humane.

Currently, only one-third of Connecticut's $2.3 billion Medicaid expenditures are spent on providing home- and community-based care. The vast majority of funds support institutional care, such as nursing facilities. Our system is out of balance.

A Long-Term Care Needs Assessment was conducted in 2007 by researchers at the University of Connecticut Health Center's Center on Aging and presented to the legislature in January.

The groundbreaking study — the first in 20 years — reveals that the overwhelming majority of respondents, nearly 80 percent, express a strong desire to remain in their homes, with home care services and supports as needed. Yet recent trends show this is not the direction we are taking.

Waiting lists for community-based services force individuals to abandon their dreams of staying at home and force many into nursing facilities. Others who are working to return home from a nursing facility must delay or even abandon their plans because the needed support is not available. To take one example, the Medicaid personal care assistance waiver, which enables people who qualify to hire support staff to help them stay at home, has a waiting list of over 70. We can do better.

Comparing Connecticut's system with community living options in other states is instructive. From 1995 to 2005, Connecticut increased spending for home- and community-based services by less than 10 percent, with most of the change coming in the late '90s.

During this same period, Oregon increased its community funding by 51 percent, Massachusetts by 22 percent and Vermont by 29 percent. The average increase for all 50 states was 20 percent. We can do much better.

The legislature is in session until May 7. The state budget is not set. Here are some items that should be on the table:

  • Fully support a new and exciting Medicaid program called Money Follows the Person that will enable Connecticut residents to use the money spent on nursing facility placement to move back into a home in the community.
  • Establish a Long-Term Care Trust Fund to reinvest the money saved the state by Money Follows the Person into expanded home- and community-based care options.
  • Establish and fund a single point of entry (also referred to as an aging and disability resource center) to inform elders, people with disabilities and their families about all options and help maximize consumer choice.
  • Add additional slots to the waiver programs and state-funded pilots that currently have a waiting list or are at capacity.

Currently, 27,000 people reside in Connecticut nursing facilities, where the average private-pay cost for one year exceeds $109,000. Services used by people living at home, who have similar support needs, typically cost between 25 percent and 30 percent of nursing facility costs.

In other words, on average, three people with support needs can be provided services in their homes for the same amount that nursing facility placement would cost for one person. The services that most people prefer are generally less expensive than the services they are often forced to use because of the lack of less expensive alternatives!

Connecticut's soaring population of older adults and persons of all ages with disabilities who need long-term care deserve the dignity of living in their homes and communities. They should have choices when it comes to long-term care.

Action taken now by the legislature can be both humane and fiscally responsible. It's a win-win for all concerned.