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As reported by, January 12, 2010.

Options for Long-Term Care Are Complex, Lack Accessibility

By James Zipadelli

The Connecticut Commission on Aging says the state’s population over 65 will rise by 64 percent by 2030, and they advise caregivers and families to plan ahead so that they don’t make decisions about a loved one’s care under duress.

“Planning for long-term care needs is a complex process that many people, understandably, find difficult,” the Commission’s executive director Julia Evans Starr says. “Too often the planning only begins when a crisis occurs which often causes even more stress and limits people’s choices in care options. We recommend that people begin planning for their long-term care needs, and those of family members, as soon as possible and make sound financial planning part of the process.”

There are two big questions: First, can a system be created that respects the rights of individuals and gives them more options for less money?

That is what Dr. Julie Robison and her colleagues at the Center on Aging at the University of Connecticut Health Center would like to see. In June 2007, they issued an assessment on Connecticut’s long-term care needs. The case study was modeled after a national study in eight states, Arkansas, Florida, Minnesota, New Mexico, Pennsylvania, Texas, Vermont, and Washington. Congress mandated the national study in 2003 to see whether there could be a “more equitable balance” between Medicaid dollars being spent in “institutional care”, such as nursing homes, and “community-based care” – such as home care or assisted living facilities.

How much does it cost?

Medicaid expenditures account for 14 percent of the state’s budget, Evans Starr says.

A resident who pays for privately funded care at a nursing home will spend on average $119,000 per year, Robison says. By contrast, a live-in home companion will make about $70,000. It should be pointed out that many nursing homes accept Medicare and Medicaid, and the potential cost savings vary because it depends on the individual’s needs.

Evans Starr also says that according to the CT Home Care Program for Elders (CHCPE), it is $12,156 to keep a CHCPE client at home versus $78,610 for a nursing home for someone on Medicaid. Evans Starr adds the $12,156 is for the state-funded CHCPE clients; it is actually $18,000 for those on the Medicaid waiver portion of the program.

According to Evans Starr, in FY2009, 53% of Medicaid long-term care recipients received home and community-based services while 47% are in institutions.

“While this represents a gradual improvement, we look to leading states like Oregon, with 85% of folks receiving services in their communities, and know we have a long way to go,” Evans Starr says.

According to Robison, in FY2008, of the Medicaid LTC dollars spent:

  • 37% of the dollars were spent on community care
  • 63% of the dollars were spent on institutional care

“The bad news is that the people in the institutions are using almost 2/3 of the Medicaid long term care dollars,” Robison says. “The people in the community are using 1/3 of the dollars. So when we look at things like rebalancing… that shows you can serve people for less money in the community than people in institutions.”

Solutions to providing long term care in Connecticut

“It’s going to take support to build and sustain the community based infrastructure,” Robison said. “We need to have regulations that are flexible enough so people can hire and fire their own staff (self-directed care). This can even include hiring family members.”

If they do choose a facility such as a nursing home, residents should consider several factors, Robison says. What kind of facility is it? How many people live in the facility? What about privacy and autonomy?

“Nursing home owners would be really smart to expand their business plans for long-term care… so they may want to have part of their facility as assisted living. Maybe open an adult-day center,” Robison says. “They might want to think about providing home health care. With the aging baby boomers, there may still be enough people to keep nursing homes full just because there are a lot more people who will need long-term care. What’s most important is that there is a continuum of services so that people have a choice, and the quality is paramount.”

Evans Starr says the Medicaid waiver system needs to be simplified for residents and easier to qualify for.

“Historically, Medicaid is institutionally biased,” Evans Starr says. “For someone on Medicaid to receive home and community-based services they need to fit into one of the narrowly defined and difficult to access Medicaid waivers.  We as a state clearly need to restructure the waiver system to make it much easier for people to have the option of staying home versus going into a nursing home.”

Robison and Evans Starr say that the financial crisis is a great opportunity for Connecticut to figure out the best way to provide those options to residents.