Tom Clark can still remember the day he received the phone call from his mother.
Jersey Clark, of Columbia, was in a nursing home recovering from a fall when she demanded to return to her home. No one was selling her house and putting her in a nursing home, she insisted.
Eventually, she got her way. But she couldn't live at home without assistance. The family was able to use savings and some federal aid to pay for the home-based care she required, including around-the-clock assistance, meal preparation, light cleaning and companionship. When Clark's mother died in May 2009 at age 93, he felt it was on her terms.
"She was like, 'Hell, no. You couldn't blast me out of my house with dynamite,' " Clark said. "Those were her wishes and, by God, I was going to honor her wishes."
Like Clark's mother, most South Carolinians prefer to age in their own homes, an AARP survey has found. But the expense of the needed in-home services are out of reach for many, advocates for increased funding for home- and community-based services say.
"I've never met a person who said they preferred a semiprivate institutional room," said Johnny Belissary, president of the South Carolina Association of Personal Care Providers. "Budgets are tight, funds are being cut. And many states have looked at home- and community-based care as a way to stretch Medicaid dollars."
It costs the Medicaid program about $32 a day for home-based care compared with $127 a day for nursing homes. The state spends nearly $500 million annually for nursing home care, but about $142 million for home and community care.
Nursing homes provide around-the-clock skilled nursing care. Providing more money for home- and community-based care would duplicate services, nursing home advocates say.
"There is a need for a continuum of care, and those who believe otherwise are shortsighted and ill informed," said Randy Lee, president of the South Carolina Health Care Association, which represents the state's nursing homes. "Each aspect of the long-term continuum of care has its place. Each is cost-efficient at providing services at that level."
Spending for institutionalized care is federally mandated, while it's optional for home- and community-based care. In tight budgetary times, state funds for those services are often cut.
That's exactly what's happening in the Palmetto state, said Jeff Stensland, spokesman for the state Department of Health and Human Services.
"We are at a point now where we have the longest waiting list [about 4,100] I think we've ever had for home- and community-based services, and that's a direct result of not having the state resources," Stensland said.
State leaders are aware of the problem. "In these most challenging economic times, we must be ever so diligent in seeking ways to be efficient and cost-effective," Lt. Gov. Ken Ard, R, said in a written statement to the AARP Bulletin. "This will allow us to ensure that our greatest generation has its challenges met … Seniors should know that we understand and take seriously this important responsibility."
Sen. Thomas Alexander, R-Oconee, chairman of the Senate Health and Human Services Subcommittee, said, "Home- and community-based services are preferred and could save the state money. That's welcome news for a budget writer when you can help people live independently with a better quality of life and save money."
Until the state provides more funding for home- and community-based services, South Carolina residents like Clark are left to wonder where they will spend their final days.
"Hopefully, I'll be the smart one to go to an institution where they'll take care of me," the 57-year-old man said. "But would you rather be in your own home with your own stuff in the final analysis? Yes, I think so."
Katrina Goggins is a freelance writer based in Columbia, S.C.
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