Help pack a million meals for struggling seniors on Sept. 11. Volunteer today


AARP Staying Sharp: Keep Your Brain Healthy


The tablet with free 24/7 customer support. Learn More


Military and Veterans Discount


AARP’s Picture Your Retirement Sweepstakes

Enter the $50K Picture Your Retirement Sweepstakes. Ends 8/31/15. No purchase necessary. Enter for Official Rules.


AARP Games - Play Now!


Learn From the Experts

Sign up now for an upcoming webinar or find materials from a past session.


Planning for Long-Term Care for Dummies

Get expert advice on planning for your own or a relative’s future care needs.

Learning centers

Get smart strategies for managing health conditions.



Heart Disease


Most Popular



State Slipping as Leader in Home- and Community-Based Care

Budget cuts are threatening those programs

Oregon State Page News April 2011

A home-care worker has helped Dorothy Willis, 85, stay in her Portland apartment. With two types of arthritis, Willis would like more help, but Oregon now has a waiting list for home-care services. — Robbie McClaran

Ten hours each month for six years, a care worker has dropped by Dorothy Willis' cozy Portland apartment to do laundry and clean, tasks the 85-year-old with two types of arthritis cannot manage.

The $200 worth of state-provided monthly care has kept Willis out of a nursing home and in her apartment, where she'd like to stay, she said, " 'til my toes curl up."

As she's become more prone to dangerous falls, Willis has requested five more hours of assistance from the care worker, but she's been put on a waiting list.

Her situation illustrates the challenges facing Oregon's long-term care system, which has been a national leader in caring for people in home- and community-based settings. Since 1981, the state has helped residents stay in their homes, but now the system is under pressure as the state grapples with a projected $3.5 billion two-year budget shortfall (PDF).

States are required to offer nursing home care by federal Medicaid regulations. But home- and community-based care is not mandated, so it's easier to cut.

Cutting payments to providers could cause home-care workers to leave the profession or refuse patients with complex needs, said James Toews, policy adviser for the Seniors and People with Disabilities Division. That could lead older people to "bump up to a higher level of care, which ends up costing more."

Nursing home care, at about $6,400 a month, costs the state two to three times more, on average, than home-based care.

As the population ages, the number of Oregonians who need long-term care is expected to double within 20 years.

A 2010 human services report (PDF) warned: "If Oregon's in-home and community care system falters, the migration into nursing facility settings at two to three times the cost cannot be stopped … without jeopardizing the operation of the entire state Medicaid program."

Oregon spends about $3.2 billion on long-term care, with $1 billion from the state general fund and most of the balance from federal funds, mainly Medicaid. In his proposed two-year budget, Gov. John Kitzhaber, D, has called for deep cuts in payments to nursing homes and home- and community-based services for long-term care.

"These cuts are disproportionate and hurt poor seniors, mostly women, while eliminating thousands of home-care workers' jobs," said Rick Bennett, director of government relations for AARP Oregon.

In 2003, Oregon's last major recession, the state cut long-term care spending by eliminating some prevention and outreach services, increasing caseloads, reducing payments to providers and tightening eligibility requirements. That last move cost 5,000 people their home and community care.

Next: Penny-wise and pound-foolish. >>

Topic Alerts

You can get weekly email alerts on the topics below. Just click “Follow.”

Manage Alerts


Please wait...

progress bar, please wait

Tell Us WhatYou Think

Please leave your comment below.


Discounts & Benefits

From companies that meet the high standards of service and quality set by AARP.

Walgreens 1 discount membership aarp

Members can earn 50 points per $1 spent on select health & wellness products at Walgreens.

member benefit aarp hear usa

Members save 15% on easy listening devices and more at the HearUSA Hearing Shop.

Eye Med 4 Membership Benefit AARP Discount

Members save up to 60% on eye exams and 30% on glasses at Target Optical.

Membership Benefits Discounts Email Genius

Brain boost? Get AARP email for access to memory exercises & more that help you focus.

Rewards for Good

Your Points Balance:

Learn More

Earn points for completing free online activities designed to enrich your life.

Find more ways to earn points

Redeem your points to save on merchandise, travel, and more.

Find more ways to redeem points