AARP researchers therefore also looked at changes in participant data over a five-year span, from 1999 to 2004. A state might be behind the national average in terms of spending yet may have reduced the number of people in nursing homes while boosting the number receiving in-home care. “We would call that a partial success,” Kassner says.
The report includes a two-page profile of every state, with pie charts showing how the state compares to the national average in terms of balancing funds and a table showing changes in participant data. Each profile describes programs and progress within that state.
AARP will host an Innovations Roundtable in August, inviting state officials and advocates to use the report and share information on best practices.
Because Medicaid is the primary payer for long-term care, how a state uses those funds can affect its long-term care infrastructure. If most of a state’s Medicaid budget goes to nursing home care, the market for entrepreneurs to develop businesses offering in-home care may be inadequate. As a result, even people who pay for long-term care out of their own pockets may have a hard time finding in-home services.
On the other hand, among states that have invested in home-based care, several have established a “single point of entry” to the long-term care system, providing one place where state residents can go to get all the information they need about options for care, whether they are eligible for Medicaid or not.
The national trend toward apportioning some Medicaid funds for home- and community-based services—which began in the 1980s—got a boost from the U.S. Supreme Court in its 1999 Olmstead decision. The high court rejected the state of Georgia’s appeal to keep two women with mental illness and mental retardation in a state psychiatric hospital long after treatment professionals recommended their transfer to a less restrictive community-based setting.
“Older people don’t want to be in institutions, either,” Kassner says. “AARP will have to ramp up its advocacy to remove the disparity in services for different populations. If we’re not going to fight for this, who will?”