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In-Home Care Crisis

Nursing Home Don’t Put Me

Severe State Budget Cuts Force Families to Make Hard Choices

Shirley Miller, an 85-year-old widow, has lived on the 10th floor of an aging rent-subsidized apartment building in Winter Park, Fla., for 21 years, close to her friends, church and doctors. Miller remains sharp and independent, but one health problem after another has left her unable to maintain her daily routine on her own.

So a year ago she applied for help with cleaning, meals and personal care from the state’s Medicaid and elder care programs. Though she qualifies for help, she was put on a waiting list.

Today Miller weighs barely 100 pounds. She eats only when friends bring her food. She cries because she cannot clean her home or even bathe herself properly.

And she has yet to receive any help from the state.

“I’m afraid now I’ll die before they get to me,” she says, in a voice just above a whisper.

Programs that help older Americans like Miller live independently in their own homes—and out of nursing homes—have not been keeping pace with the needs of people age 85 and older, the fastest-growing age group. Across the nation more than 300,000 individuals are already on Medicaid waiting lists for home or neighborhood services.

Now, shocking budget deficits produced by the deepening recession are forcing state lawmakers to freeze or even cut these lifelines for older residents. At least 46 states plus the District of Columbia face shortfalls this year or next; and an estimated $350 billion in state deficits loom over the next 30 months, according to the Center on Budget and Policy Priorities (CBPP), a Washington think tank.

“Every program, every bill and every policy issue will be affected by the economy,” William Pound, executive director of the National Conference of State Legislatures, wrote in a recent NCSL report on the budget outlook.

At least 22 states and the District of Columbia are cutting or proposing cuts to home and community services or are significantly increasing what low-income people must pay for them, according to the CBPP. In a recent national survey of state area offices on aging—which direct many such state programs—70 percent said they anticipate “severe” budget cuts.

Alabama, for instance, has ended homemaker ser­vices for more than 1,000 older adults. Rhode Island now charges low-income older residents more for adult day care. And the Florida legislature, grappling with deficits of more than $2.8 billion for 2009, lopped almost $2 million from the state’s Community Care for the Elderly program—which supplies home care, meals, adult day care and a host of other services—before Republican Gov. Charlie Crist vetoed the cut.

Such reductions around the nation could undo progress in shifting funding for long-term care away from nursing homes and into services that give people more choices for where to live. Some of these home services are fully funded by the states; others are part of Medicaid, the joint state and federal health care and long-term care program for low-income Americans. On average more than 21 percent of all state spending goes to Medicaid, which makes its programs a tempting target for budget cutters.

By law, state Medicaid programs are required to pay for nursing home care for those who qualify for help with long-term care, and the majority of long-term care dollars go to these facilities. But the federal government also gives states the option to develop services that help people who qualify for long-term care to remain in their own homes—a choice nine of 10 older Americans prefer over nursing homes, according to AARP research. From 1995 to 2007, total Medicaid spending on such services more than doubled to 41 percent, according to the Kaiser Commission on Medicaid and the Uninsured. These programs now serve some 2.8 million Americans.

Reducing these services, experts say, is a false economy because it forces people into nursing homes, which cost the state more. Florida’s Community Care for the Elderly, for example, spends about $5,000 a year to help one older person remain in her home; more extensive state Medicaid home services cost $8,000 per person, and the average cost of a Florida nursing home is $65,000.

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