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Spending More on In-Home Care

Expansion of Home First program could help residents stay out of nursing homes

Ohioans overwhelmingly want their older family members to get the care they need at home, rather than in an institution. A surprising three out of four would support a tax increase for that to happen, according to a recent statewide AARP poll.

See also: The challenges of caregiving.

“The numbers are very, very strong, especially in the economic climate we’re in here in Ohio,” said Bill Sundermeyer, AARP Ohio associate state director.

AARP is not advocating a tax increase, but wants more existing state funds dedicated to in-home services.

Sundermeyer said he hopes the poll results will bolster efforts to expand in-home care for the elderly—which will be critical as Ohio’s population grows older and Medicaid costs put increasing pressure on the state budget.

State demographics underscore the need for change: Those 85 and older are the state’s fastest growing population segment, and the number of Ohioans over 60 is expected to increase by a third from 2007 to 2020.

In the poll, 85 percent said the state should make it a top priority to help people stay in their homes as long as possible. Two-thirds want more money for home services, even if it means cutting funds for nursing homes.

“Not everyone who ends up in a nursing home really needs to be there,” said Kathy Keller, AARP Ohio communications director. In-home care is not only popular, it’s much less expensive, she said, costing about one-third as much as nursing home care.

When it came to supporting new taxes, home-based long-term care outpolled police protection, jobs, K-12 education and health care. The poll also showed three-fourths of those surveyed had a positive attitude toward people who care for the elderly.

The poll was taken in the fall and has a three-point margin of error. The sample of 800 registered voters was evenly split between people younger and older than 50, but the results showed no real difference between age groups, Sundermeyer said. “We tested it and found that … AARP’s membership is pretty reflective of the general population.”

Sundermeyer plans to use the poll to help persuade lawmakers who set policy for long-term care. His message: Support for in-home care is politically popular. AARP hopes to see a bill introduced this year that would take another step in broadening access to in-home and community-based care, without raising taxes.

In 2005, Ohio adopted Home First, a program that lets Medicaid-eligible nursing home residents move back into their homes without having to wait for an opening in one of the programs for home- or community-based care. Assisted living was added as an option for Home First in the recently adopted budget.

Advocates would like a Home First-type option for people who may be about to enter a nursing home, said Larke Recchie, executive director of the Ohio Association of Area Agencies on Aging.

“We want to try to catch them before they … go to a nursing home,” said Recchie, who has been working with Sundermeyer on the issue.

There is broad agreement that Ohio spends too much on nursing homes and needs to increase access and options for community-based alternatives.

Ohio ranks 43rd in terms of how much money it spends for home- and community-based care versus institutional care, said Barbara Riley, director of the Ohio Department of Aging. “There is a great need for better balance.”

Nursing homes account for about three-fourths of Ohio’s Medicaid long-term care spending for older and disabled adults. “The estimate is that long-term care, which now consumes 24 percent of the state budget, will eat up 48 percent of the budget within the next 10 years if we stay where we are,” Sundermeyer said.

Vince McKelvey is a freelance writer based in Dayton, Ohio.

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