Creating a National System for Home-and Community-Based Care
Table of Contents
- » Introduction
- » Redefining the Challenge
- » The Problem is Overstated
- » Meeting the Challenge
- Spending Health Dollars Wisely
- Improving Longterm Care
- Promoting Better Preventive Care
- Creating a National System for Home- and Community-Based Care
- Livable Communities
- Keeping Social Security Solvent
- Helping Americans Build More Retirement Assets
- Helping Americans to Work Longer
- Restoring the Federal Revenue Base
- » Conclusion
Most older people and those with disabilities want to remain independent and receive the assistance they need in their homes and communities, not in nursing homes. Currently, America has no organized system for doing this. Most of the care people need as they age is personal care, not medical care—that is, help with various daily activities such as dressing, bathing, or preparing meals—which often is provided informally by family members. Providing care at home or in assisted-living facilities instead of nursing homes can improve quality of life, as well as provide better value, thereby allowing many more people to obtain essential care.
In order to both improve quality of life and continue to contain costs, broad changes are necessary in the way care is delivered. Several important steps in this process include:
- Support family caregivers better, through financial and other resources, and by providing respite care—temporary residential care for patients that provides relief for the permanent caregivers.
- Improve access to services outside nursing homes by reorienting Medicaid’s funding toward home- and community-based services. (Currently, approximately two-thirds of Medicaid long-term care funding is spent on nursing homes and only one-third on home- and community-based services.)
- Encourage "consumer-directed" services in publicly funded programs such as Medicaid so that individuals could take more charge of their own care.
- Expand the network of local adult day care centers and provide transportation, for people needing services who are able to leave home. In addition to providing activities and personal care, these centers also could deliver many health services.
- Expand volunteer programs that provide regular, dependable services like shopping, friendly visits, or driving services. In addition, increase training and reduce barriers (e.g., liability) to volunteering. America already has a strong tradition of volunteering, and the need for a renewed effort to tap into this tradition on behalf of older people and those with disabilities is clear.