Carl Meyers was concerned about his ability to care for his wife, Edith, when she came home from the hospital after surgery and a stroke five years ago.
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"I thought, 'Hoyer hoist? What's a Hoyer hoist?' " the 85-year-old Westerville resident recalled, referring to a type of hoist that helps caregivers safely lift a person from a bed to a chair. "I've never taken care of anybody before."
His concerns eased once Edith, 84, qualified for a home-based Medicaid program that covers a number of services, including daily visits by health aides. They were glad to have the opportunity to keep Edith out of a nursing home. They're not alone in that desire.
A 2011 survey of AARP Ohio members found nine out of 10 think it's extremely or very important to have long-term care services that help family members stay in their own homes as long as possible. But only about half of those interviewed felt well informed about such services.
Bonnie Kantor-Burman, director of Ohio's Department of Aging, said she hopes to make these types of services easier to understand and more widely available.
"When we know what people want, and it's appropriate, and it happens to cost less, it's a pretty easy decision to make," she said.
By next year, the agency wants half of its Medicaid clients enrolled in home- and community-based programs, which typically cost about a third to half as much as nursing homes. Currently about 42 percent are enrolled in such programs, with the balance receiving nursing home care.
A number of initiatives have been proposed to pave the way. Starting this summer, Gov. John Kasich, R, wants Medicaid's long-term care funding placed in one unified budget.
Ohio now spends about 24 percent of its long-term care budget on home- and community-based services for older adults and people with physical disabilities. By comparison, states such as Washington, Minnesota and Oregon spend up to 62 percent.
Ohio is moving in the right direction but needs to accelerate its efforts, said Robert Applebaum, director of the Ohio Long-Term Care Research Project at Miami University's Scripps Gerontology Center in Oxford.
The state's aging and disabled populations are projected to skyrocket. Between now and 2040, Ohio's 65-and-older population is expected to double to more than 3 million. The older population with severe disabilities is expected to double to about 300,000.
"We can't afford to double the number of nursing home beds. That would break the bank," Applebaum said.
To further strain the system, steady increases in disability numbers are also anticipated for younger age groups.
"Given the population growth, Ohio must invest in home- and community-based services in this budget," said Jane Taylor, AARP Ohio state director. "A lack of action now creates a spending imbalance we can't afford in the future."
AARP Ohio continues to push for reform, testifying at state budget hearings and lobbying legislators and the governor's office to shift more money toward keeping people in their homes as long as possible. It also has provided background information and talking points to its members and encouraged them to speak on the issue to their local lawmakers.
Bonnie Dingess, director of long-term care programs for the District 7 Area Agency on Aging in southern Ohio, encourages older people and their families to plan for long-term care.
"Many folks come to us when they're in a state of crisis," Dingess said. It's easier to start with a lower level of services at home and ramp up later as needed, she said.
All 12 of Ohio's area agencies on aging offer free, in-home assessments. Call your local agency, or 1-866-243-5678 toll-free, or go to ohioaging.org, to learn more.The assessments include full medical and financial reviews, said social worker Linda Oiler of District 7. Using that information, she can educate people on all the programs available to them.
Older residents in 72 of Ohio's 88 counties benefit from dedicated tax programs covering everything from meals to transportation. And not all require Medicaid-level income eligibility.
For those who do qualify for Medicaid, PASSPORT is the state's biggest home care program, with nearly 32,000 people enrolled.
For Edith and Carl Meyers, the program allows the couple, married for 64 years, to stay together. When aides arrive to bathe and dress Edith, Carl can run errands, knowing his wife is comfortable, with her belongings within reach."There's just something about being home," Carl Meyers said. "It's good therapy. It makes you feel better."
Sarah Hollander is a freelance writer living in Cleveland, Ohio.