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I’m Not That Old Yet

Ohioans want to avoid moving into nursing homes as long as possible

If it weren’t for regular assistance from an aide and nurse at her apartment in suburban Cincinnati, Mabel Reed knows she’d be headed for a nursing home.

See also: Getting help to age in your home.

Reed, 73, is diabetic and has heart disease, high blood pressure and a leg infection. An aide comes to her home on weekdays to help with bathing, laundry, shopping and housekeeping. A nurse visits daily to check her vital signs, wrap her legs to prevent swelling and set up her medications.

“Thank God,” she said, “for PASSPORT,” Ohio’s popular home-based service for Medicaid clients. “I feel if I give up and go into a nursing home I’ll have lost all control of my life. To me, I’m not that old yet.”

Nine in 10 older Ohioans want to stay in their homes as long as possible, AARP surveys show. Yet Ohio lags behind other states in Medicaid spending on home and community care.

Ohio spends about 17 percent of its Medicaid long-term care budget on home and community services; the rest is spent on nursing homes. Oregon, a national leader, spends more than three times that amount—56 percent—to help people in their homes.

AARP wants Ohio to shift more money toward keeping people in their homes as long as possible.

“They can’t have the choices they want until Ohio really gets serious about balancing Medicaid dollars,” Jane Taylor, AARP Ohio senior state director, said. “Many states have started making changes.”

The push for reform isn’t just about choice, but about making better use of limited money, Taylor said. Home and community services cost considerably less than institutional care.

An Ohio Business Roundtable study estimated the state could save $900 million a year in Medi­caid costs by boosting its percentage of noninstitutional care to the national average of 27 percent.

If the state doesn’t make changes, Medicaid could consume half of Ohio’s total budget by 2020, according to Robert Applebaum, director of the Ohio Long-Term Care Research Project at Miami University’s Scripps Gerontology Center in Oxford. The demand for long-term care will skyrocket as the population ages.

“We’ve created a system that’s not sustainable,” said Applebaum, who serves on AARP Ohio’s executive council.

The Ohio Department of Aging supports a shift toward more home- and community-based care, but budget cuts have slowed progress toward that goal, director Barbara Riley said. The department has scaled back new PASSPORT enrollment from an average of 900 people a month to 680, resulting in waiting lists.

Riley urges people to call 1-866-243-5678 toll-free for details about senior services in their communities.

For the first time, the new state budget creates a process to divert nursing home dollars to home and community alternatives. Historically, the money has been allocated into separate pots.

“Some people need nursing home care. And our job is to make sure that they get good care,” Riley said. “But my job moving forward is to make people aware of other alternatives.”

The department eventually wants to switch to one unified long-term care budget so that Medicaid dollars follow consumer choices. A coalition including AARP Ohio, businesses and social service organizations is working toward that goal.

Sarah Hollander Sarah Hollander is a freelance writer living in Cleveland.

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