John Belissary wrote the following Opinion piece at SC Now promoting the cost effective idea of using Medicaid funds to keep people in their homes instead of being neglected in an institutional setting.
In recent weeks, the South Carolina Department of Health and Human Services has been working with interested parties to explore ways to more efficiently manage our state’s Medicaid program. The agency and work groups are specifically debating how to address the needs of a growing population of elderly and disabled with a dwindling revenue stream.
The agency and stakeholders agree the goals of all services should be to:
Protect medically necessary benefits,
Provide access to all individuals who are eligible,
Ensure no one recipient category or provider group is disproportionately harmed,
Encourage value over volume,
Embrace multiple forms of care coordination and
Conform the federal requirements.
There is consistently one area of services that meets all these criteria – home and community-based services. Home and community-based services focus on programs to help individuals who want to live at home, need assistance with their care, and are financially eligible for Medicaid. Under this option individuals can remain at home and avoid unnecessary or premature nursing home placement. Services are available for persons age 18 years or older who are unable to perform activities of daily living such as bathing, dressing, and toileting due to illness or disability. In order to meet the qualifications to enroll into this waiver program, the individual must meet the same level of care that is needed to enter a nursing facility.
Services offered include assistance with general household activities, help with activities such as bathing, dressing, preparing meals, housekeeping, and observing health signs, companion services that provide short-term relief for caregivers and needed supervision of clients, home delivered meals, adult day health care (medically supervised care and services provided at a licensed day care center), transportation to and from the home for medical appointments, and temporary relief for the client’s caregiver.
These options are cost efficient and provide services that have a higher return on investment. Currently nursing homes account for slightly more than 43 percent of the state’s long-term care expenditures which include home and community-based services, residential care and other waiver programs. Community choices services cost on average of $32 per day while nursing homes cost $127 per day. Nursing home patients are decreasing while costs are increasing. There are currently about 12,000 served by home and community-based services while there are about 10,500 served by nursing homes.
Home and community-based programs contribute in so many other ways to the stability of the family. Without these services, families would lose income because a family member would have to give up a job to take care of a loved one. This can be a drain on family finances and take its toll on middle income families. In most cases, it is the woman who gives up her career to take care of a love one; when the caregiver returns to work the earning potential is usually lower. If we are going to continue to meet the needs of our elderly and disabled population, we need to use our state’s monies in the most economical manner and the manner in which this population receives the best quality of life. That is most definitely through home and community based services.
Editor’s note: The author serves as legal counsel and assistant administrator for New Generations Home Care and New Generations Adult Day Center. He is currently vice president / president elect of the South Carolina Association of Personal Care Providers.