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Home is where the money goes when it comes to long-term care

Are individuals who need care where they should and can be? You may have noticed last week. There were four articles and press announcements within just a few days – sourced separately that belong together. No insurance or government program is all that transparent or straightforward, but policy and practice variations across states seem to have one victim – the person who needs care.  They ability to obtain that care at home (or in the right setting) depends on the state you live in and what the policy, practices, and costs in that state. Genworth’s newly-updated report is revealing about long-term care costs in multiple settings and categories.

Person wants to be at home, but is stuck in a nursing home.  In this first nursing home-wants-own-home example, the individual spent 11 years in a nursing home, finally having to sue to go home, where he is now doing well with a home care aide. Even with a 1999 Supreme Court decision, Money Follows the Person, and general agreement that home care costs are lower –  it took that long to get him out. And in this case, it was bureaucracy that kept him in. And it should be no surprise that he was in Maryland: take a look at the State Scorecard for LTC Support Services 2014 and see the state’s bottom quartile rank on ‘choice of setting’ and then take a look at the costs of nursing home versus home care in the Baltimore area.

Person should be in a nursing home, but is stuck at home. Next up, the cost savings algorithm kept this patient out of a nursing home. In this WSJ article, a woman who seems to have 24-hour care requirements is part of an experiment: The Independence at Home program, a pilot launched in 2012, is a 'money-saving’ program to treat the sickest ‘high-intensity’ Medicare patients at home. In this example, however, the paralyzed “wheelchair-bound 87-year-old has emphysema and diet-controlled diabetes, is dependent on oxygen, and recently tore the right rotator cuff on her good arm."  So is it a triumph that she can be cared for at home by "two aides who provide six hours of daily personal care, far more than she would receive in a pricier nursing home." Really?  That is a triumph? As noted in the article’s comments, what if she fell out of the chair when the aides weren’t there? Is this program "a win for patients, providers and taxpayers" as described? Or just for taxpayers? And what if one of those taxpayers was this patient’s family?

Decision-making about setting -- up is down and down is up.  Both of the above location choices made by state or federal programs were based on allocation of money, not the wants or needs of the individual.  Both also reveal the tangled swamp of variable state rules and regulations – or lack thereof -- that underpin the ‘options’. So many years of seeing woe-is-us articles about the lack of consistency, quality, and standards across the states for long-term care of all types, kudos to Genworth for annually shining a bright light on long-term care costs. And thank you to AARP Public Policy Institute for scoring quality of long-term care services, tracking improvement, and hopefully keeping on with this effort each year.


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