Dispatch... Dollars and sense

From the Columbus Dispatch…

Dollars and sense

New report, budget crisis should push state to keep elderly at home

Sunday, December 19, 2010

http://www.dispatch.com/live/content/editorials/stories/2010/12/19/dollars-and-sense.html?sid=101

When the candy jar is empty, willpower is easier to come by.

So Ohio's $8 billion budget crisis might finally force lawmakers to spurn the mighty nursing-home lobby and shift state policy and tax dollars toward delivering compassionate and cost-effective care for the elderly at home.

A new report by a state-appointed advisory council cautions that the state is going to run out of money if it doesn't.

"Projected growth in our senior population will create unsustainable expenditure increases in Medicaid long-term," the Unified Long-Term Care Systems Workgroup says. "To be prepared as a state, we must take action today."

Medicaid, the federal program that covers health care for the poor and disabled, pays for 70 percent of all nursing-home care in Ohio. It's an expensive option.

A nursing-home bed costs taxpayers about $52,000 a year. Caring for a person in his home - providing help bathing, dressing or eating through the state's PASSPORT Medicaid-waiver program - costs about $17,000 a year.

And while the elderly make up only 20 percent of Medicaid recipients, they account for 68 percent of the cost. It's easy to see why: Instead of keeping senior citizens at home, the state's policies have favored expensive nursing-home care that benefits their operators.

The stars have aligned to put an end to this, providing political absolution for a permanent fix. This fits nicely with the campaign promise made by Gov.-elect John Kasich to end business as usual in Ohio.

With most baby boomers now eligible for senior discounts, other states have devised innovative ways to help the frail and elderly remain at home by better balancing Medicaid spending. Not Ohio.

Last year, Ohio ranked 44 {+t}{+h} among the states in the amount of Medicaid dollars it directs to in-home and community-based care vs. paying for institutional care. Last year, 58 percent of Ohioans older than 60 needing long-term care were in nursing homes; the remaining 42 percent got in-home care.

Ohio needs to thoroughly examine the best practices of other states. If the Buckeye State just brought its Medicaid spending on nursing homes in line with the average among states, it would save quite a bit. With diligence and strong leadership, Ohio might find itself above average.

Nursing homes are useful for those who require constant care. But the many elderly people who simply need a bit of assistance to remain home ought to be afforded that dignity - especially when it is more affordable.