By Al Norman
If you think you’re seeing more elderly people at the grocery store, the bank, and the movies—you are. In the period 2010 to 2030, the 65+ population in Massachusetts will increase by approximately 60 percent –while the under 65 population will decrease by approximately 4.5 percent. In the first two decades of this century, the commonwealth will add around 585,000 more people over the age of 65.
As our older population grows, so does the cost of caring for them. According to the Executive Office of Elder Affairs, an estimated 61,200 elders, or 6 percent of the 65 and older population in Massachusetts, are qualified for either a nursing facility or home care services. As the elder population grows, there will be 7,400 additional elders requiring nursing facility level services in the next five years, and a total of 87,100 elder residents needing these services by 2030.
The average nursing facility cost to Medicaid monthly is $5,995, compared to the average monthly cost of home care supports at $1,858. By diverting individuals from nursing facilities to home settings, the distribution of costs would change and overall long term services and supports (LTSS) costs would be reduced,
Since the year 2000, we have cut the number of Medicaid-paid patient days in nursing homes by -34 percent. But the number of people in nursing facilities in the commonwealth is still above the national average. If we could lower our nursing facility use, which is now 40.6 beds per 1,000 elders, to the national average of 28.1 beds per 1,000 elders, we could save taxpayers $6.3 billion by the year 2030.
So given the greying of our population, and the cost savings from keeping people at home—you would think that policy-makers would be doing everything in their power to shrink the number of people in nursing facilities, and expand our capacity to keep elders at home.
In fact, we have been making some progress in “rebalancing” how we spend our tax dollars between institutional care and home care. As of 2013, Massachusetts ranked ninth in the country for the percentage of its long term services spending on community care (5 percent. Eight other states spend a higher percentage of their long term services spending on community care: Oregon, Minnesota, Alaska, Vermont, Arizona, Washington, California and Wisconsin. Oregon ranks first at 77 percent of LTSS spending on home and community based services.
Things have been slowly changing over time. In 2009, Massachusetts ranked 22nd in the nation for its percentage of community care spending. By 2014, the commonwealth reported that 45 percent of its long term services dollars were being spent on community care services. But if Massachusetts were to spend at the same rate as Oregon (77 percent), our state would see a shift of $765 million into these services. Our state’s total long term services spending in 2013 was $4.463 billion, of which community care was $2.671 billion. An Oregon percentage shift would increase community care to $3.436 billion.
Our state likes to boast that it has a “community first” policy for elders, but here are a few bills that did not pass in the State Legislature this last year that would improve home care:
- S. 361, to raise the income eligibility limit for home care from $27,000 to $35,000 a year.
- H. 534, a “small home” housing program for up to four unrelated individuals as a way to bring people out of nursing facilities.
- H. 70, to allow spouses to be paid as caregivers by Medicaid
- H. 113, to allow people who need cueing/supervision to get personal care attendants
- H. 1022, to end age discrimination in the Medicaid program by making the income and asset rules for seniors the same as more generous rules for people under 65.
We don’t have a lot of time to set the table for our aging population expansion. We know our elders want to live at home, and we know it’s less expensive to care for them at home. If we do nothing, we will have long waiting lists for care, and rationing of services.
Print this article and send it to your state representative and state senator at this address: Mass. State House, 24 Beacon St, Boston, MA 01233. You can find all their names and room numbers at: https://malegislature.gov/ or call 617-722-2000 and ask for your legislators by name.
Al Norman is the Executive Director of Mass Home Care. He can be reached at 978-502-3794, or at info@masshomecare.org. Archives of articles from previous issues can be read at www.fiftyplusadvocate.com.
