Report shows growing demand for home-based care

Seniors and their families are increasingly turning
to home- and community-based long-term care, according to a recent report. While
overall state spending for long-term care increased only slightly, spending
is shifting from institutional care to home- and community-based care, the annual
report shows.



Lt. Gov. Charles Fogarty, chairman of the state’s Long-Term-Care-Coordinating Council, released last month the annual report on long-term care spending, which he says supports what he and others in the industry have said for years – that the growth and demand will come in the home- and community-based care.



“Consumers are much more informed,” Fogarty said. “People value their independence and want to stay in the community. There are much more providers out there, and they range from a little bit of assistance, to assisted living, all the way up to a full nursing home.”



Cynthia Conan Arp, executive director of the Feinstein Adult Day Program in Cranston, agrees that the aging population needs to have choices.



“(The state) needs to shift the balance of resources to both institutional and community-based care, and people need to be empowered to move across the system,” depending on their needs, she said. “These services can help keep that person in the community longer, and giving consumers choices and flexibility in the type of long-term care they choose (is vital).”



Spending increased only 2 percent ($8.5 million) from FY 2002 to 2003, the report said, but spending on home- and community-based care rose 14 percent, while institutional spending (nursing homes) only rose 1 percent. It’s a trend that shows the state is going in the right direction, Fogarty said.



“It’s a positive trend over the last seven years of focus on home- and community-based services and it’s much less costly to taxpayers,” he said. “We will always have need for nursing homes, but (home- and community-based care) has been able to do much more to build up a network of services. The good news is that this means Rhode Island is moving in the right direction; the not-so-good news is that it’s not moving as fast as is needed, given our aging population.”



In 2003, 10 percent, or $40.8 million, of total spending went toward home- and community-based care, the report said. Institutional care still accounted for 88 percent, or $373.8 million, but there has been a steady increase in spending in home- and community-based care, from 1997 to 2003, the report showed. Home- and community-based care spending was approximately $35.7 million in 2002. Total spending in long-term care for 2003 was $423.3 million.



As an example of the state’s need for services, Fogarty stressed the issue of the state’s Department of Elderly Affairs co-pay program as one example of need for a policy shift. Last October, Gov. Don Carcieri froze the program, which pays $2,500 each year toward the overall cost of home or adult day care for low-income seniors. As a result, Fogarty said, there was a waiting list of more than 250 seniors and at least seven who couldn’t wait were forced into nursing homes. Fogarty added that the governor has proposed to remove the freeze this year.



At the Feinstein program in Cranston, seniors who spend the day there have dementia and Alzheimer’s, and the facility is specific to their needs. Family and friends take care of them, so providing support to the caregiver is as important as supporting the recipient, Conan Arp said.



“Seventy percent of the people who need care get it from their family and friends, and those people could sustain that care for a longer period of time if they got a little help from the state,” she said. “Rhode Island, while making progress, has a skewed long-term care system. Nursing homes can be warm and wonderful too, but a lot of folks can be productive in the community with just a little help.”



There is definitely a demand for this kind of long-term care, Fogarty said. There are 200 units scattered throughout the state for assisted living; the state is authorized for 180 more and there is a waiting list for them, but funding is also an issue, he said.



“Assisted living has been shown to be one-half to two-thirds cheaper than institutional care,” he said. “When every dollar counts, it’s better to pay $2,500 (for the co-pay program) than $30,000 to $50,000 a year for each senior that goes into a nursing home if those services are not provided. We need to continue this trend. As baby boomers age, they will want options.”



Fogarty said he hopes the report shows the state that its legislators’ efforts are having an impact on long-term care, and proves that home- and community-based care saves the state and its taxpayers money. Conan Arp said it’s useful and important in showing the flow of spending.



“I hope this shows (the Finance Committee) that these programs are making a difference and improving seniors’ quality of life,” Fogarty said. “This validates that the programs are working, and it shows the legislative leadership, in promoting the programs, that we are getting our money for the investment.”

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