My Turn: State shortchanges home care


Published: 7/1/2018 4:47:02 PM

In June of 2017, the Massachusetts State Legislature passed a budget that called for a “study of the cost effectiveness of the home care program … including estimated savings from avoided nursing facility admissions.” On Feb. 1, the state’s Executive Office of Elder Affairs submitted the required report, which covered a six month period from July through December of 2017.

The home care cost effectiveness study showed that 12,939 elders who were eligible for nursing home care were enrolled in the home care program. The Commonwealth spent $33.4 million on home care services for these elders. “If these consumers were living in a nursing facility during this time,” the report concluded, “the estimated cost is approximately $406.4 million assuming a nursing facility per diem of $210.20.” In other words, the home care program saved taxpayers $373 million in six months, or $746 million projected over a year’s time, by avoiding nursing home care.

The Massachusetts home care program was created 45 years ago. Most lawmakers understand that this program has been one of the most cost-efficient human services programs ever launched. Since the year 2000, the nursing home population has declined by 36 percent because of community-based options now available.

The number of individuals in Massachusetts ages 65 and over is expected to grow dramatically over the next 20 years, increasing the need for long term care and the demand on the workforce. Additionally, people with disabilities and chronic conditions are living longer, adding to the demand. The growth in the state’s population ages 65 and over is projected to increase 46 percent by 2035. If we could reduce the state’s nursing home use from 40.6 beds per 1,000 elders to the national average of 28.1 beds per 1,000 elders, Massachusetts could save $6.3 billion in long term care costs by the year 2030.

Unfortunately, the Senate budget that just passed on Beacon Hill continues to nickel-and-dime community-based care for elders:​​​​​​

an amendment to add $2.6 million in elder abuse prevention for “screening, investigation, and ongoing services” provided by designated protective services agencies” was rejected;

an amendment to increase the payment rates for the adult foster care programs by $2 million was rejected;

an amendment to increase payment rates for adult day health services by $4 million was rejected;

an amendment to add $100,000 for elder homelessness prevention was rejecte​​​​​​d;

and an amendment to increase rest home rates by $1.75 million was rejected.

The Senate did pass an amendment to add $38.3 million for “wages, shift differentials, bonuses, benefits … paid to direct care staff of nursing homes,” but no funding increases were provided for the thousands of home care workers. Massachusetts likes to say it is as “community first” state — but once again the governor, the House and the Senate have failed to shift enough dollars from institutions to community care.

Most worrisome of all is the secretive method the House and Senate now use to process the state budget. The State Senate just handled 1,196 budget amendments in closed door “caucus” sessions. The leadership “bundles” amendments into 10 categories, and then announces which amendments have been approved, rejected, or withdrawn. There is no public debate during this process. Some sponsors can seek floor debate after the “bundles” have been reported out, but what used to be an open, transparent budget debate, is now hidden and obscured from public view. There are only 38 sitting senators today. Some amendments with more than 20 sponsors were rejected behind closed doors, even though they had enough sponsors to pass on a floor vote.

The budget and the process are both failing elderly voters. Home care is clearly a smart investment but the governor and the Legislature behave as if they are demographically deaf to the voices of their elderly constituents. who just want to live out their lives at home.

Al Norman worked in the field of aging services in Massachusetts for 38 years.

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