Let’s pay spouses to provide elder care


Published: 3/17/2020 9:13:16 AM

For more than a decade, elder advocates in Massachusetts have tried to get state lawmakers to pass legislation that would allow a spouse to be paid to care for an elderly or disabled spouse. Seventeen other states currently allow spouses as paid caregivers, as does the Federal Veterans Health Administration. Veterans in Massachusetts today can choose their spouse as a paid caregiver.

On Beacon Hill, the State Senate has adopted a spouse as caregiver bill, but the House let the bill die in committee, and Gov. Charlie Baker opposed it. The bill would expand the definition of family members who now can be paid to provide such care — which includes brothers, sisters, adult children, aunts, uncles, everyone except the person you are married to. Some MassHealth programs allow family members to be paid caregivers, like the Adult Foster Care program, and the Personal Care Attendant program. But these programs do not allow “spouses” to count as family caregivers.

In 2016, the Massachusetts General Court required the governor to prepare a feasibility report on spouse as paid caregiver. The governor filed an eight-page report in May of 2018, detailing five ways the state could pay spouses as caregivers – but concluded “it is not feasible at this time to pursue any of these options.” The governor claimed that spousal caregivers would create a “woodwork effect,” inducing another 2,400 people to apply for home care services, increasing net cost by $20 to $30 million dollars.

But a major study published in The Gerontologist of the California spouse as caregiver system, which has been in place since 2004, found “There were no financial disadvantages and some advantages to Medicaid in terms of lower average Medicaid expenditures and fewer nursing home admissions when using spouses.” The study also concluded that “allowing spouses and parents to be paid caregivers would not lead to induced demand (or so-called ‘woodwork effect’)” for home care services. Among elderly recipients, those with paid spouse providers had “lower predicted average monthly Medicaid expenditures than those with nonrelative providers,” and “more desirable outcomes for those who chose relatives as paid caregivers,” including “significantly fewer hospital admissions and fewer nursing facility placements.”

Instead of employing spouses to keep elders and the disabled at home, Gov. Baker chose to spent $20 million more on nursing facility care, despite the fact that nursing facility occupancy has fallen more than one-third since the year 2000.

But the fight for spouse as caregiver has continued. Legislation was refiled (S. 28) last year by state Sen. Jo Comerford, Hampshire, Franklin and Worcester District. “Studies have demonstrated that a major advantage of authorizing a spouse to serve as a caregiver is the reduction in turnover,” Comerford testified last June. “Continuity of care is an important factor in overall quality of care and positive outcomes. One study found that turnover among family member Personal Care Attendants was less than half that of non-family PCAs. It is also widely understood that paying spouses as the caregiver for their loved one will strengthen the family’s economic security.” S. 28 has been stuck in the Health Care Financing committee for the past 7 months.

While advocating for a spouse as caregiver bill, I met married couples who actually got divorced so that their former spouse could legally take care of them. The current policy in Massachusetts is anti-family, and anti-taxpayer. It forces people into more costly settings, like nursing facilities. In 2006, Gov. Mitt Romney signed a bill I wrote that requires MassHealth to care for its members in the “least restrictive setting appropriate to their needs.” Spouse as caregiver helps elders and the disabled to live at home. It also expands the number of caregivers at a time when a severe shortage of workers is impacting the entire state. It is shameful that Gov. Baker ignores spouses as caregivers, while investing more tax dollars into institutional care — the very care consumers want to avoid. We should welcome a “woodwork effect” that brings more people into home care — not run from it. But research shows the woodwork effect is a myth.

Readers who want to see spouses allowed as paid caregivers, should write to the chairs of the Health Care Finance Committee, Sen. Cindy Friedman at 617-722-1432, and Rep. Dan Cullinane at 617-722-2430, and ask them to favorably report S. 28. Spouses deserve more support to keep elders at home, not years of legislative neglect.

Al Norman was the head of a statewide home care network in Massachusetts for 32 years. He can be reached at: alnormaneldercare@gmail.com


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