Home and Community–Based Services for Seniors

Senior Community Services Vary Across States

November 15‚ 2002 — Medicaid–funded home and community–based services for the elderly may be readily available in one state‚ but not in another‚ according to a study by the U.S. General Accounting Office (Report to the Special Committee on Aging‚ US Senate‚ September 2002). The report looked at how easily a typical Medicaid recipient could obtain adult day care‚ residential care in a facility other than a nursing home‚ and personal attendants to help with bathing‚ eating‚ and household chores.

Not every state is required to provide home and community–based care through a Medicaid program‚ even if a senior prefers that route to living in a nursing home. States that do fund in–home care vary in what services are covered‚ and who may be eligible. Also‚ local case managers who screen Medicaid–eligible seniors may customize care plans depending upon whether family members or other informal caregivers are present in the home.

Researchers collected data on long–term care delivery in four states—Kansas‚ Louisiana‚ New York‚ and Oregon. They also interviewed case managers and Medicaid officials. They found that hypothetical elderly individuals with identical disabilities and needs would receive different types and amounts of home and community–based care in the different states and even within the same community.

In Louisiana‚ case managers were limited in the number of hours of in–home care due to a cap of $35 per day. Kansas case managers seemed to be cost–conscious‚ stressing that lower costs per client could enable more clients to be served. They often offered fewer hours of in–home care than were offered in other states. In New York and Oregon‚ case managers had less cost restrictions and offered more in–home hours for clients. When out–of–home placements were recommended‚ Oregon consistently favored adult foster care or assisted living facilities; case managers in the other three states more often recommended nursing home care.

In Kansas and Louisiana‚ seniors with disabilities are not able to immediately receive most Medicaid home and community services due to long waiting lists. These two states allocate a smaller proportion of their Medicaid long–term care expenditures to home and community–based services than do New York and Oregon. New York had the highest Medicaid spending on long–term care services‚ with per capita spending nearly two–and–a–half times the national average.

According to Sen. John Breaux (D–LA)‚ chairman of the Senate Special Committee on Aging‚ the report shows the inconsistencies of long–term care delivery across the nation. He noted that the state disparities are due to limitations imposed by a Medicaid system that was not created to cover long–term care services. He urged federal‚ state and local governments to better inform consumers about available long–term care services and how to pay for these services. He also supports legislation to provide tax deductions to those who purchase their own long–term care insurance and to provide tax credits for family caregivers.

At Brayton Purcell‚ we are concerned with the well–being of our senior citizens. Our experience includes elder abuse law‚ nursing home abuse cases‚ and pain management issues. If you have a question about senior legal rights‚ please feel free to contact us.

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