Last year Kentucky ranked worst in the nation on the AARP Public Policy Institute’s scorecard on long-term care services and supports. A recent report by the Legislative Research Commission (LRC) provides some ideas about ways Kentucky could better support family caregivers of elders in order to improve long-term care.
Although the majority of seniors want to age in their homes, the state programs that provide related supports in Kentucky are seriously underfunded. Thus many seniors find themselves in nursing homes instead.
State funding for the Department for Aging and Independent Living (DAIL) programs has decreased 27 percent since 2009, according to the LRC report—and there are currently waiting lists for almost all of the programs, which include: Adult Day Care And Alzheimer’s Disease Respite Program, Homecare Program, Nutrition Program for the Elderly, and Personal Care Attendant Program. The number of Kentuckians waiting for a DAIL program or service was more than 13,000 in 2014. Kentucky ranks 30th—out of 39 states providing data—in total expenditures for the aging, disabled and caregiver population.
According to the AARP scorecard report, improving overall state performance in long-term care requires “shifting funds away from an overreliance on nursing homes to support more funding of home- and community-based services.” Nursing home care is typically much more expensive than in-home care—and not preferred by most seniors. According to the LRC report, the annual median rate for nursing home care is $73,000 for a semi-private room ($80,300 for a private room); in contrast, full-time private in-home care costs $44,370 a year. Kentucky’s Medicaid program pays approximately $48,000 per year for a nursing home bed compared to $15,000 for in-home supports.
The state currently spends about 81 percent of all long-term care dollars on nursing home care, while the remainder goes to supports to help seniors age at home. The Medicaid Home and Community Based Waiver is available to states to permit them to use Medicaid funds for some nonmedical services and supports to elderly people so they can remain in—or return to—their homes. However, the use of this option in Kentucky is limited. According to the LRC report, the top two states for using the waiver, Minnesota and New Mexico, allocate only 35 percent of Medicaid spending on long-term institutional care.
Unless needed changes are made, Kentucky’s long-term care problems are expected to increase as the elderly population grows. The LRC report warns that “The growth of the senior population may outpace available Medicaid funds without a redistribution of spending.” Twenty percent of the state’s population is projected to be age 65 and older in 2030—an increase of 321,415 seniors—meaning an increased need for long-term care.
Among the report’s recommendations are to:
- Increase support for the state’s 15 Area Agencies On Aging and Independent Living (AAAIL): According to the report, not only are there waiting lists for many services available through the AAAILs, the same services are not available through all AAAILs. This has to do with funding for the programs coming from several sources, including federal, state and local dollars as well as consumer contributions—so the ability of each AAAIL to provide services varies.
- Enhance employment policies for caregivers: The federal Family and Medical Leave Act (FMLA), which guarantees up to 12 weeks in a 12-month period of job-protected unpaid leave for a worker’s or family member’s serious health needs, is an important resource for caregivers—although the federal policy does not apply to businesses with fewer than 50 employees and many family members. Some states have expanded eligibility for family and medical leave to businesses with fewer than 50 employees and expanded the definition of “family member” to include grandparents, in-laws, domestic partners or siblings. Without these and other supplemental provisions, the FMLA only covers about 60 percent of workers. Some states also offer paid family and medical leave to workers, which they often fund through an employee-paid tax.
- Change the allocation of Medicaid funds spent on long-term care: One way to increase the number of Kentucky seniors and their caregivers who can be assisted under the Medicaid Home and Community Based waiver is to implement presumptive eligibility for services that help seniors stay at home; this means those who seem to qualify would be temporarily enrolled while officially eligibility is still being determined, reducing waits for services.
- Reduce shortages of home health and personal care aides: Kentucky ranks 44th in the number of home health and personal care aides per 1,000 population aged 65 and older. There are 22 per 1,000 compared to a median of 33 per 1,000 for all states.
The LRC report shows that increased support for caregivers of elders in Kentucky would not only be good for the state’s seniors and their families, it would also be less costly for the state. These savings could then be applied to further strengthen supports and serve more elderly Kentuckians and their caregivers.