skip to Main Content
Written by: Michael Bolton on Friday, December 3, 2010 Posted in:

A recent study conducted in an NPR Investigative News Series, “Home or Nursing Home, America’s Empty Promise to Give the Elderly and Disabled a Choice,” concluded that home care may be cheaper, but States still fear it.  Why?

According to NPR, states, slowly, have started spending more on home- and community-based care (HCBS). But there are barriers to change: Federal policies are contradictory, and states face record budget deficits. As a result, for many in nursing homes — or trying to avoid entering one — this means the promise to live at home remains an empty promise.

Nursing home care is an entitlement, but home-based care is not.  This means that states can’t keep waiting lists for people who are eligible for nursing home care. In 1999, states spent about 25 percent of their Medicaid long-term-care budgets on home-based care. There’s been a steady increase since. Now states spend 66 percent of their long-term-care for the disabled and elderly on nursing homes and 34 percent on home-based care. But that’s still not enough to keep waiting lists from growing.

Today, many people fear going into a nursing home. So their family members provide the care at home.  State policymakers know that they benefit from this “free” care (although it comes at a cost to the caregiver in lost wages and retirement savings, in stress and poor health care). And policymakers worry that if a more attractive alternative is available, then people will come out of the “woodwork” to demand this new service, and that, as a result, the state’s costs would rise.

Do you believe fear justifies states’ actions to limit access to HCBS?

Read the full NPR report here.