Debate and discussion around the ideal setting to care for older individuals has raged for decades. The trends are somewhat cyclical.
In the distant past, virtually all aging took place at homes. “Traditional,” nuclear families were more common, and so seniors who could no longer live on their own almost always moved in with family members. Long-term care facilities were virtually non-existent.
However, seniors who did not have available family caregivers or who needed more support than caregivers could provide were left in dire straits. The growth of various senior housing locations filled the gap. These separate spaces catered exclusively to senior needs, ideally providing better, more efficient care without overburdened family support networks.
Yet, over the years the special senior facilities (epitomized by the nursing home) became more and more institution-like. Calls have grown steadily for reform, seeking to minimize quality violations and provide more compassionate care. If you ask most New Yorkers these days, they report preferring to “age in place,” similar to the older model of caregiving via a networked a trusted friends and family.
Financing Long-Term Care
The biggest hurdle that most face in securing their preferred elder care is financial. How do you pay for the often costly aid, including professionals to visit one at home and provide daily care? Those who have long-term care insurance are often well-situated. But what about those who do not? The vast majority rely on public assistance via the Medicaid program.
Unfortunately, the Medicaid program was developed and grown during the era when institutional caregiving was gaining popularity. As such, Medicaid program defaults tend to send seniors into nursing homes to receive care. Individual residents have little flexibility, often receiving few options from the program itself.
More and more are recognizing the need to change this rigid system. Of course all large-scale changes of government programs are slow going. To help spur the effort and analyze the best ways for Medicaid to adapt to current trends, the AARP is hosting a conference later this month entitled, “Modernizing Medicaid: Putting Home and Community-Based Services on Equal Footing with Nursing Homes.”
Promotional materials for the event explain that more seniors need options to receive long-term care in their own communities and homes. This is not even a very controversial proposition. The announcement notes, “This discussion comes at a time of growing bipartisan support for changing Medicaid’s requirement to fund LTSS in nursing homes while funding home and community-based services (HCBS) on a limited and optional basis. In addition to restricting choice, the half-century old provision makes it difficult to meet a growing demand for LTSS in a cost-effective way.”
For more information on this program, please take a look at the AARP website here.