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HOME AND COMMUNITY-BASED SERVICES
2004

More than 80% of people who have long term care needs rely on family members and friends to provide most of their care, at an estimated value of $257 billion annually. These individuals live either in their own homes, with or without a spouse, or in the home of a close relative or friend.

Currently more than 12 million Americans of all ages need long term care as a result of chronic physical or cognitive limitations. Two-thirds are over the age of 65 and require assistance with activities of daily life, such as eating, bathing, dressing or getting around.

Long term care options are limited and can be costly unless home and community-based services are available. Medicare does not cover long term care services. The annual cost of care in a nursing home ranges between $45,000 to more than $110,000. Current long term care insurance is cost-prohibitive for older Americans with modest incomes and benefits are limited in scope and duration. Before individuals can qualify for Medicaid, the largest government-funded long term care program, many are required to "spend down" their assets.

The most preferred form of long term care is provided through home and community-based services, such as home-delivered meals, homemaker services, and respite care, that enable people to remain independent in their own homes and communities. For nearly 30 years, Area Agencies on Aging (AAAs) and Title VI Native American aging programs, along with others in the Aging Network, have coordinated and/or provided these home and community-based services for older adults and their caregivers.

The Current Long Term Care System Must be Rebalanced Away From Institutional Care Towards Home and Community-Based Care

Despite strong evidence that individuals prefer home and community-based services, Medicaid's basic long term care entitlement is directed to covering the cost of nursing home care. During the last several years Medicaid funding for home and community-based services has increased. However, Medicaid long-term care expenditures are still predominantly institutional. More than 70% of Medicaid's spending for long term care continues to go to nursing homes, even though it costs considerably less to provide care for someone in their own home or community.

The National Family Caregiver Support Program, enacted in 2000 and administered by AAAs at the local level, was a first step toward acknowledging the valuable role of caregivers of older adults and persons with disabilities and their need for community-based support. These program funds enable local communities to connect families with information on caregiver resources and local services, to provide counseling, training and peer support for caregivers, and to provide services needed by older adults and their families, such as respite care, in-home services and adult day care.

In order to rebalance the long term care system, federal funding for Older Americans Act services and the Social Services Block Grant (SSBG) program should be increased and options under home and community-based Medicaid services should be expanded this year.

National Association on Area Agencies on Aging (n4a) and Center for Aging Policy (CAP) 2004 Goals

1. Increase funding for all Older Americans Act (OAA) programs and services by a minimum of 10% above FY 2004 levels. The Older Americans Act (OAA), enacted in 1965, is the foundation of services for older adults throughout the country and is the heart of a national network of home and community-based services. OAA funding has not kept pace with inflation or the growing population of individuals eligible for services over the past several years. Significant increases in federal appropriations are crucial to assure the availability of services and programs that enhance the ability of older Americans to live independently in their chosen environment, their own homes and communities.

2. Preserve access to health and long term care services currently provided through Medicaid for low income seniors and persons with disabilities and extend the expiring two-year increase in the federal share of the Medicaid program (FMAP). It is critical that the Medicaid program, the health safety net for millions of vulnerable older adults and people with disabilities, retains its current open-ended federal matching funds structure, which allows states to respond to fluctuations in the economy and to state-specific changes in health care needs. As many states continue to experience the worst fiscal crisis since World War II, extending the temporary increase enacted last year in the Federal Medicaid match would protect the states from further restricting eligibility or eliminating vital health services.

n4a and CAP support shifting more Medicaid long term care funding to home and community-based services. We endorse extending needed Medicaid home and community-based services to older individuals above current eligibility levels, allowing more older adults to remain integrated in society, avoiding or delaying the need for more costly institutional care.

3. Restore the authorization level to, and fund the SSBG program at, $2.8 billion and restore the TANF transfer allowance to 10%. Title XX of the Social Security Act, the Social Services Block Grant (SSBG), provides flexible funding to allow states to make a wide range of critical services available to low-income and vulnerable older adults, persons with disabilities, children and families. Services for older adults under SSBG include home care, protective services to prevent abuse and neglect, congregate and home-delivered meals, adult day care, case management, legal services and transportation. As a result of the repeated cuts to the program in the last several years, social services for some states' most vulnerable citizens have been significantly reduced or remained severely threatened.

n4a and CAP also support advancing legislation that provides tax incentives for the purchase of long term care insurance and the provision of family caregiving.