A clear goal of the new health care reform law: increased access to home-based care.
Last month's health care law contained some benefits for the nation's older population. It provided long-term care options to allow more seniors to stay in their current homes rather than seek institutionalized care, and called for more publicly available information about nursing homes.
Most seniors prefer to stay where they are than move into assisted living or a nursing home. AARP surveys show that roughly nine out of 10 senior adults prefer to "age in place." But, in many cases, health issues force a senior to seek out a facility where they receive individualized, round-the-clock care.
Parts of the new law help seniors and their families navigate such difficult situations.
The most high-profile provision related to long-term care in the new law is the Community Living Assistance Services and Supports act, or CLASS. It will allow adults with mobility problems to receive home care through a voluntary insurance plan. A handful of other programs will improve access to home and community-based services to complement CLASS, including one that provides matching federal dollars to states that expand their home care services.
And, the legislation requires that nursing homes report important information like staffing data, so families can make informed decisions about where to place their loved ones.
"The key thing to realize is the health care reform bill actually has probably a couple of dozen opportunities, all told, to think differently about aging successfully," said Dr. Bruce Chernof, president of The SCAN Foundation, a nonprofit proponent of long-term care for seniors funded by SCAN Health Plan, a Medicare Advantage plan.
The number of Americans over 65 will mushroom in the coming decade, as roughly 75 million Baby Boomers reach retirement age. Their long-term health care needs will strain the nation's collective wallet, stretching thin programs like Medicaid and Medicare.
AARP reports that it costs as much in Medicaid dollars to care for one person in a nursing home than it costs to care for three older adults and people with disabilities in home and community-based settings.
Meanwhile, more than 10 million Americans are currently in need of long-term services that help them function in their daily life, and that number is expected to rise to nearly 15 million by 2020, according to the National Council on Aging.
Enter the CLASS voluntary insurance program.
Under CLASS, working adults who need daily assistance would have at least $50 per day to pay for home care — more if the adult has a higher level of impairment. After five years of paying into the program, recipients could use the money to pay for a home health-care aide.
CLASS funds also can be used to pay for adult day care, transportation, and safety features like grab bars and handrails. They also can be used to help pay for assisted-living facilities and nursing homes.
Seniors who enroll in CLASS will have a better chance to remain independent and active in their communities. That provision also helps their caregivers, who in many cases are adult children who may feel they are spending too much time and money looking after their parents.
CLASS includes protections ensuring the program will be solvent for 75 years, and could result in Medicaid savings in the long haul.
Another benefit to seniors is a collection of programs that improve access to Medicaid's home- and community-based services but which aren't a voluntary insurance plan like CLASS.
For example, the Community First Choice program creates a state-based plan to keep people with disabilities who require an institutional level of care out of nursing homes by providing them with home-based attendant services. States will receive federal matching funds if they adopt this program.
Another program increases funding for Aging and Disability Resource Centers, which offer information and counseling about the various long-term health-care options available to seniors. And, another provision protects spouses from being forced to spend all the couple's assets to get access to home- and community-based care, similar to benefits already in place for nursing home residents covered under Medicaid.
These programs are meant to keep the senior at home. For those who have no alternative but to move into a nursing home, there's something for them, too.
Nursing homes will be required to submit ownership information, staffing data and other items to increase transparency and accountability. People will be able to search the Nursing Home Compare Web site (found at http://www.medicare.gov) and find information on quality of care, consumer rights, staffing and other issues to help them choose a nursing home.
The Obama administration's reform effort is not the definitive answer to seniors' health care needs. Just call it an important first step in providing long-term, home-based health care for America's older adults.
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