State starting to shift aid to at-home care programs

Beth Slovic

Friday, Feb. 25, 2005 | 8:48 a.m.

People prefer home and community-based care for senior citizens, including assisted-living facilities, and it is cost-effective. But according to a recent report by the think tank arm of AARP, Nevada still does not spend enough of its $2.4 billion in Medicaid money on those forms of care.

Instead, the state continues to funnel about three times as much of its federal and state Medicaid dollars to institutions such as privately run nursing homes, Carol Sala, an administrator for Nevada's Division for Aging Services, said.

In part, this funding imbalance results from the fact that nursing homes have been around longer than at-home care services and are more expensive. Though the state has started to change the structure, shifting gears requires time, Sala said. In his latest budget, Gov. Kenny Guinn has proposed an increase of about $3.2 million in spending for the Medicaid program that pays for at-home care.

Charles Duarte, a state administrator who oversees the Medicaid program, said Nevada has made great strides in shifting money from long-term care institutions to at-home programs. As evidence of this, he pointed to the fact that the number of Nevadans in nursing homes has remained steady at just under 3,000 for a number of years even as the population has exploded, he said.

But the funding pattern worries some local advocates for senior citizens. They want more home and community-based services in place and adequately funded for people who need that safety net, they said. Medicaid covers long-term care only for older residents who are also poor.

In October 2002, state officials with the Department of Human Resources drafted a strategic plan for senior services calling for a major shift in funding to home and community-based programs from nursing homes, which are more costly than the other options.

The intent is to dramatically change the way Nevada addressed the long-term care needs of senior citizens as the state's population continued to grow. If the change is accomplished, the state should save money and be able to satisfy consumer's demand for at-home care.

More than two years down the line, the state has increased the number of slots in its Medicaid waiver program for at-home care, Mary Liveratti, the deputy director of the Department of Human Resources, said. And the governor's budget, if approved, would allow the state to increase the number of slots by several hundred more, Liveratti said.

But hundreds more people are waiting for slots to open up in the program, meaning demand for the subsidized service is not being met. As of January, an additional 996 people were waiting for one of the nearly 1,500 occupied slots budgeted for 2005, Sala said.

In the meantime, Medicaid is paying for 2,800 to live in nursing homes, Duarte said.

Compared with all other states and Washington, D.C., Nevada ranks 50th in home and community-based spending per capita in the recent report by AARP's Public Policy Institute. That amount averaged $30 in Nevada compared with an average of $95 in the rest of the nation.

This concerns Carla Sloan, the state director of AARP Nevada, who advocates increasing the state's budget for Medicaid waiver programs.

People want to grow old at home, she said. And programs that allow people to do that save the state money, she said.

The numbers also raise a flag for Mary Jo Gibson, the senior policy advisor from the AARP think tank. In part, that's because the population of residents 85 and over is growing faster here than in any other state in the country, she said. And Nevada's population growth among residents 65 and over is surpassed by only one state, Alaska.

The study also found housing affordability to be a problem for seniors in Nevada. Nearly 29 percent of Nevada homeowners 65 and over spent 30 percent or more of their income on housing in 2002. The nationwide average was about 23 percent.

Also, about 65 percent of home renters 65 and over spent 30 percent or more of their incomes on housing in 2002 in Nevada, while that figure stood at about 60 percent nationwide.

And Medicaid spending on long-term care per capita was $91 in Nevada in 2003 compared with $288 in the nation as a whole, the report found.

Joanne Alleva, a 64-year-old retiree from Millersville, Md. who along with her husband Fred, 71, leads a line-dancing class three times a week, does not want to think about long-term care, she said recently while observing a class at Henderson's Multigenerational Center on Green Valley Parkway.

However, Alleva said she and her husband could cover the cost of an assisted living facility should they need one.

"We're OK, but there are some people who are not," Alleva said. "They depend on Social Security and it's not enough."

Annette Wright, 66, a dancer in Alleva's class, said she and her husband were not taking any chances on their long-term plans. They purchased long-term care insurance, which would cover a portion of the costs of nursing home or at-home care, if they needed it.

This option is one currently being touted by Gov. Kenny Guinn in television commercials urging residents between the ages of 50 and 70 to plan for their own long-term care.

An associate professor of aging issues at UNR's Cooperative Extension, Claudia Collins said it's not just up to residents to deal with issues of long-term care. Nevada officials should work to expand services for older residents now, before it is too late, she said. Retirees who buy houses and pour money into the economy today, will need costly care tomorrow, she added.

"We don't realize they're not going to be healthy and wealthy in 10 years," Collins said. "Some of them are going to need help, and we're overtaxed here."