More long term care options under consideration

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LANSING — Michigan can improve long-term care by providing more home and community-based services as alternatives to nursing home care, AARP Michigan says, but an industry group cautions that nursing facilities are crucial to the state’s health care system.

According to the AARP, 35 states spend fewer Medicaid dollars on nursing home care than Michigan. Those states’ services include aides and nurses who visit seniors in their homes.

Lisa Cooper, manager of advocacy at AARP Michigan, said, “Michigan currently spends only 21.6 percent of our long-term care budget for older adults and people with disabilities on home and community-based services. We spend 78.4 percent of our long-term care dollars on nursing home care.”

The report said nursing homes are expensive and becoming more so. In 2011, $80,300 was the median annual cost of a semi-private room in a Michigan facility.

“If Michigan were to re-balance our system like other states to provide relatively more home and community-based services, which is the setting that people overwhelmingly want, we could save taxpayer dollars and create a system that is economically sustainable,” Cooper said.

However, David LaLumia, president of the Health Care Association of Michigan, said his organization supports the entire long-term care continuum, but the public should realize the major role nursing facilities play in ensuring quality care options.

“Caring for more than 40,000 Michigan residents each day, nursing facilities play an integral role in our health care system. Medical care should be provided in the right setting, in the right place, at the right value for an individual’s medical needs,” LaLumia said.

As the state struggles with budget problems, AARP wants to move the discussion of long-term care toward alternatives to nursing homes.

“A long-term care system that begins with the individual and helps people stay in their homes and communities can prevent a costly and unnecessary stay in a nursing home,” said Robert Kolt, AARP Michigan president.

An AARP survey found that an overwhelming majority of Michigan seniors prefer remaining in their homes as long as possible. By one estimate in the report, community-based services, on average, can save $57,338 per participant per year.

Rebalancing the system would provide more substantial support for unpaid family caregivers, who provide most such services. In Michigan, an estimated one of every seven adults cares for an adult relative, according to the report.

But LaLumia said, “There is no way we are going to meet the demand of the future simply by ‘rebalancing.’”

He said it is a great challenge to meet consumers’ personalized demands.

“Currently, our demographics are dramatically changing, with baby boomers turning 65 at the rate of 10,000 per day,” he said.

The Department of Community Health has five programs that offer in-home services.

For example, through Home and Community-Based Waiver Services, adults who meet income and asset criteria can receive Medicaid-covered services like those provided by nursing homes, but can stay in their own home or another residential setting.

Tom Czerwinski, executive director at Area Agency on Aging of Western Michigan Inc. in Grand Rapids, said the average cost for a MI Choice Medicaid Waiver client is $52 per day across the state. The average nursing home cost is $175 per day.

MI Choice Medicaid Waiver is one of the programs offered by the department. He said there are more than 7,500 people on waiting lists statewide for the program.

Czerwinski said there are challenges to helping people transition from a nursing home back to the community.

“The major obstacle is housing. For many people who no longer have a home to live in or can’t afford an apartment, low-income subsidized housing is necessary for many nursing home transition clients, he said.

“Clients also need an array of home care services to meet their needs; the most important part in building a long-term system is to always keep the client’s needs the priority,” he said.

That’s where the continuum comes in, LaLumia said.

“Long-term care today is a continuum of services — a range of options that have evolved over the last decade to reflect both consumer demand and public policy change. The continuum now includes: skilled nursing and rehabilitation, assisted living, adult foster care and homes for the aged, home health or home and community-based waiver services.”

He said each plays an essential role to meet the varied needs of individuals, and one is not a substitute for the others.

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