Nursing homes are necessary, and many provide good care. But you'd be hard-pressed to find a senior who wants to live in one. Surveys show the vast majority of older people want to stay in their own homes as long as possible.
Despite this, Iowa ranks second in the country for the number of nursing home residents per 1,000 people age 65 or older. Our Medicaid program spends a smaller percentage of its long-term care dollars on community-based services than the national average.
The wave of the future in this state must be cultivating home- and community-based services to help aging Iowans stay in their homes. But the first step toward creating the infrastructure to foster independence isn't necessarily spending more money. It's working to make better use of the public money already being spent on senior care.
It's a lot of money - about $22,000 per year, per senior, for everything from Medicare to food programs, according to an analysis by the non-profit Brookings Institution. In fiscal year 2008, federal and state spending on long-term care for Iowans age 60 and older was $533 million.
A few ideas to make better use of the money:
Spend Medicaid dollars wisely
Iowa spends two-thirds of its Medicaid dollars on institutional care. Thousands of low-income seniors - frequently those who first used up their own resources on care - rely on taxpayer-funded Medicaid to pay for a nursing home.
The Medicaid Elderly Waiver allows seniors with certain intensive care needs to receive home-based care. Seniors using the waivers cost taxpayers an average $607 per month. Compare that to $3,687 for seniors in nursing homes. There is currently no waiting list for these waivers. Families should look into using them.
The government also should promote waivers as an alternative to more expensive nursing home stays. Keeping people in their homes should be the standard, not the exception. Not something that requires a waiver.
Pay caregivers adequately
Keeping seniors in their homes means having a good work force to make that possible. Experienced caregivers who provide assistance to disabled people and seniors are already in demand. As the population ages, demand will grow.
These workers are undervalued and frequently underpaid. There have been proposals for government to make changes, such as setting a higher minimum wage for these workers. But it's not simple for the government to intervene in a private-sector work force issue.
What really needs to happen: Private companies in the senior care business should do more to redistribute the millions of dollars in profits some collect - paying those who push papers less and those who actually provide care more. That will help build a fairly compensated and experienced work force.
A few years ago, the Register reported that Care Initiatives, a "charity" that operates 56 homes in Iowa, paid its CEO $2.1 million in one year and members of its board of directors $412 an hour. That was an example of money flowing to the top, rather than to the people who directly care for seniors.
Means test for some services
The federal Older Americans Act has funneled billions of dollars to states over the past 45 years. Title III of the law ensures seniors receive services including home-based meals, day care, senior centers and home modifications, such as a wheelchair ramp. The goal is to help people remain independent. The Iowa Department on Aging administers nearly $14 million in Title III money.
But none of the Title III services are means tested. That means anyone older than age 60 is eligible to receive help without proving financial need.
Congress should consider requiring people to prove financial need before tapping into services paid by taxpayers. A recent report from the Government Accountability Office noted that demand for Title III services will grow, making it "increasingly important for service providers to focus services on those most in need."
- - -
Helping seniors stay in their homes must be a priority in this state. There are opportunities - in both the public and private sectors - to redirect the dollars already being spent. This state should take advantage of those opportunities for the sake of older Iowans and taxpayers.
Despite this, Iowa ranks second in the country for the number of nursing home residents per 1,000 people age 65 or older. Our Medicaid program spends a smaller percentage of its long-term care dollars on community-based services than the national average.
It's a lot of money - about $22,000 per year, per senior, for everything from Medicare to food programs, according to an analysis by the non-profit Brookings Institution. In fiscal year 2008, federal and state spending on long-term care for Iowans age 60 and older was $533 million.
A few ideas to make better use of the money:
Spend Medicaid dollars wisely
Iowa spends two-thirds of its Medicaid dollars on institutional care. Thousands of low-income seniors - frequently those who first used up their own resources on care - rely on taxpayer-funded Medicaid to pay for a nursing home.
The Medicaid Elderly Waiver allows seniors with certain intensive care needs to receive home-based care. Seniors using the waivers cost taxpayers an average $607 per month. Compare that to $3,687 for seniors in nursing homes. There is currently no waiting list for these waivers. Families should look into using them.
The government also should promote waivers as an alternative to more expensive nursing home stays. Keeping people in their homes should be the standard, not the exception. Not something that requires a waiver.
Pay caregivers adequately
Keeping seniors in their homes means having a good work force to make that possible. Experienced caregivers who provide assistance to disabled people and seniors are already in demand. As the population ages, demand will grow.
These workers are undervalued and frequently underpaid. There have been proposals for government to make changes, such as setting a higher minimum wage for these workers. But it's not simple for the government to intervene in a private-sector work force issue.
What really needs to happen: Private companies in the senior care business should do more to redistribute the millions of dollars in profits some collect - paying those who push papers less and those who actually provide care more. That will help build a fairly compensated and experienced work force.
A few years ago, the Register reported that Care Initiatives, a "charity" that operates 56 homes in Iowa, paid its CEO $2.1 million in one year and members of its board of directors $412 an hour. That was an example of money flowing to the top, rather than to the people who directly care for seniors.
Means test for some services
The federal Older Americans Act has funneled billions of dollars to states over the past 45 years. Title III of the law ensures seniors receive services including home-based meals, day care, senior centers and home modifications, such as a wheelchair ramp. The goal is to help people remain independent. The Iowa Department on Aging administers nearly $14 million in Title III money.
But none of the Title III services are means tested. That means anyone older than age 60 is eligible to receive help without proving financial need.
Congress should consider requiring people to prove financial need before tapping into services paid by taxpayers. A recent report from the Government Accountability Office noted that demand for Title III services will grow, making it "increasingly important for service providers to focus services on those most in need."
- - -
Helping seniors stay in their homes must be a priority in this state. There are opportunities - in both the public and private sectors - to redirect the dollars already being spent. This state should take advantage of those opportunities for the sake of older Iowans and taxpayers.
