Long-term care - another budget buster?

• Author: Romig, Candace
• Position: States face increasing long-term care expenses as population ages rapidly - Includes related articles

AS PEOPLE LIVE LONGER AND THE POPULATION OF THOSE OVER 85 SKYROCKETS, DEMANDS WILL ESCALATE FOR LONG-TERM CARE.

If you're worried about your state's rapidly aging population and you want to know what troubles are ahead for long-term care - look to Florida. The Sunshine State is 15 to 20 years ahead of the nation in the sheer number of elderly citizens and knows how complicated it is to provide the special services they require.

"Long-term care is the black hole of state government," says former Florida Senator Curt Kiser. Nursing home costs in his state (and many others) are increasing at more than twice the rate of most budget line items.

Twenty years ago, older couples with healthy checkbooks retired to Florida to enjoy leisure activities and life in the sun. "Now many of these seniors have had a spouse die, their resources are depleted, and they aren't playing golf anymore," explains Kiser. "Florida has the most rapidly rising population of 85-year-olds in the country. We can't be putting everyone in nursing homes. We must help them stay in the community where they want to be."

For the past 15 years, states have been testing and developing programs that help older people stay in their homes and communities.

What does an elderly woman need to be able to stay in her own home? A hot meal delivered every day, transportation to the doctor, the pharmacy and the grocery store, transportation to social activities to keep her active. She might need someone to stop by to help pay bills, clean her house, do laundry. Eventually, she might need someone to come in to help her bathe, go to the bathroom, dress and eat. She might need nursing services once or twice a week.

When an old person has to leave her home, where does she go? If she has the resources, to a private nursing home or community that offers meals, nursing care, transportation. If not, to live with her children or a niece or nephew or a sibling. Then she might need day care and her family, other kinds of respite help, because 75 percent of those who care for an elderly relative are working women.

NUMBERS OF ELDERLY WILL EXPLODE

The fastest growing segment of the population is the very oldest, and the aging of the huge baby boomer population looms in the future. The number of 85-year-olds will explode from 3.6 million today to 17.6 million by 2050. Florida knows what this means. Its rapidly growing older population is expected to increase by 25 percent between 1990 and 2000. During that time, the number of citizens over 85 will increase by 78 percent. As the population changes, funding pressures for long-term care and public pressure for alternatives to nursing homes will continue to grow.

Will states be ready?

So far, efforts to redesign long-term care programs to meet the changing needs and preferences of older citizens have come from the states. With a growing number of services that delay or eliminate the need for institutionalization, states as a whole have managed for the last 10 years to keep increases in the nursing home population to 24 percent despite a 35 percent increase in the number of people over 85. Except for the Older Americans Act, which provides little funding, there is no definitive federal policy on long-term care. To leverage federal participation, state programs have been built on Medicaid and Medicare, the social insurance for poor and elderly citizens that came out of the '60s before we knew how many Americans would be living longer and healthier lives. Medicaid, which pays for much of long-term care both for the poor and the one-time middle class (made poor through spend-down qualifications), is biased heavily toward institutional care. So biased and "rigid," according to the National Association of State Units on Aging (NASUA), that "complicated and unwieldy 'waiver' programs have had to be introduced to enable states to divert a modest level of resources toward long-term care programs that keep people in their homes."

States have been aggressive in the past decade in developing systems that more closely meet the needs and preferences of their older citizens and finding ways to pay for them. But there's a long way to go. Most state programs use cost-sharing mechanisms so that people who aren't poor can get services if they need them. And about half the states put money unmatched by federal funds into expanding their programs.

These are the problems that still plague most state programs:

* States don't have the data they need to serve the growing elderly population. They don't know what kinds of...