Planning Ahead
Hawaii and Minnesota are two states that have been planning for ways to contain costs and keep seniors safe and healthy in their homes into the mid-21st century.
"We have a rapidly aging population and this is a big issue," said Hawaii state Sen. Rosalyn Baker, a Democrat who chairs the Commerce, Consumer Protection and Health Committee. "People want to age in place and stay at home. We need to find ways to help them do that."
More than a decade ago, Hawaii passed a law setting up a framework for a long-term care financial plan. Even before that, Hawaii created Kupuna (Hawaiian for 'elder') Care, a state-funded program aimed at keeping frail older adults in their homes by providing them personal care, housekeeping or other services. The program is free and has no financial eligibility requirements, although priority is given to lower-income people who don't qualify for Medicaid.
This year, Baker sponsored a bill that would have created a first-in-the-nation, public long-term care insurance program, adding a half-cent surcharge to the state’s excise tax on goods and services. The money could have provided residents about $70 a day for 365 days to pay for caregivers or respite care. The measure passed two committees but died in a third.
Baker said the bill would have saved the state money by reducing the number of people who would need to rely on Medicaid for in-home care. She said it failed because many of her colleagues were opposed to any tax hike in an election year. She plans to propose a similar measure next year.
Minnesota also has been planning ahead, and ranks first in a scorecard compiled by AARP and other groups on the quality of states' long-term care systems.
Three decades ago, Minnesota placed a moratorium on nursing home beds and set out to build a community-based care system for older adults. The number of nursing home beds dropped from more than 48,000 in the late 1980s to about 29,000 last year, according to Loren Colman, an assistant commissioner for the state's Department of Human Services.
More than 31,000 elderly people now get home- and community-based care through Medicaid, he said. Across the state, local agency staffers help them find services so they can stay in their homes.
"Most older adults are limited in their resources. They’re comfortable in their homes. They want to stay there," Colman said. "They want services to be brought to them."
Colman said Minnesota is fortunate that legislators, governors, advocates and policymakers all have been on board with the state's long-term care vision.
That hasn't been the case everywhere.
In California, Democratic state Sen. Carol Liu, who chairs a select committee on aging, proposed a bill creating a long-term care czar, setting up a consumer-friendly internet portal where residents could get information, and consolidating all aging and long-term care programs under one state agency. The czar and portal proposals didn't fly. And Liu revised the reorganization provision to instead create a council that would collaborate on issues and develop a strategic plan.
Her bill passed the Senate in January and awaits action in an Assembly committee. But it faces stiff opposition from the state's Health and Human Services Agency, which says it's unnecessary and would be a financial and administrative burden. A Senate Appropriations Committee analysis estimates it would require about $600,000 in start-up costs and $425,000 a year in operational costs.
All of this frustrates Liu, who said after 20 years of hearings and studies about long-term care, California's system remains fragmented, inadequately funded and ineffective. She said a patchwork of 112 programs in 20 different state agencies, departments and offices is responsible for long-term care, and staffers work in siloes and don’t communicate with each other.
Liu fears that the state isn't prepared to handle the aging demographic, and points to a 2015 study that projects that by 2030, more than a million California seniors would require some type of personal care help. Another study estimates that the state’s Medicaid long-term care costs could grow from $6.6 billion a year in 2013 to as much as $12.4 billion in 2023.
"The situation is almost criminal," she said. "If this continues and we don't get our act together, by 2030, the costs to the state — and to our seniors — will be incredible."