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Aging and Youth Directors Corner

 

COMMUNITY-BASED SERVICES
SAVE AN AVERAGE OF $88,000
PER PERSON ANNUALLY
IN MEDICAID COSTS

 

The Department of Aging and Youth provides in-home services in the form of personal care aides, home delivered meals, and personal emergency response units for people who require assistance to live safely and independently in their own homes and apartments. State, Federal and County funds are utilized to pay for these services and participants are encouraged to make donations to help offset the cost with the exception of the aide service program which requires participants to share the cost of service—anywhere from zero to 100%—based on their income.

These services assist in maintaining seniors in their homes and help to support seniors’ family members who may be able to provide some—but not all—of their care, thereby preventing or delaying applying for Medicaid.

Below is the typical profile of someone who receives community-based services from the Department of Aging and Youth:

• Woman, 80+ years old, lives alone
• She depends on Social Security as her main source of income and she has less than $20,000 in assets
• She does not drive and needs a rides for shopping, medical appointments, and social activities
  
• She relies on friends and family to maintain her home
• She is independently mobile, but relies on various supports (cane, walker, or wheelchair)
  
• She can do some limited light chores and basic meal preparation
  
• She has an informal support system that includes family, neighbors, and church.

A significant number of seniors who our office serves with community-based programs would qualify for and would probably receive care in a nursing home if these in-home services and supports were not available. While it is true that A&Y is unable to serve individuals with medically-complex issues or who need 24-hour care, we do serve people who have multiple health issues and have lost the ability to perform some essential activities of daily living. This severely impacts their independence and safety.

It is critical to provide community-based services for a number of reasons:

• Seniors prefer to remain in their homes and communities over moving to a nursing home;
  
• Services provided in the home can prevent or delay nursing home care; and
  
• The cost of providing services in the community is significantly less expensive than nursing home care.

The following data support cost savings from in-home care:

• Community-based services delay nursing home placement up to 32 months. A preliminary study from the Administration on Aging demonstrated that providing three community-based services in the home can delay nursing home placement of high-risk clients up to 32 months. (Advanced POMP: Rhode Island Department of Elderly Affairs, October 2009)
  
• States with extensive home and community services spend less. The cost-effectiveness of home and community-based long-term care services is supported in a recent article in the Journal of Health Affairs (Kaye, et al., 2009), which analyzed state spending data from 1995 to 2005. The research shows that spending growth of Medicaid and Medicare for long-term care services was greater for states that offered limited community-based services than for states with larger, well-established community based programs.

Here in Wayne County, an average community-based services case consists of five home delivered meals, four hours of personal care aide service, one hour of case management, and a personal emergency response unit per week.

Services - Weekly Cost, Annual Cost
5 meals - $52.55, $2,733
4 hours of personal care- $88.00, $4,576
1 hour of case management- $44.24, $2,300
PERS unit- $5.77, $300
Total $190.56, $9,909

The average cost per year for an individual to receive four community-based services in Wayne County through the Department of Aging and Youth is $9,909. Costs listed are the Department’s actual costs; service recipients generally pay much less.

The average daily cost of nursing home care in this area is $275 so the annual cost of nursing home care is $97,900. Compare $9,909 per year for A&Y services to $97,900 per year in a nursing home. The difference in cost is $87,991.

Most people who go into nursing homes spend all of their savings within the first year and are then eligible for Medicaid to cover the expense from that point on. Studies show that the average life expectancy for someone in a nursing home is approximately three years, so, on average, the financial burden of the next two years of care falls to the county and state.

If 100 people enter nursing homes, the cost to the government over two years is $17.6 million. The cost for 100 people receiving A&Y community-based services for two years is just $2 million. The difference is an astounding $15.6 million!

The Department of Aging and Youth’s community-based services are essential to maintaining many people with long-term care needs in their own homes and apartments at lower costs all while promoting independence and dignity. We’re proud to make this happen.

Penny Shockley, Director