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Receiving Long-Term Care Gets Harder As Demand, Cost Grow

A man eats applesauce at a nursing home.

Crothersville resident James Dailey considers himself lucky. At age 79 he still gets around fine. He even helps others by volunteering at the senior center to drive people to the store or to other appointments.

Dailey has talked to his three daughters about what he wants if the time comes when he cannot care for himself.

“And I say when everything goes wrong put me in there, but let me stay and do things by myself as long as I can, and as long as I’m reasonable and knowledgeable about what’s best for me,” he says. “But let me stay home if I can.”

Best case scenario of course is Dailey will never need assistance, but if he does, those services could be hard to come by.

Waiting In Line, Finding Ways To Pay

Long-term care services can be extremely expensive, but they are also in great demand. The fastest growing population in Indiana is people who are 85 and older, and more than 115,000 Hoosiers fit into that age bracket.

To help offset some of the costs, Indiana offers assistance to eligible seniors in the form of a program called C.H.O.I.C.E. or Community and Home Options to Institutional Care for the Elderly and Disabled.

The program provides in home services. But the waiting list is about 5,000.

“The people who are on a waiting list to get those services to get those C.H.O.I.C.E. dollars – how many of them are going to still be here and live to see getting onto the list?” asks Cora Lucas, who oversees the center in Jackson County where Dailey volunteers.

Lucas and Dailey, along with dozens of seniors, drove to the statehouse last week to rally legislators to support community based services.

“Funding has to continue and the growing population of the baby boomers and it’s going to force us to increase funding and budgets are being cut or not increased for the demand how are we going to meet the needs?” she says.

The answer is difficult. Medicaid is the largest funder of support services, largely because it is required to pay for long term care.

But IUPUI professor Kathleen Unroe says states have direct control over how much money if any goes to in home care or assisted living services.

“There are a number of people who could remain in their homes if they got four hours of care in the morning and a couple of hours in the evening,” she says.

Indiana Ranks Low For Quality, Availability Of Care

Some states are doing well at diverting or transitioning seniors to in home care instead of institutional facilities. A 2011 report from the AARP’s policy institute ranked Indiana 47th in the nation for its quality and availability of long term support services.

If the state improved to the level of some of the best performing states such as Minnesota, more than 4,000 nursing home residents with low care needs would instead be able to receive services and live in their communities.

Back at the statehouse seniors are continuing to rally for more money to provide in home community based services.

From his office two stories up, House Ways and Means Committee Chair Tim Brown cannot hear their chants. He acknowledges that supply is not keeping up with demand, but he says the solution to providing seniors with quality care is like a three-legged stool.

“You have to have the long term care insurance,” Brown says. “You have to have maybe some screening online eligibility requirements as you go forward and then you have to have family and your own self pay.”

Brown says the state and the federal government should then help people who are needy and might otherwise fall through the cracks.

The current budget the house is considering allocates nearly $49 million for C.H.O.I.C.E., which is the same amount the program has received since the early 2000s despite the growing need.

For more on the challenges facing long-term care, watch this month’s episode of IN Focus, WTIU’s public affairs program.

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