As lawmakers return to Washington to tackle health care reform, AARP is pressing them to improve the country’s long-term care system as a part of comprehensive reform.  Millions of older Americans rely on Medicaid for the long-term services and supports they need, but the program’s bias toward institutional care prevents most from getting more affordable care where they want it: their own homes.

“It’s shameful that so many people are forced into nursing homes when we could improve their quality of life and typically spend less money by caring for them at home,” says Jim Dieterle, AARP New Jersey senior state director. “As we overhaul the health care system, we need to build on win-win solutions that expand choices and could save billions of dollars.”

Under current law, Medicaid—the largest payer of long-term care—has an institutional bias. While states must provide coverage of nursing facility services, they do not have to cover most home and community based services (HCBS). On average, Medicaid can pay for three older people in HCBS for every one person in a nursing home. Despite this, HCBS is often one of the first programs to lose state funding during an economic downturn, often forcing more people into higher cost nursing facilities even if they would prefer to remain at home.  

AARP has endorsed the Empowered at Home Act (S. 434), sponsored by Senators John Kerry (D-MA) and Chuck Grassley (R-IA), which would provide incentives and greater opportunities for states to expand access to home and community based services. It would also provide the spouses of people receiving HCBS with protection against impoverishment.

The Association has also endorsed the “Retooling the Health Care Workforce for an Aging America Act” (S. 245/H.R. 468) sponsored by Senators Herb Kohl (D-WI), Bob Casey (D-PA) and Blanche Lincoln (D-AR), and Representative Jan Schakowsky (D-IL). This legislation would provide support, training and information to family caregivers, and improve the health and long-term care workforce to better meet the needs of the aging population.

Dieterle adds, “Real health care reform isn’t only about covering every American. It’s also about rethinking how we provide care. Allowing people to live in their homes with their loved ones means a drastic improvement in the quality of life and potentially huge cost savings in the long term.”

AARP’s Public Policy Institute released a new fact sheet, “Providing More Long-term Support and Services at Home: Why It’s Critical for Health Reform,” which is available at aarp.org/research/housing-mobility/homecare/fs_hcbs_hcr.html.

For details on AARP’s health reform priorities, including long-term care, visit aarp.org/governmentwatch.