| THE INDIANAPOLIS STAR MONDAY, APRIL 26,1999 OTHER VIEWS LETTER SPOTLIGHT Expand funding for home care BY JOHN CARDWELL In 1987, all 150 members of the Indiana General Assembly voted for the
passage of the Community and Home Options to Institutional Care for the Elderly and
Disabled Act, or The CHOICE program, which provides home care services for the elderly and persons with disabilities of all ages, has gained a national reputation as the best publicly funded home care program in the nation. It has been lauded for its effectiveness and ability to save money when compared to the cost of nursing home care. In fact, the average cost of care per year for a citizen served by the CHOICE program is $7,400. By comparison, Medicaid-funded nursing home care starts at $27,500 a year for low-end care and runs up to $37,500 a year for skilled care. Both programs are paid for entirely by public dollars. But with nursing home costs 4.3 times higher than CHOICE, the cost effectiveness of institutional care does not remotely match what the CHOICE program achieves. In a 1998 study conducted by Indiana University, CHOICE consumers gave the program a 4.66 rating on a five-point scale in terms of protecting their autonomy and choice. These consumers rated the respectfulness and trustworthiness of their private sector home care workers contracted through the Area Agencies on Aging at 4.87, and the quality of the overall care received through the program at 4.56. Unfortunately, the high marks the CHOICE program receives from consumers, the public as a whole, long-term care professionals and government administrators have not translated into comparable funding from the Indiana General Assembly. In a plan put forth by the state's CHOICE Advisory Board, the statutory body created by the General Assembly to advise it and the governor on long-term care policy matters, the CHOICE program was identified as needing $45 million in new funding to meet the needs of Indiana's citizens over the next two years. That plan was embraced in Senate Bill 568, a product of the Democratic minority, but the bill was not given a hearing in the Senate Finance Committee. The Republicans, the minority in the House, also embraced the CHOICE board's plan but received no support from the majority Democrats. Subsequently, the House Republicans tried to get $36 million in new CHOICE dollars into the state budget bill, House Bill 1001, but the Democrats moved it through the House with only $10 million in new funding. Once the bill was in the Senate, the Democrats in that body tried to raise the new funding to a total of $35 million but were blocked by the majority Republicans. Worse yet, the Senate Republicans amended HB 1001 to change the eligibility standards for the CHOICE program. Under current law, persons earning between $12,300 and $28,000 have to pay for part of the cost of their care through a sliding fee scale mechanism. Consequently, a person earning at the top of the eligibility scale has to pay for virtually all costs associated with receiving services through the CHOICE program. This brings in more money to the state to fund additional care, allows more people to be served by the program, and makes the people paying cost-share very responsible. The Senate Republican amendment totally eliminates anyone from eligibility with an income of over $16,480 per year. This amendment will stop the state from receiving more than 75 percent of its cost-share income. But the real tragedy of the Senate amendment will be to force people with modest incomes into poverty, and ultimately into nursing homes, as they try and fail to cover the full cost of their home care services. The Senate amendment is an example of politicians breaking something that isn't broken. Senate Democrats and the House Republicans need to be told by Gov. Frank O'Bannon that their efforts to fully fund CHOICE, and then to seek an honorable compromise of $35 million in new funding, are examples of what should be done by the General Assembly. The governor should also tell them to leave CHOICE's current eligibility criteria intact. Cardwell is chair of the Indiana Home Care Task Force in Indianapolis.
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CHOICE.
Former Gov. Robert Orr signed the act into law.