Hoosiers weary of nursing homes’ monopoly of long term health care

Throughout Indiana there is clear evidence that Hoosier taxpayers and consumers are losing their patience with the nursing home industry’s monopoly over public dollars spent on long-term health care.

In meetings, in newsletters and newspapers, in correspondence and conversations with politicians, people are saying they’re tired of their tax dollars going to nursing homes instead of humane and cheaper home and community based long-term health care.

According to Steve Carter of the American Association for Retired Persons, the intensity of people’s feelings on the issue of home care versus nursing home care has never been higher.

In meetings on the subject of long-term care in Indiana that have been scheduled for Crown Point, Kokomo and Terre Haute, Carter reports that the organization is having to turn away people who want to register for the events because of unexpectedly high turnout.

Roger Voelker, CAC’s northern Indiana field representative and a local AARP leader, said "When the subject of long-term care comes up, people are angry that more than 10 years after the enactment of the state’s CHOICE home care program, people are still being forced into nursing homes because of a lack of funds for home care.

"People are saying to me, if nursing homes are fully funded by tax dollars then why isn’t home care? That’s a fair question, but so far the citizens of Indiana haven’t received a fair answer."

However, that question is being raised at the State House in Indianapolis. The answer to that question will determine whether Indiana stops the inhumane, expensive and needless practice of forcing persons with disabilities and the elderly into nursing homes and other institutions.

Ultimately, Governor Frank O’Bannon and the Indiana General Assembly must answer this question and be held accountable for their answers by the citizens of the state.

Reason to hope

Beginning in March of 1997, a tentative dialogue began between representatives of the Indiana Home Care Task Force and Gov. O’Bannon. The Task Force is largely responsible for the passage of the CHOICE program through the General Assembly and the gradual increases in funding for that program over the past decade.

The dialogue between the Governor, his administration and the Task Force has centered around the question of changing the disproportionate public funding of nursing homes. Nearly 90 percent of the public funding for long-term health care in this state goes to the nursing home industry.

Nursing homes are spending over $700 million per year in tax dollars in Indiana through the Medicaid program and other sources of public funding. By comparison, the state spends just $37.4 million per year on the CHOICE home care program.

Nearly 90 percent of the public funding for long-term health care in this state goes to the nursing home industry. Nursing homes are spending over $700 million per year in tax dollars in Indiana through the Medicaid program and other sources of public funding.

The O’Bannon Administration/Task Force dialogue is looking at how to dramatically expand the use of Medicaid waivers for home and community based long-term care. Since 1985, Congress has allowed Medicaid dollars to be used for certain forms of home care at set spending levels. So far, Indiana has made limited use of these Medicaid "waivers."

If Indiana would expand its use of Medicaid waivers, Hoosiers could soon be using Medicaid dollars for such things as assisted living, adult foster care and personal attendant care services in addition to the wide array of services that are already available through CHOICE and the existing Medicaid waivers.

The Task Force is raising two additional issues with the administration: expanding the state’s investment in the CHOICE program, and exploring direct means for reducing the unnecessary use of nursing homes.

John Cardwell, CAC’s Legislative Director and the chairperson of the Task Force, puts it this way:

"If we move to a system that makes the most appropriate form of long-term care available at the moment that care is needed, then we’ll have created a market-driven system that will cost taxpayers and users far less money, and which will achieve better care outcomes for consumers."

Indiana’s long term care system must also be a system that does not make people wait to receive the care they need. Paul Severance, Executive Director of United Senior Action and a member of the CAC Board of Directors, sees the removal of waiting lists as a central issue in the overall long-term care debate.

Because the 1999 General Assembly will be responsible for passing Indiana’s next two-year budget, much is at stake in the discussions that are currently taking place between the Task Force and the administration. The various organizations that make up the Task Force will be communicating directly with members of the General Assembly this summer and fall.

What we must do as citizens

However, hearing from organizational leaders and advocates will not be enough to persuade legislators in this crucial public policy battle. CAC members should communicate directly with Gov. O’Bannon and the members of the General Assembly, reminding them of the need to fundamentally change the public investment in long-term health care from one based primarily on nursing homes to a new system that is based on the care people need and want.

Please contact Gov. O’Bannon (call 317-232-4567 or write Office of the Governor, Second Floor, State House, 200 West Washington Street, Indianapolis, IN 46204), or your State Representative and Senator.

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