You may not be familiar with the names Lois Curtis and Elaine Wilson, but these Georgia women had a significant impact on the options you have for how and where you will receive long-term care if issues of disability or age-related frailty arise.
Lois and Elaine, who both had developmental disabilities, were voluntarily admitted to the psychiatric unit in a state-run Georgia hospital. Following the women’s medical treatment, mental health professionals determined each was ready to move to a community-based program.
However, the women remained confined in the institution for several years after the initial treatment ended. They filed suit under the Americans with Disabilities Act (ADA) for release from the hospital.
In June 1999, the U.S. Supreme Court held in Olmstead v. L.C. that unjustified segregation of those with disabilities constitutes discrimination in violation of Title II of the Americans with Disabilities Act. The court held that public entities must provide community-based services to those with disabilities as an alternative to institutional care such as nursing homes.
With this landmark decision, states came under a federal mandate to make home- and community-based alternatives to institutional care a real option for seniors as well as younger people with disabilities.
In response, states across the nation developed home- and community-based long-term care (LTC) options.
In Michigan, the largest home and community-based LTC option is the MI Choice Waiver program. MI Choice serves people 18 and older who need nursing home level of care and delivers that care in the setting of their choice – most often in their own home or the home of a loved one.
More than 750 people in Southwest Michigan receive their LTC services through the MI Choice Waiver program each year. PACE is another home- and community-based program and serves about 230 people.
Making home- and community-based care a robust LTC option also makes good fiscal sense. The cost of providing care in a person’s home through the MI Choice Waiver program is only 45 percent of the cost of nursing home care.
With the annual growth in Medicaid spending and the challenge of balancing state budgets, that’s good news. Michigan can serve more people in the setting of their choice at a lower cost by providing that care through home- and community-based programs like MI Choice Waiver and PACE.
Across the nation, on average 57 percent of Medicaid-funded LTC is now provided in home- and community-based settings, which is where 90 percent of people say they want to live as they age.
Oregon leads the nation by spending 80 percent of its Medicaid LTC dollars in home- and community-based settings. While Michigan ranks sixth worst in the nation spending only 40 percent of its LTC dollars on home- and community-based care. That’s due in part to the structural differences in how institutional and home- and community-based services are funded in Michigan.
Nursing home care is a set benefit for all Michiganders who need nursing home care and qualify for Medicaid. Conversely, state appropriators allocate a set amount of funds each year for community-based care.
Under this construct, the state effectively limits the number of people who can receive care in their homes by allocating a set number of “slots” for people who want that care in community-based settings instead of an institutional setting.
As a result, in Michigan you can receive care in a nursing home and have it paid for by the state if you qualify functionally and financially for Medicaid-funded LTC. If you prefer to get that care in your home, you have to hope the state has appropriated enough funds to allow you a “slot” to provide for your care along with other Michiganders who have that same preference.
You can build on the legacy of Lois and Elaine by letting your state legislators know you want to receive care in your own home, should the need for LTC arise, and ask their support of policies that expand access to home-based care. You can find your legislators’ contract information at openstates.org/find_your_legislator.
If you or a loved one need care now and want to explore your options, aging and disability experts are on hand to help you know your options so you can make an informed choice. You can reach them on the Info-Line for Aging and Disability at 800-654-2810.
You can read this article in the weekend edition of the Herald Palladium. Long-term care patients want to age in place, but state funds are limited | Features | heraldpalladium.com.