This op-ed originally appeared in the Bangor Daily News on September 27, 2018. Read the original there.
There’s no way around it: Most of us will need some kind of assistance and care as we get older. But will we be able to choose what that care looks like and where it will be provided?
Nearly 90 percent of us would actually make the same choice — preferring care that allows us to stay in our homes and communities for as long as possible, surrounded by what we know and love. But currently our system prevents that choice for all but the wealthiest. That’s why it’s so important for Mainers to vote yes on Question 1, the Universal Home Care Initiative, on Nov. 6. A “yes” vote will support a plan to allow Mainers to live life as they age on their own terms, at a cost they can afford.
Families in need are often surprised that our system is so out of touch when it comes to our caregiving needs and desires. Many people think that when an older relative’s (or one’s own), care needs arise, Medicare will cover home care. But, in fact, Medicare only covers some home care services for a small segment of people who need it: those who are homebound and need skilled nursing or therapy pursuant to a doctor’s plan of care.
As a long-time advocate for older adults and people with disabilities, I’ve seen far too many cases where people have been denied Medicare home care for flimsy reasons. For example, a family once contacted us at the Center for Medicare Advocacy because their older loved one, living with dementia, was told he didn’t qualify as homebound because he wandered outside. Not having access to home care was a danger to the patient, yet the fact that he put himself at risk by roaming outside was the rationale for denying him care.
The irony doesn’t stop there. Others have been told that Medicare will only cover one bath a week for their aging loved one, or that their loved one’s health would have to get much worse before being able to access therapy. Home care improves health outcomes, but it can’t do that if the care won’t be provided until one’s health has already declined. These unfair barriers to care defy common sense, and sometimes even the law.
Question 1 would bring common sense to Maine’s caregiving supports, and some relief to caregiving families, which are already struggling with soaring health care and medication costs. As too many lawmakers avoid action on this issue — jeopardizing our families’ health and our state’s budget — Mainers are stepping up themselves to solve the problem. Maine’s families deserve nothing less.
The Universal Access to Home Care Initiative would improve the quality of life for families, older adults and caregivers. Access to home care has been shown to decrease isolation, which, in turn, reduces the incidence of many age-related conditions, including dementia. Further, patients with dementia who receive home care are 12 percent less likely to be admitted to hospitals — creating enormous savings for families, hospitals, Medicare and Medicaid.
Despite all the evidence in support of home care, it is significantly less available compared to other types of long-term care. Nationally, 60 percent of nursing home care — which costs twice as much as full-time home care — is covered by government programs, compared with just 13 percent of home care. This means families are forced to cover most of the costs, in a setting they don’t want — costs of approximately $54,000 per year in Maine. The Universal Home Care Initiative would offer a far better option: providing quality, affordable care at home.
Question 1 for Universal Home Care is built on the principles of spending more efficiently while prioritizing what Mainers’ want: the freedom to live where and how they want as they age. Vote yes on Nov. 6. The Universal Home Care Initiative makes moral sense, common sense, and economic sense, too.
Judith A. Stein is executive director of the Center for Medicare Advocacy.