For those of us who work in long-term care, California’s budget crisis can be viewed in two ways – as yet another devastating blow to the seniors and people with disabilities we care for – or as an opportunity to get things right. Which of these views turns out to be accurate will depend on the choices we make.
Formulaic cuts to hours or types of services are not the right approach. The necessary search for savings has the potential to help California develop a more forward-looking approach to long-term care, but only if we go about it strategically. We need to use the federal funds available to us and expand the savings we have already achieved by taking more aggressive measures to care for more people at home instead of in more expensive institutions.
The cuts proposed in the Governor’s budget would move us in the opposite direction and need to be replaced with new policies aimed at strengthening and extending California’s shift to home and community-based care.
Consider the following families, each of whom who would be affected by both the proposed 8.6% cut to hours and the proposal to eliminate domestic services completely for recipients who live with their caregivers:
Yadira Real and in-home caregiver, cares for Raul, her husband of 35 years. Raul has diabetes, congestive heart failure and osteoporosis. Doctors have advised Yadira not leave Raul alone, and his more than 40 daily medications and special diet require constant support and management. If Raul’s IHSS hours are reduced and domestic services eliminated, Yadira would have to work outside the home to replace that income, and Paul’s health would be threatened.
Cindy Valdez and her partner Jeff would also face severe challenges under the budget proposal. Cindy left her job as a store manager to become a full-time caregiver for Jeff, who lives with Multiple Sclerosis. Because of the consistency of care Cindy gives Jeff, she is able to anticipate and prevent debilitating muscle spasms. Under the proposed budget, Cindy’s hours would be significantly reduced, forcing her to find another job and leaving Michael without Cindy’s skillful, attentive help for most of each day.
Sylvia Lucas, 80, never planned to spend her retirement years as a caregiver, but when her son Michael broke his neck in a fall 13 years ago, she rearranged her life around caring for him. If not for the care Sylvia provides, Michael would be in a nursing home. With her retirement savings wiped out in the economic crash, Sylvia relies on her income as a home caregiver to pay the rent. Reductions in her compensation could push the family over the brink and into homelessness.
Pulling the rug out from under these hard-working families by reducing overall hours and eliminating their domestic service hours completely would move us in the wrong direction, pushing more people into institutional care and making home and community care less available.
We have a better way to achieve the savings we need.
A provision of the new federal health care law, the Community First Choice Option, for instance, will allow California to draw down at least $160 million in federal funding annually to help seniors and people with disabilities stay healthy at home.
A concerted effort to inform people now in nursing homes – and those who are at risk of nursing home confinement in the future – of their options to remain healthy at home, with their families, can sharply reduce the need for expensive nursing home care. Other states that have instituted deliberate, coordinated systems of diversion from nursing homes and assistance in transition have seen substantial savings. In a 15 year period Oregon decreased the number of Medicaid-supported nursing home residents by 35%. Like California Oregon has a strong homecare program but they are still reducing nursing home stays and saving money. This has the potential to save millions in California.
Finally, helping seniors and their caregivers manage their healthcare needs better at home through innovative support can reduce expensive emergency room visits, hospital stays, and nursing home stays. No state has embodied America’s ability to innovate, rise to the challenge and prosper like California has. Our long-term care system is no exception, but that work is incomplete. We need to complete the transition to a sustainable, primarily home- and community-based system, and that means making wise choices now.