After more than a year at home, now we all can appreciate need to keep people there as they age
Based upon various national and state studies, we at AARP New Hampshire can say with confidence that we know this much is true: Granite Staters want to stay at home as they age. Every two years, despite the fact that we are two years older, we continue to not fund services to keep people at home. Our leaders simply continue to overlook and/or disregard their preferences by not funding in ways that could make those wishes a reality. Among the lessons of 2020 (for Granite Staters of all ages) was just how safe our homes could be and how happy most of us could be in them. It is time, finally, to insist our elected leaders honor the preferences of Granite Staters to stay at home as they age by making smart and strategic funding choices.
The economics are compelling. We know that care through the State’s Choices for Independence (CFI) Program – which is for people who are clinically eligible to be in nursing homes – is about one third the cost of keeping someone in a long-term care facility. It is cheaper to keep people at home and home is where they want to be for as long as possible. A lack of funding shouldn’t compel people to leave their homes when they could, with some support, stay there longer until they need – truly need – the excellent care our state’s long-term care facilities provide. The state’s budget and this budget process should align with both fiscal realities and our preferences, particularly as the Granite State continues to age. This is an opportunity for our elected officials to leverage incoming Federal money – flowing in to New Hampshire as we recover and emerge from the pandemic – to change course. It is an opportunity to make lasting systemic change allowing us to age how and where we choose. And (at the same time) give the tens of thousands of unpaid Granite State family caregivers opportunities for rest and breaks needed to continue doing their part to keep loved ones at home with minimal cost to the state.
The governor’s proposed budget provides some increases for some services to keep people at home. It simply doesn’t go far enough. The three services that saw rate increases under the CFI program still don’t adequately fund the cost to provide those services. In other words, providers lose money trying to provide certain services or they can’t pay sufficient wages to attract and retain workers. We all know that sometimes it makes sense to spend money to save money or to make money. Other services such as adult medical day care (which, if done well and broadly, could leverage private pay dollars) have not received an increase, even when that service is currently reimbursed at about half of the actual cost of providing the service. As a result of perennially inadequate funding, many adult day care facilities have closed in the last five to ten years. This is bad news for New Hampshire’s 177,000 unpaid family caregivers, many of whom could, would, and did use such services for needed respite without burdening state budgets. We must do better. This doesn’t only impact Medicaid recipients. It also means these services aren’t there for private payers either. This affects all of us by taking away an important service from families who are doing the right thing by keeping their loved ones at home instead of prematurely placing them in more expensive settings. Once every two years, our elected officials (and all of us who can influence their votes) have a chance to do something different. Now is that time.
New Hampshire continues to spend significantly more money on institutional care versus in-home care. Both settings have their place; funding should not drive choice. The current budget proposal has some increases to address this imbalance, but it still falls short. Even for the services receiving increases, the increases do not make payments for these services comparable for similar services in the same area. Further adjustments are necessary.
As a state, we can and must do better. This really is about honor. We must make immediate efforts (in this budget cycle) to honor people’s choices of settings (in their home and communities), to honor the people themselves by ensuring that they can get the services they need, and those providing those services in their homes and communities are paid well. We must fund things (such as adult day care) to lighten the heavy loads of tens of thousands of family caregivers.
Think about aging as contact, or the absence of it. Now is the time for us make contact with our elected officials to ensure the funding that allows us to keep the contact with our homes and communities we want as we age. I urge you to go to nh.gov and look up how to reach Governor Sununu, your elected state representatives and senators, and make contact. Urge them to make aging a priority while it is still fresh in everyone’s mind just how welcome a place home can be.
Todd Fahey is the AARP New Hampshire state director. He may be reached at firstname.lastname@example.org.