Statewide expansion of an Ohio program that enables the elderly to remain in their residences instead of going into nursing homes hinges on future funding and whether there will be enough home health aides, officials say.

Surveys show that more than 90 percent of Ohio seniors would prefer to age in their own homes rather than in a facility.

Ohio launched the Choices Home Care waiver program in 2001 and expanded it again in 2004. It currently serves 390 clients in Columbus, Toledo, Marietta and Rio Grande.

It has been a success, especially in rural areas where home health agencies are harder to find and for clients who require split shifts or odd hours for their care, said Judy Patterson, who oversees the program for the Ohio Department of Aging.

Whether the program is expanded to the rest of the state depends on what happens to the next biennium budget, which legislators will vote on in June, department officials said.

For the past decade, Ohio has been struggling to shift more of its frail elderly and disabled away from nursing homes and into lower cost alternatives such as assisted living and home care.

In 1995, 90 percent of Ohio’s long-term care recipients were living in nursing homes. By 2005, that percentage had dropped to 65 percent. The Ohio Department of Aging estimates the shift has saved Ohio taxpayers $1 billion.

An economic recovery, coupled with Ohio’s plans to allow the disabled more choices in their care, could mean shortages if the pay issue isn’t addressed. More than a dozen states, including Ohio, are exploring the possibility of paying clients to hire their own relatives or friends to provide in-home care.

Home care typically costs less than a third of what states pay for nursing homes. But at current wage scales of $10 to $12 an hour, the turnover rate among home health agency staff is high — 90 percent of aides leave their jobs within the first two years, according to the Institute of Medicine.

Gov. Ted Strickland’s administration is pushing for a unified long-term care budget that would eliminate the spending caps for assisted living and in-home care. If approved by the legislature, putting the full range of long-term care services on an equal footing could save the state up to $900 million in Medicaid spending, said Barbara E. Riley, director of the department of aging.

But Ohio lags behind other states that are moving faster toward giving people choices in home and community-based care.

According to a study by the AARP, Ohio spent 30 percent of its Medicaid dollars on alternatives to nursing home care in 2007, ranking 39th among states in providing home- and community-based care.

In the current economy, Riley said, the state has no plans to increase Medicaid payment to home health aides.

“But if we’re able to reduce long-term care spending up to $900 million, then the money becomes available to do things like raise the amounts of payments” to caregivers, she said.

Despite her severe arthritis, 94-year-old Peggy Wilson continues to live in her own home at Bethany Lutheran Village in the Dayton suburb of Centerville — thanks to home health aide Rita Fashjian, who helps her with dressing, cooking, cleaning, even writing her letters.

Ohio’s severely disabled population is expected to double from 175,000 to 350,000 by 2035, according to the Scripps Gerontology Center at Miami University. As the nation’s 78 million baby boomers reach retirement age in 2011, “They will face a health care work force that is too small and woefully inadequate to meet their needs,” warns a recent Institute of Medicine report.


Information from: Dayton Daily News,
The Associated Press
Posted Mar 09, 2009 @ 05:02 PM

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