Helping seniors stay home

Advances in modern medicine coupled with increased awareness of healthy lifestyle habits are allowing more and more Americans to live longer than ever before. But accompanying that good news are the stark realities of where these older Americans will live, how they will afford their healthcare, and how society will respect the dignity that these seniors have earned over their lifetimes. 

Nowhere is this more dramatically evident than when it comes to caring for low-income, chronically ill Medicare beneficiaries who, in overwhelming numbers, want to remain in the comfort of their own homes rather than going to a nursing home if given the choice. Sadly, that choice is often taken from them by an outdated system that provides neither the financial support nor the moral compass to allow these citizens to choose how and where they wish to live.    

{mosads}Fortunately, sensible help is on the way, which is why we and the 14 organizational members of the Coalition to Support Independence in Medicare wholeheartedly endorse bipartisan legislation (H.R. 2704) introduced by Reps. Linda Sánchez (D-Calif.) and Patrick Meehan (R-Pa.).  Similar legislation, sponsored by Sens. Chuck Grassley (R-Iowa) and Ben Cardin (D-Md.), just unanimously passed the Senate Finance Committee.  

H.R. 2704 would establish a new Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration program that would target home- and community-based services for low-income Medicare-only beneficiaries who need assistance with basic activities of daily living. Enabling these seniors to remain in the community through providing them the support they need could significantly improve the quality of life for them and their families while simultaneously delivering savings to both the state and the federal government.   

Under H.R. 2704 the new demonstration would operate in up to five states initially, building on Medicare Advantage plans that have proven-successful experience caring for this frail population. The plans would tailor services to beneficiaries, depending on individual needs. For instance, they might provide assistance with bathing or dressing, housekeeping or transportation, or even respite care for their primary caregiver. 

Absent such a program, seniors in need of these services often have little choice but to enter a nursing home. But under the present system the federal government does not pay for long-term services and support, unless an individual is on Medicaid. Nursing home costs are expensive and long-term care insurance is drying up. As a result, these seniors end up spending down their dwindling assets until they become eligible for Medicaid. This is a system where nobody wins: not the senior who exhausts their income only to end up in a nursing home where they never wanted to be; nor the government, which now has another person unnecessarily on Medicaid. It is a vicious cycle to which attention must be paid.  

The Sanchez-Meehan proposed legislation is a common sense solution at a time when common sense is becoming a rarer and rarer commodity. If passed, the bill will not only give hope to some of the nation’s most vulnerable individuals but at the same time will offer a path toward state and federal budget savings. One study estimates four-year savings of nearly $60 million for a demonstration of 5,000 Medicare members by postponing or preventing hospitalization and institutionalization. 

H.R. 2704’s community-based approach gives seniors the support and dignity they deserve and acknowledges the reality that nobody wants to go into a nursing home if they don’t need to. We urge passage of this sensible bill, which will not only make life better for frail seniors but is a critical step in reshaping the provision and financing of long-term care in America.

Wing is chief executive officer of SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans.