The emphasis in recent weeks on directing additional funds to Maine’s nursing homes highlights a disconnect between where policymakers such as Gov. Paul LePage are focusing their attention and what older adults in Maine actually want.
By and large — and this isn’t surprising — older adults in Maine want to remain in their own homes as long as possible as they age.
AARP Maine recently commissioned a poll of 2,000 Maine residents age 50 and older to gauge the issues and concerns they’re thinking about as they make their voting decisions this fall. Eighty percent of respondents — four out of five — said it’s extremely or very important that they remain at home as they age.
That desire informs a number of policy preferences for the voters AARP surveyed. Three-quarters of those polled said elected officials should make funding for services that help them stay at home — home health care and transportation, for example — a high priority.
Nearly 80 percent of voters 50 and older, according to the poll, are likely to vote for a candidate who devotes attention to ensuring older Maine residents can afford to remain in their homes as they age. And those polled by AARP are civically engaged: Ninety-three percent said they voted either in all elections or most.
Meanwhile, Maine has a nursing home funding situation that needs to be fixed, and the attention paid to the plight of nursing homes by LePage and Republican legislative leaders has intensified the discussion to an all-consuming crisis level.
Nursing homes play a critical role in our society in ensuring the health and safety of some of the state’s oldest residents with limited ability to take care of themselves. Maine’s nursing homes will remain a critical part of Maine’s long-term care system.
But there’s already been a shift away from nursing home care, both in Maine and nationally. In the 1990s, Maine had about 10,000 nursing home beds across the state. Today, the number is about 7,000. And nationally, the number of nursing homes fell 5.3 percent between 2002 and 2011, according to the federal Center for Medicare and Medicaid Services. Occupancy rates slipped in that time, even with fewer homes.
In Maine, much of the shift away from nursing homes occurred in the 1990s as the state set stricter nursing home admission standards, and more older adults transitioned to assisted living facilities that provide a less intensive level of care. But states also are using more of their Medicaid funds to pay for long-term care services delivered at home. In 1995, states spent 20 percent of their Medicaid long-term care funds on home- and community-based services, according to the Kaiser Family Foundation. By 2011, that percentage had risen to 45 percent.
Delivering long-term care services at home isn’t just popular among older residents, it’s more cost-effective for the taxpayers who are often footing the bill through Medicaid. According to AARP, the cost of a year of nursing home care in Maine amounts to 303 percent of the median household income for someone 65 or older compared with 96 percent for home-based care.
Maine and other states have been making progress in delivering more long-term care at home, but more needs to be done. As the state ages even more, older residents will need to have viable care options that allow them to stay at home and delay the need for nursing home care.
Maine House Speaker Mark Eves, D-North Berwick, in January convened a roundtable on aging to start devising plans on delivering long-term care for an aging population — from boosting the ranks of direct care workers and their pay to assembling volunteer-based transportation networks to rethinking communities’ infrastructure so it’s more “age-friendly.” Sen. Susan Collins also has spoken about the need to help family caregivers care for older adults in their family at home.
With this level of political consensus, Maine should be able to make more headway in allowing seniors to remain at home longer. While additional funding for nursing homes is critical, so are creative solutions to help an aging population.