March 2004 | Let N.J. Seniors Choose Their Care, Study Urges; Home, Nursing Facility Decision Should Be Theirs
BOB GROVES, STAFF WRITER
23 March 2004
The Record
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New Jersey should enable residents to choose whether they grow old at home or in a nursing facility, a study by the state chapter of AARP recommends.
The state should allow residents to use state dollars to fund the kind of care they want - such as hiring a home health aide - instead of steering them into nursing homes, according to a report by AARP, the non-profit organization for people age 50 and older. In a concept known as "money follows the person," a resident could change how they spend that money as their needs change.
The report also urges the state to cut red tape in its eligibility process.
Though it has increased funding for home care and community services in recent years, New Jersey puts 82.5 percent of its long- term care dollars into nursing homes and hospitals.
Ideally, half the funding should go to home care, said Susan Reinhard, a deputy commissioner in the New Jersey Department of Health and Senior Services, member of the AARP New Jersey executive council, and co-director of the Rutgers Center for State Health Policy.
Similar "money follows the person" plans have been successful in Washington, Oregon, and Vermont, said Roger Auerbach, a consultant for the Rutgers Center for State Health Policy, who authored the AARP report for New Jersey.
"It means more choice over location and type of service a person receives," he said. "It assures that financing those services moves with the person to the most appropriate and preferred setting as his or her needs change."
Medicaid, the major government program to fund long-term care, is biased toward nursing home and hospital care, and usually requires a waiver to be used for home care, Auerbach said.
An AARP survey answered by 1,222 of its 1.3 million New Jersey members showed that 92 percent preferred home or community-based care to nursing homes. New Jersey has 1.4 million residents over 60 - a figure expected to nearly double by 2020.
In his recent budget address, Governor McGreevey called for an additional $2 million for caregivers.
About 800,000 New Jerseyans provide some form of unpaid caregiving service for an elderly or disabled family member or friend. For fiscal year 2005, the state has budgeted $151.6 million for home and community care, and $639.7 million for nursing home care. That means that 19.2 percent of long-term care funds would go to home care, while 80.8 percent would go to nursing homes.
Between 1997 and 2002, the state increased the money it spent on home care from 7 .3 percent to 15.3 percent of its total long-term care budget, and decreased the money for nursing facilities from 92.7 percent to 84.7 percent, the report said.
During that time, residents served by home care increased from fewer than 6,000 to more than 13,000. Those in nursing facilities dropped from more than 30,000 to fewer than 27,000.
In general, 2.5 people in home care cost the government the same as one person in a nursing home or hospital, Auerbach said.
Other community care options include adult day care and family care, in which up to three seniors live with a family not their own, Reinhard said.
The state pays $40 per person per day for this, compared with $120 a day in a nursing home, she said.
New Jersey needs an outreach program and a consumer information center to counsel elderly and disabled people on how to get home care, AARP said.
AARP concedes that shifting to the "money follows the person" plan and more home care could take a while.
"We're working with the governor's office," Auerbach said. "Some of it can happen through the budgeting process, or the legislative process, or an executive order from the governor's office. This is really just he beginning of a multiyear process."
The AARP study concludes that New Jersey needs to recruit, train, and retain more long-term care workers, especially for home care.
But Ray Garcia, spokesman for the advocacy group New Jersey Quality Home Care Campaign, says agencies that employ these aides provide insufficient wages and benefits, and need more state oversight.
"More home care - that's fine, that's great. But we want to make sure these questions of accountability for home care agencies are answered, and that will help ensure there are quality jobs and quality care," said Garcia, who helped lead a rally for home care workers recently in Trenton.
Home care agencies pay "poverty wages," he said.
But Carol Kientz, a spokeswoman for home care in New Jersey, said there is plenty of state oversight of the industry.
"We have licensure of agencies, accreditation, audits, and surveys," said Kientz, executive director of the Home Care Association of New Jersey, one of three trade organizations that represent about 400 licensed home care nursing agencies.
"We totally support our workers. We have exceptionally fine workers in New Jersey," she said.
The legislature will probably approve McGreevey's request to put more Medicaid money into home health care, said Assemblywoman Loretta Weinberg, D-Teaneck, chairwoman of the Assembly health committee.
"Anybody who is frail and needs care would prefer being at home instead of in a nursing home," she said.
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E-mail: groves@northjersey.com
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