Sara Myers

A Good Enough Daughter

As a professional in the field of aging, Sara had seen it all—until her own mother broke her hip at the age of 88 and became profoundly confused, unable to live in her own home. Join Sara on her journey through the strangeness that is dementia while trying to make sense of it all and finding humor in the details. [Editor's note: Sara no longer contributes to Silver Planet, but we have made her archived blog entries available as a service to our readers.]

Obama Wants to Reduce Entitlements

How will this impact services to old people?

By Sara Myers

Most people have little interest in budgets and policies that impact services to older adults—until the issue becomes personal. When Mom or Dad needs home care or adult day services or a nursing home, families suddenly sit up and pay attention. And that is a good thing.

Obama is the latest in a long line of politicians who have talked about reducing entitlements—code for reducing Medicaid long-term care and Medicare expenses. I am betting that within the next four years, Americans will see strong efforts to shrink federal dollars that pay for services for older and disabled adults.

Here's a brief tutorial on federal Medicaid long-term care: Medicaid must pay for nursing home services in every state. In most states, it also pays for an array of home- and community-based services, such as home care, adult day care, and adult day health care, in addition to residential options, such as assisted living and adult family homes (sometimes called adult foster homes). There is a federal match with the state. The state pays, say, 50% of the cost of care, and the feds pay the other 50%. In some states, the match is different. Instead of 50/50 it may be 33/66; it depends on the state.

I have two reasons for being very concerned about this pending reduction. For one, my mother uses Medicaid to pay for her assisted living. If Medicaid does not pay enough to cover the cost of an assisted living, they will not keep her—leaving nursing homes as her only option. Please, God, spare us both that fate.

The other reason I’m concerned is professional. I am very involved with adult day care and adult day health care in my state of Washington and on a national level. Year after year, the dollars get tighter, services become more limited, and eligibility requirements become more stringent. Net result: medical costs rise. People use the emergency room more often and end up in the hospital more frequently; most importantly, because services at home are harder to come by, quality of life suffers. What does this mean for caregiving families? The answer is obvious.

Medical costs will rise if expenditures for community-based long-term care services shrink. Ultimately, a robust home and community care system will save dollars. Pay attention when a politician talks about “reducing entitlements.” We all have a vested interest. Most of us are going to live a very long life.

For more information about the fight to keep adult day care and adult day health care alive in Washington State, please visit the Washington Adult Day Services Association Web site.

By Sara Myers
A Good Enough Daughter Blog


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