Change needed to long-term care

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By The Staff

Indiana's long-term care system is out of balance. Studies confirm that most Hoosiers prefer to receive long-term care services and support in their home, or in a home-like setting, instead of a nursing homes. Yet according to our Division of Aging, Indiana is ranked 45th among all states in 2009 in the amount of dollars spent on long-term care services to support Hoosiers in the home or community.

I authored House Bill 1325 to bring greater balance to Indiana's long-term care system. Not only will this ensure more people are able to receive services they most desire, but it is also the fiscally responsible approach. On average, the Medicaid program can provide home and community based services to three people for the cost of serving one person in a nursing home.

HB 1325 seeks to reduce red tape by allowing individuals who are likely to qualify for Medicaid to receive such services immediately (termed "presumptive eligibility"). Sixty-two percent of funding for long-term care services comes from Medicaid recipients who use Medicaid as a primary payer.

These individuals currently experience long wait times before being determined Medicaid-eligible. For those unable to wait, the nursing home may be their only option.

Data from other states reflect that presumptive eligibility determinations are rarely made in error. This can save the state money by avoiding more costly nursing home placements, allowing those with greater needs to receive care where they prefer - at home or in the community.

Another way to serve more individuals at home is to remove artificial barriers that prevent loved ones - those preferred by most of us, to assist with highly personal activities such as bathing or dressing - from qualifying as attendant care providers. HB 1325 would add legal representatives to include parents and spouses to the list of those who can provide such assistance, while still allowing the state to determine under what circumstances these individuals may be reimbursed.

Southwestern Indiana Regional Council on Aging is one of 16 Area Agencies on Aging statewide that assist thousands of individuals with their long-term care needs each year. HB 1325 seeks to give the AAAs greater flexibility in determining how various funding streams should be prioritized at the local level to serve the greatest number of individuals. AAA would still maintain state oversight to ensure expenditures are made in accordance with state and federal guidelines and agreed upon outcomes are met or exceeded.

The bill also provides greater assurance that individuals in need of long-term care services are made aware of free case-management services available through AAA at the time of a hospital discharge and upon admittance to a nursing facility.

The earlier people become aware of all available long-term care options, the greater chance they have to maintain their dignity and independence at home or in the community as they age.

As amended, HB 1325 also seeks to ensure that any savings discovered by avoiding more-costly nursing home placements are available to provide additional services in the home and community. There are many more initiatives that must be (adopted) in order to strengthen our long-term care system in Indiana.

I believe HB 1325 is a good start, and one that seeks to redistribute existing dollars instead of requiring new spending, particularly during these difficult economic times.

On Feb. 2, HB 1325 passed out of the Indiana House of Representatives by a vote of 69-22. The bill now begins its journey in the Senate, where it is being sponsored by my colleague, Sen. Vaneta Becker (R-Evansville).

Crouch's southwestern Indiana district includes portions of Spencer County.