Joel Pett, Herald-Leader cartoonistHerald-Leader Editorial

Kentucky must do better by elders

June 29, 2014 

"Wake-up call" does not begin to convey the urgency of improving care for older and disabled Kentuckians.

A new study that ranks Kentucky's long-term care 51st among the states and Washington, D.C. should be more like a status-quo-shattering earthquake.

Not only did Kentucky score worst overall and near the bottom on most measures, our score declined from 2011 to 2014.

With the first baby boomers just 12 years from turning 80 and Kentucky aging faster than most states, the costs will be unbearable — in dollars and human suffering — if we do not aggressively gear up to expand services for people in their homes.

Compare the average annual costs of caring for a frail or elderly Kentuckian, according to state data:

■ $67,525 in a private-pay nursing home.

■ $47,187 in a Medicaid-paid nursing home.

■ $15,000 for community- and home-based services.

Helping people age at home or in their family's care is much cheaper. It's also what people want.

Yet, Kentucky sinks a disproportionate share of its resources into nursing homes and institutional care.

Just 22 percent of Kentucky's long-term care spending goes to home- and community-based services and support. The national median is an also disappointing 31 percent.

But the best states — New Mexico and Minnesota — put 65 percent of their long-term care resources into services provided in homes and the community.

That's according to a detailed national scorecard compiled by AARP, the SCAN Foundation and the Commonwealth Fund (www.longtermscorecard.org).

Fortunately, the Beshear administration is working on Medicaid reforms that will expand services and supports for family caregivers and elderly Kentuckians living at home. The broader range of services could be in place by next spring.

But Medicaid reforms alone won't bring about the needed revolution in expectations. The long-term care industry must shift its business model toward rehabilitation and in-home care. Health care providers must become more flexible and responsive. Change will have to take place at the community level, and Kentuckians will have to demand it.

One of many examples of the mind-set that must be overcome is the monopoly on who can provide care. The survey looked at 16 tasks that family members routinely learn to provide, such as tube feedings, giving medications and managing bowel and bladder care.

In the best-performing states, nurses can delegate all 16 tasks to paid home health aides. In Kentucky, nurses can delegate only four of the 16 tasks. Kentucky's restrictions on home health workers make it harder for family members who have jobs or health problems to care for loved ones at home and more likely that a nursing home will become the only option.

Expanded in-home services would have to be monitored for quality and to prevent abuse and neglect, but nursing homes also require a high degree of monitoring.

Other states have shown that providing services, including meals and transportation, to people in their homes improves their quality of care and quality of life.

While the study looked only at older adults and those who have physical disabilities, Kentucky also lacks supports for adults who have developmental disabilities such as autism or Down syndrome.

Aging parents are sadly discovering that their children who were educated in the least restrictive settings now face limited options for independent living as young adults.

The longer Kentucky delays common-sense changes to long-term care, the costlier it will be for everyone.

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