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Elderly need home options

On Nov. 12, The Spokesman-Review published the compelling story of an elderly gentleman, Paul Dunham of Hayden, who was able to stay in his home with his wife of 60 years, Nancy Dunham, despite a chronic and progressive illness that required significant care.

Their determination to live together in dignity – in their own home and community – was enabled with the help of a Medicaid assistance program for long-term care at home. Through this program, Mr. Dunham was able to receive 25 hours of weekly medical assistance and the couple were able to do what they wanted: stay together in their own home. Unfortunately, this care was not able to stop the progression of Mr. Dunham’s illness. On Monday, I was saddened to learn that Mr. Dunham had passed away.

My heart and prayers are with Mr. Dunham’s family in their time of grief. I hope that they take both pride and comfort in their decision to enable Mr. Dunham to remain in his home and community, surrounded by family and friends. Indeed, Nancy Dunham asked that I convey to my Senate colleagues the importance to her and her husband of their ability to stay in their home despite his debilitating illness.

I share Paul’s and Nancy’s enthusiasm for home- and community-based care. And I want those inspired by the Dunhams’ compelling story to know that as the new health care law takes effect, people in need of long-term care will have much greater opportunity to choose to remain in their homes and communities.

Home- and community-based long-term care allows seniors to remain with their loved ones, maintaining independence and a much higher quality of life. Remaining in their homes allows individuals receiving long-term care to continue actively participating in their communities and partake in the day-to-day activities dear to their hearts.

This is an option also overwhelmingly preferred by seniors. A recent AARP study showed that nearly 90 percent of Americans 50 or older prefer to remain in their own homes as long as possible.

The problem for many states is that their spending has largely been steered toward institutional care. Even though home- and community-based care is much less expensive and the preferred option of most seniors, the incentive for states to use the option of home- and community-based services has not always been available.

Under the historic health care reform bill passed earlier this year, that will change, to the benefit of our seniors and the federal treasury. On average, home- and community-based services are 70 percent less expensive than nursing home care. The potential savings are so great that diverting just 5 percent of seniors from institutional care to home-based care is estimated to save an estimated $10 billion nationwide over five years.

Specifically, the new health care law contains a provision that I authored with Sen. Kohl, chair of the Senate Special Committee on Aging, which helps more seniors remain in their homes through the expansion of home- and community-based long-term care services. The law provides incentives for states to shift Medicaid spending from institutional care to home- and community-based care. In addition, the health care reform law will prevent spouses from having to spend down all of their assets prior to one spouse being eligible to receive home- and community-based care. Previously, this protection was only afforded to spouses of those opting for institutional care.

Washington state has long been a leader in giving seniors the option of home- and community-based services, and these new federal provisions were based upon the innovative framework implemented in our state.

I commend The Spokesman-Review for bringing us the Dunhams’ story. All across America, couples like the Dunhams are facing difficult decisions about long-term care. The Dunhams teach us that the nursing home does not have to be the only choice, and the new options available to seniors under health care reform will bring the choice to remain at home within reach for millions.

U.S. Sen. Maria Cantwell, D-Wash., is a member of the Senate Finance Committee, which has jurisdiction over health care issues. This commentary was prepared with the assistance of John Diamond, communications director on her staff.


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