Reform Puts Big Strain On In-Home Care

Changes in Washington’s long-term care program are reducing spending, saving lives, and better serving the state’s oldest citizens by prolonging their independence.

The changes, ordered by state lawmakers a few years ago, encourage and enable elders in need of limited assistance to continue living at home as long as possible, with a little help from the state. This, experts agree, is far healthier and cheaper than prematurely institutionalizing the elderly in nursing homes.

Thus far, the strategy pursued by lawmakers is working well.

So well, in fact, according to a newly formed coalition of long-term care organizations in Eastern Washington, that the state’s in-home care providers are overwhelmed with work, and the elderly are at risk.

In an effort to avert this outcome, the coalition of care givers will ask lawmakers in the upcoming session for money to hire more case workers and in-home care givers.

“Our main goal is to preserve quality in-home elder care,” said Nick Beamer, director of Aging & Long Term Care of Eastern Washington and an organizer of the coalition. “At the rate that our caseload is escalating in response to the lawmakers’ reforms, we simply cannot keep up with demand. Reform has been more successful than anyone might have imagined.”

As a result, says Lynn Derrick, supervisor of case management for the Elder Services division of Spokane Mental Health, caseloads have been spiraling upwards.

“When the big push began and our case managers went into the nursing institutions to bring people back out into the community, lawmakers expected in-home care numbers would increase by about 150 a month,” says Derrick. “Instead, the increase is double that number, and lawmakers haven’t backed up the increase with funds. So case management is dangerously understaffed.”

For elderly persons who wish to remain at home as long as possible, as virtually everyone does, an Elder Services case manager assesses the physical and financial situation and helps develop a plan. A variety of resources can be tapped, including family members, neighbors, community services, private in-home care givers, and a wide range of government programs, depending on income.

“To provide quality in-home and community-based care,” said Derrick, “the ratio of our case managers to clients should be 1 to 50. Instead,” she said, “it is 1 to 100.”

“Some case management loads will go to 125 next year if we don’t do something,” said Beamer. “If you look at in-home care honestly in terms of in-home care vs. nursing home costs, it makes outstanding financial sense to get more help with case management.”

In Eastern Washington, the average cost of in-home and community-based care is $600 to $800 a month, says Beamer. Nursing home care in Eastern Washington averages about $3,100 a month - four or five times as much.

“The state averages are roughly parallel,” said Beamer. “These are the facts. This is our business and we know the figures. We don’t make them up.”

Beamer said the coalition, composed of eight groups from hospitals to private in-home care operators - will ask legislators to budget an additional $31 million for long-term care statewide.

“This would get us to caseloads of 1 to 75,” said Beamer. “It would cost another $11 million to bring down caseloads to 1 to 50, where we should be.

“At 1 to 50, we can help in the home when we should be there to prevent a crisis,” said Beamer. “Whereas, at 1 to 100, we get there in a crisis.”

“This is not just an elder issue,” said Derrick. “It is a family issue. Even if it is not affecting you directly, it is affecting someone you care about.”

Lacking funds to support safe care in the home, the pendulum will swing the other way once more. Instead of living independently at home, more older persons will end up institutionalized in nursing homes again at far greater costs both to taxpayers and to families.

, DataTimes MEMO: Associate Editor Frank Bartel writes on retirement issues each Sunday. He can be reached with ideas for future columns at 459-5467 or fax 459-5482.

The following fields overflowed: CREDIT = Frank Bartel The Spokesman-Review