Baucus long-term care plan overlooks research

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This week, Sen. Max Baucus (D-MT) presented a healthcare reform plan that calls for a shift in long-term care services from institutions to home care. McKnight’s readers were not impressed.

Our story about his plan, http://www.mcknights.com/Baucus-healthcare-plan-would-direct-funds-away-from-nursing-homes/article/120951/, generated a chorus of opposition. Generally, readers disagreed with Baucus that home care would be cheaper than institutional care—and would deliver better care. (A link to download the plan accompanies the story.)

I tend to agree. While home care sounds great (who wouldn’t want to stay in their own home as they age?), it is not a panacea for our long-term care financial and care woes.

This is not just an opinion, if we are to believe a 2007 report commissioned by the American Health Care Association. Home- and community-based services (HCBS) increase total long-term care spending and are not cost-effective for state long-term care budgets, according to the study, “Medicaid-Financed Home and Community-Based Services Research—A Synthesis,” by Avalere Health LLC.

The study found that HCBS actually drove up demand for Medicaid-financed services. Further, an HCBS state plan option that allows states to limit enrollment and expenditures would increase Medicaid spending by $766 million between 2006 and 2010 and $2.6 billion between 2006 and 2015.

Regarding the argument that home care provides better care than nursing homes, the study also points out some weaknesses.  Research on this subject matter is scarce, according to Avalere researchers. “There is no national HCBS quality data collection process, and gathering such data is challenging,” authors noted.

Beyond disagreements over cost and care, there is still one more point to be considered: Can home care really provide for those people with complex medical conditions?

It certainly is easy for lawmakers to spout out solutions to difficult problems. But it sure would be nice if they were better informed about the problems they were trying to solve.
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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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