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Unified Long Term Care: Services Based on the Individual's Needs

May 2007

We have long known that given their choice, older Ohioans overwhelmingly want to "age in place" in their own homes. We also know consumers choose wisely and economically when they are offered a full array of services, including both home-based and facility-based services.

However, knowing these facts, Ohio still has an established bias toward nursing homes, ranking 49th out of 50 states in serving Medicaid long-term care clients in home- and community-based settings.

In an effort to help provide consumer choice and to achieve better balance within our long-term care system, Governor Strickland supports providing Medicaid consumers with a choice of long-term care services. This includes offering an array of services that meet the consumers' needs throughout their lives.

The Ohio Department of Aging has been directed to lead an inclusive group of consumers, providers, advocates, policymakers, and others to establish a process that will lead to the creation of a unified long-term care budget. Working together, we can create a budget based on the philosophy that an individual's needs should drive the services available, rather than which funding stream has available "slots."

What will a unified long-term care budget do for Ohio? It will:

• Provide a choice of health care services and supports that improve consumers' quality of life;
• Provide a flexible array of services that meet the changing needs of consumers throughout their lives;
• Help consumers make timely and informed decisions that reflect their preferences;
• Assure the state has a system that is cost-effective, links services across agencies and jurisdictions and reduces duplication.

This will be a massive task with many details to be discussed, including:

• Who and what should be covered?
• Who will determine who is eligible and the level of care they need?
• Does everyone receiving long-term care need care management?

We know that a unified long-term care budget works. Washington is one of a handful of states that has an established unified budget. Consumers can access an array of services, as they need and choose. Under this system, most Washington residents receive care in their own homes.

We also know that the average cost of long-term care varies greatly, from about $1,100 a month for in-home care to around $5,000 a month for nursing facility care. We need a full array of services - nursing homes for critical care; a wide range of in-home services for those who may be impaired, but do not need of costly institutional care; and all sorts of living arrangements in between - to offer Ohioans real choice.

I firmly believe we need to develop a unified long-term care vision for Ohio to successfully provide services and control Medicaid costs in Ohio. We have to address these issues now, because the status quo won't work as the baby boomers age. In 2050 more than one million Ohioans will be over age 85. We must build the system that we want for them, and let's be honest, for ourselves and our loved ones.

Barbara E. Riley