Efforts to help older Ohioans age in place are working
Over more than a decade, rebalancing efforts have increased consumer direction while reducing costs

A recent Scripps Gerontology Center report shows that the proportion of Ohioans receiving long-term care Medicaid services in their own homes and communities compared to those cared for in nursing homes has increased from less than 10 percent in 1993 to 42 percent in 2009. The report, "Coming of Age: Tracking the Progress and Challenges of Delivering Long-Term Services and Supports in Ohio," emphasizes that the shift to home and community services has lowered Ohio's long-term care Medicaid spending on older people (when adjusted for inflation) over the past 12 years while raising the average number of persons served each day by nearly 10,000.

Since 1997, Ohio has altered how it delivers long-term services, particularly for individuals age 60 and older. Between 1997 and 2009 the population age 60 and older in Ohio rose by 15 percent; yet during that same time frame Medicaid nursing home use for older Ohioans dropped by 14.5 percent, and home- and community-based services increased by more than 100 percent. This change means that Ohio's Medicaid long-term expenditures for its older population, when inflation adjusted, are lower today than in 1997, despite increasing the number of people served each day by 9,300.

The increase in non-institutional Medicaid services, the report observes, is due, in part, to the expansion of the state's PASSPORT home-care program (from 15,000 to 30,000 participants) in roughly the same time period, along with the state's recent provision of Medicaid-funded assisted living units and other home-care alternatives. According to the report, Ohio's average monthly Medicaid reimbursement for a PASSPORT client was $1,067, compared to $4,281 for a nursing home resident in FY 2009. The report specifies a 14.5 percent decrease in Medicaid-funded nursing home use by Ohioans age 60 and older between 1997 and 2009, despite a 15 percent increase in Ohio's overall 60 and older population, findings that are especially significant as Ohio's severely disabled older population is expected to double by the year 2040.

While these shifts have been significant, Ohio's biggest challenges lie ahead of us, as the population age 60 and older will increase by 25 percent by 2020 and will nearly double in size by 2040. It is critical for Ohio not only to build on today's progress, but also to create tomorrow's innovative system. The report offers recommendations to do that:

• Develop policies and programs to promote prevention and self-sufficiency to reduce the percentage of older adults with severe disability who rely on Medicaid (currently 49 percent).
• Position Ohio as a leader in developing technology to help serve the growing elder population.
• Continue current efforts to make Ohio's service system more efficient and effective through improved regulations, management practices, training and applying research evidence to practice.
• Continue and enhance efforts to support family members who provide long-term care and assistance to aging loved ones.
• Carefully study long-term care utilization by Ohioans under age 60 and formulate a strategy to respond to their needs.
• Continue to expand nursing home diversion and transition efforts, such as Home Choice and Home First, that target individuals at highest risk.
• Take a comprehensive look at the current state of the nursing home industry and work with them to ensure their focus and capacity are in line with the system's needs.
• Improve data collection so that Ohio has the same measures of program participant characteristics collected in a comparable way across programs and settings.

The report, authored by Scripps researchers Shahla Mehdizadeh, Robert Applebaum, Ian Nelson and Jane Straker, and funded by the Ohio Department of Aging and the Ohio Long-Term Care Research Project, notes that, despite considerable gains over the past decade, Ohio still is below the national average in the proportion of Medicaid funds allocated to home- and community-based services.

While the report validates efforts to help older Ohioans age in place in their homes and communities, the department will continue its work to rebalance long-term care funding in Ohio.

Related Links

Home Choice

Ohio Long-Term Care Research Project

"Ohio's Aging Network Efforts to Enhance Nursing Home Diversion and Transition"

PASSPORT program

PASSPORT Administrative Agencies

Scripps Gerontology Center

Unified Long-term Care Systems and Supports