Community alternatives to Tennessee
nursing homes are needed now

Taxes and the budget are dominating state politics, but we cannot forget that that this state is heading for a catastrophe in long-term care. The former Tennessee Comptroller, William Snodgrass, reported that the "long-term care of the elderly is facing a crisis. The elderly population is increasing andwill soon increase dramatically. [Long-Term Care of Tennessee's Elderly p. 1]." Yet Tennessee has failed to respond. Our legislature is now struggling to patch together a budget for one year, ignoring a significant cause of the problem and coming budget difficulties. 

Here's a simple approach that will help save money and improve the quality of care: let more people choose to receive long-term care in community-based programs instead of nursing homes. It's a solution that makes sense on many levels.

First, it saves money. 

Medicaid costs are soaring now and will only grow.The Governor's proposed rewrite of TennCare does not appreciably effect the largest Medicaid item: long-term care. Between 1995 and 2000, Tennessee's Medicaid expenditures on nursing home increased from $588 million to $1.027 billion. Nursing home costs make up 21% of Tennessee's entire FY 2000 Medicaid budget - larger than all inpatient hospital care and larger than the costs of all prescription drugs. Community costs for similar services are much less expensive. 

"Numerous states, such as Oregon, Washington, Wisconsin, Arizona, Minnesota and Georgia have successfully used home and community based services to provide efficient effective services to their elders [Long-Term Care of Tennessee's Elderly p. i]."

Second, people want it.

Congress has recognized that "Federal medical assistance programs have been criticized, for emphasizing institutional services to the extent that a bias is produced tending to promote the institutional confinement of public assistance clientele. Sometimes needed services can be provided and paid for only if the person is placed in a nursing home. This is an unfortunate bias both from the point of view of the medical care and economics."

Third, community based services are better.

Nursing homes are the most expensive and least desirable form of long-term care and the quality of care is at least as good, if not better in the community. Study after study concludes that people want to live in their own homes with appropriate support and services. Obviously, people who need care don't want to live at home without it and also don't want to be forced as the only option to go to a nursing home. Although community-based programs exist and are successful, Tennessee spends over 95% of public funding for long-term care in facilities and institutions.

So why is it that most people who need long-term care end up in nursing homes? 

The nursing home industry is a very strong political player in Nashville and in Washington D.C. State and federal lawmakers don't have the political fortitude to take on the nursing home PACs and would rather continue funding unnecessary institutionalization in nursing homes, regardless of the costs. The fourth largest provider of political gifts in Tennessee, the nursing home lobby, pushes an agenda of expanded public subsidies, weaker consumer protections and fewer state inspections.

Medicaid is now over 30 years old and needs reform on a federal level; however, Tennessee has the opportunity to save money and improve care; we shouldn't let entrenched interests stand in the way. Community-based care makes fiscal sense. It's good medicine. And it's the right thing to do.

Thursday, February 21, 2002