Long-term care: The system is out of balance

New Hampshire’s 60-plus population is expected to swell from 262,000 today to 419,000 in 2020 and to 504,000 by 2030. That has significant implications for the delivery of health care and for the public policies that help drive that care.
A 2009 survey of AARP New Hampshire members found that only 2 percent want care delivered in a nursing home. The vast majority, or seven out of 10, want care delivered at home.Despite that finding, the fact of life is that over 80 percent of New Hampshire’s long-term care funding goes to institutional care, such as nursing homes, and only 20 percent goes to less expensive and more popular home- and community-based care.Given the projected growth of the 60-plus population in the state, spending eight out of 10 long-term care dollars on the most expensive type of care is not cost-effective or sustainable.With our financial challenges, it makes common sense to rebalance our system of long-term care.According to the New Hampshire Department of Health and Human Services, the costs of long-term care are borne mostly by private pay and Medicaid. The annual cost for a nursing home resident averages from $66,775 a year to $89,000 a year. Care at home averages from $25,000 a year to $36,900 a year.The lower costs of home- and community-based care, together with the desire of people to be at home as long as possible, make a substantial argument in favor of rebalancing the system of long-term care.Clearly, there are times when some people need to move to a nursing home or other facility for more extensive care if their needs can no longer be met at home, but the current priority is nursing home care and not home care.Over 70 percent of individuals over age 65 will require at least some type of long-term care during their lifetime. On average, someone age 65 today will need some long-term care for three years. Women need care longer than men. And 20 percent will need care for longer than five years.More than eight in 10 of the 50-plus population surveyed in New Hampshire support shifting some long-term care funding so a greater percentage goes to home- and community-based services. Those services include everything from family and volunteers to visiting nurses to Meals on Wheels.Furthermore, a 2010 New Hampshire survey by AARP found that nearly one out of every three adults has provided unpaid care to an adult relative or friend – higher than the national average of about one in five adults.As our population continues to age, and with a challenging budget and revenue picture in our state, funding more home- and community-based services makes good public policy and sound financial sense. Rebalancing our system of long-term care will give New Hampshire citizens more choice, more control over their quality of life, more independence, and at a cost that is more affordable.Fred Kocher is volunteer state president of AARP New Hampshire.