2006 State Report > Our Health > Long-Term Care > Home and Community-Based Care
Our Health: Home and Community-Based Care
Older adults with physical disabilities, medical problems, and cognitive impairments may need help with activities of daily living, such as bathing, dressing, housework, and shopping. Home and community-based care can help people with such limitations remain in their homes instead of entering nursing facilities. While an estimated 78 percent of seniors receive assistance from relatives and friends, the remaining 22 percent get at least some long-term care help from paid sources.
In 2004, every state except for Arizona had one or more home and community based waiver programs. The South Carolina Department of Health and Human Services oversees the state's Community Long Term Care Program, which provides home and community-based services for those who qualify for nursing home care but would prefer to remain in their communities. The cost to Medicaid is much lower than that for a nursing home stay. To qualify for the elderly/disabled waiver, residents must be over 18, eligible for Medicaid, and meet the nursing facility level of care criteria. Services available to those who qualify include personal care, attendant care, adult day health care, home delivered meals, environmental modifications, companion services, and respite care.
In Federal Fiscal Year 2003-2004, there were 13,570 elderly/disabled waiver recipients statewide. The average full year (365 days) cost for a recipient in the Community Long Term Care program was $13,949. This is composed of $6,959 for home and community based care plus $6,990 for other Medicaid services. The average length of stay for home and community based recipients is 291 days. For the same time period, there were 17,366 persons in Medicaid funded nursing homes. The average full year (365 days) cost for a recipient in nursing homes was $37,300. This is composed of $33,577 for nursing home care plus $3,723 for other Medicaid services. The average length of stay is 248 days. The comparable cost for the two services is $102 per day for nursing home services versus $38 for Community Long Term Care services.
A variety of other programs can also help older adults to postpone or eliminate the need to enter a nursing facility:
- Medicaid offers a mandatory home health benefit which covers skilled nursing services and physical and other therapies.
- Medicare provides home health services to seniors who are homebound and require intermittent help.
- Programs funded by the Older Americans Act provide the following services to adults aged 60 and over with social and economic needs:
- Home-delivered and congregate meals
- Information, Referral and Assistance services
- Home care services, including housekeeping, shopping, meal preparation, and personal care
- Adult day services
- Transportation services
- Physical fitness
- Legal services
- Health and wellness, and medication management
- Insurance Counseling And Referral for the Elderly (I-CARE) program services
- Medicare Fraud Patrol services to help seniors be aware and report Medicare fraud by medical service providers
- Senior Employment Services for the Elderly – Title V
These services, together with family caregiver support program services and ombudsman and elder abuse services, provide the core home and community based services which are instrumental in helping our state's seniors remain independent and in their homes. These services and funding are authorized by Congress to provide seed money for state and local entities to develop statewide services on the state, regional and local levels to serve a state's senior population. These monies in combination with other funding sources are particularly important in serving thousands of South Carolina's seniors.
While federal funds for aging services have increased slightly over the last five years, state funding has remained flat.
Source: South Carolina Lieutenant Governor's Office, Office on Aging.
State Funds Per 60+ Person Eligible: Fiscal Years 2001-2005
Source: South Carolina Lieutenant Governor's Office, Office on Aging.