Long-Term Care - Illinois General Assembly

• Revise the formula used to determine for how many hours of home care the state will pay for
people over 65, so it is an honest comparison of home care versus nursing home care for
each individual. When Illinois initiated its Home/Community Care waiver, we were paying
for 8 to 10 hours of home care a day for people. Paying for that many hours was still
cheaper than paying for nursing home care. We now pay for 4 hours a day. This isn't
because nursing home care has gotten cheaper in comparison to home care. In fact, the
opposite is true. It's because the formula has been distorted to artificially lower the number
of hours for which people are eligible. This formula, and the assessment process, need to
be made honest, again.
• In saying this, we recognize that the "woodwork effect" is real. If Illinois starts paying for the
maximum number of hours of home care that are theoretically cost-effective, we can
anticipate families, who are now paying for this care themselves, or doing the care
themselves, applying for the state program with no savings at all to the state. Instead of
capping the hours at the theoretical maximum, Illinois should be exploring creative use of
the Medicaid waiver to help families who are caring for their relatives: For example, the
state would pay for one hour of care over 6, for each hour the family paid for, or provided
care directly, up to some maximum.
• Expand the availability of adult day care, especially for people who are incontinent. Expand
the availability of accessible transportation to and from adult day care. This can be done,
not by buying a lot of new accessible vans, but by facilitating dual use of existing accessible
vans owned by, for example, day training programs and nursing homes.
• We know that there is a shortage of affordable, accessible housing. Of course we need to
build more. But we also need to make better use of the housing we already have. Illinois
should expand the number and breadth of its existing home-sharing programs, both for
full-time residences and for day-time only care, so elderly adults can be cared for while their
family members are working. Take a lesson from the Cook County Public Guardian, who
keeps some of his wards out of nursing homes by having 2 or 3 share an apartment and
split the cost of housing and personal care. Tie home-sharing into the Assistive Technology
project, and existing Medicare funding for occupational therapists, who can do home visits,
assess individuals, and make recommendations about what equipment and home
adaptations can allow disabled elderly people to stay home safely.
• Create a central clearinghouse of available services, especially housing, with supportive
services and personal care services. ICBC is already doing this, in a small way. We would
be happy to show others how to do it.
• Put supportive services into existing senior housing, such as Chicago Housing Authority
(CHA) senior buildings. There are obvious economies of scale in coordinating emergency
call systems, chore and housekeeping services, meal services, and personal care.
• Make the services available under the Medicaid waiver programs uniform for all groups. It
simply makes no sense that the waiver program will train family members of some groups of
people how to care for their relatives, but not others, or do home-adaptation for only some
people.
• Work with high schools that require community service credit for graduation, to refer
students to programs that do shopping and home-delivered meals for home-bound people.
49