Richard Davis: Proactive elder planning can save money and lives


It is rare for legislatures and state government to take significant proactive steps on any issue. Most of the political process is reactive and that means that the problem is already festering well before solutions are worked on.

This happens because lawmakers are reluctant to spend money on a problem that has not happened yet, especially when it means that new taxes will have to be implemented. The most obvious example of a lack of visionary planning has to do with health care. Sure, there have always been problems but crafting solutions for future health care problems, solutions that will save money and lives in the long and short run, has been nearly impossible.

That is why efforts by the states of Washington and Hawaii in the past few years to support care for elderly citizens seems so remarkable. In a June 7 Kaiser Health News report it is noted that, "The number of Americans 65 and older will double to 98 million by 2050, and studies show few have the financial resources to pay for care in old age. More than half of adults 65 and up will require long-term assistance at some point with everyday activities, for an average duration of about two years, according to a 2015 study by the Department of Health and Human Services. Finding a way to help people stay in their homes — and not move to nursing homes — can keep them happier and save them and the state money. Medicaid programs help cover the costs of 62 percent of nursing home residents."

Washington state is about to put in place a 0.58 percent payroll tax to help provide a few basic supports to people who have paid into the system for at least the prior three years. The tax will fund a $36,500 benefit for individuals to pay for home health care, as well as other services — from installing grab bars in the shower, to respite care for family caregivers.

Hawaii has created a less generous program but it is a first step and is at least a recognition that a problem exists and that solutions must be found. According to Kaiser News, "Hawaii's Kupuna Caregivers Program, which was initiated in 2017, is also publicly funded, but state budget allocations limit enrollment and benefits. It provides up to $210 a week for services when family caregivers work outside the home at least 30 hours a week."

It was also noted in the Kaiser report that Washington, "created a benefit system with a broad definition of covered services, from paying someone to build a wheelchair ramp to helping a caregiver learn how to deal with aggressive or violent patients. They could have shrunk this list to make the program less expensive, but Washington policymakers believed offering a wide menu of services would help keep people out of nursing homes."

Other states were noted for their programs to help elders age in place but it was troubling that Vermont was not mentioned. Our state has been at the forefront of proactive policies to allow people who need a nursing home level of care to remain safely at home with support. The Choices for Care program has existed for many years and, despite a constant struggle to gain adequate funding, many Vermonters have been able to stay at home while saving taxpayers a significant amount of money.

Vermont's program only helps people who are Medicaid eligible, yet it was mostly a proactive move. The Hawaii and Washington plans recognize that a broader coverage base is needed. As other states grapple with issues related to eldercare perhaps they can learn from each other and figure out a way to prevent unnecessary suffering while saving everyone money. It would be a novel strategy for government, but we are living in strange times and that means that anything is possible.

Richard Davis is a registered nurse. He writes from Guilford and welcomes comments at The opinions expressed by columnists do not necessarily reflect the views of the Brattleboro Reformer.



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