Home and Community-Based Care (HCBC)
HCBC is not an entitlement for those who have little monetary resources left and need this level of care. Instead, in order for their care to be paid for by Medicaid, Hoosiers are forced into nursing home facilities - care which is an entitlement - where their chances of returning home or improving are poor. If HCBC were to be designated a "state entitlement" we would see more people return to their homes with appropriate services, including skilled nursing and therapy services, where they are more likely to improve. If Indiana were to establish an "independent provider" system with appropriate standards and appropriate reimbursement rates, we would soon have enough home care workers to provide quality care in the home, even in our most rural areas.
However Indiana continues to embrace the policies and practices that support the more expensive nursing facility care. Why does the state continue to waste our tax dollars on this more expensive, less effective care for many people? Why is Indiana consistently ranked among the worst states for providing long term care services, including the poorest quality of nursing facility services? This will change only when Hoosiers insist that our state and our elected representatives start listening to us and start spending our money wisely to care for those who raised us.
A Balanced System of Care
United Senior Action believes in a balanced system of long term care. In a balanced system of care people are able to receive the care they need in the environment of their cholce. And they are able to move from one environment into another as their care needs change. In otherwords, a person is free to choose home and community care if the appropriate supports and services are available. And they are able to move into or out of facility or nursing home care when those supports are no longer adequate at home or in community-based settings like adult day care, assisted living, or adult foster care.
Research has proven that people in need of care prefer to receive that care their own home or in community settings. However current federal and state laws and policies drive people into nursing homes because that care is an entitlement while home and community-based services are not.
Although federal policy is offering states opportunities to re-balance their systems of long term care by providing more care in homes and communities, Indiana is not taking advantage of these opportunities And although our legislature passed a law in 2003 (SEA 493) which provides the road map for a complete, flexible and financially sound balanced system of long term care, state administrations have fallen far short in implementing the law.
Now is the time to fully implement SEA 493 and to do even more. In this time of debt crisis and possible double-dip recession, it makes perfect sense to provide long term services in the home and community. This shift in spending will allow the state to serve more people at a smaller cost, transition or divert people away from nursing home care and serve them in their own homes. The money is already in the system paying poor quality nursing facilities. Let's use it to buy the care people need in the places they want to receive it-their homes and communities.
Staying in our own home. That's what we all want as we age. To accomplish this, services through the CHOICE and Medicare Waiver home care programs can be incredibly helpful. Go to our HCBS-resources page to learn more about these programs and how to access them.The wait lists are long, so be sure to sign up the person who needs care as soon as you can - they will be assessed and ready to go when they get to the top of the list.
Indiana's Shame: When you can't stay at home any longer, you want to maintain your dignity, be respected and maintain as much control over your life as possible. You want to get the help you need when you need it. You want to be cared for in a clean environment, free from danger. This doesn't happen in many nursing facilities in Indiana- which is our shame.
Indiana Advocacy: The Generations Project was begun in 2001 to work on improving access to home and community-based services in Indiana. The project works with organizations including United Senior Action and the Indiana Home Care Task Force to keep abreast of HCBS issues and what is needed in Indiana. They hold annual listening sessions throughout the state to hear from consumers, their families and service providers. Go to the web site to read the publications they have produced over the past several years. The lastest publication is The Good Road Home. This publication lists fifteen consensus conclusions about Indiana's home and community-based services. You may also want to read Lessons From Home Applied and other publications.