No place like home

Seniors deserve an equal choice when it comes to home care

By Brian A. Joyce and Michael E. Festa

It’s an all too familiar story.

An aging parent reaches a point where they can no longer care for themselves, leaving their family to make the difficult decision between placing their loved one in a nursing home or moving their parent into their own home to provide needed medical care.

During this already difficult and trying time, the most compassionate, and often simplest option is usually overlooked – letting the parent remain in the comfort of their own home with the help of home care services. And it is this very option that the vast majority of seniors would select if given the option.

Unfortunately, due to the current structure of Medicaid reimbursements in our state, home health care is just not an option for the thousands of seniors who can no longer live at home independently.

Massachusetts has one of the highest percentages of residents over the age of 65 – and one that is expected to significantly rise over the next few decades.

Yet despite our state’s aging population, the level of compassionate choices provided to our seniors is sorely lacking. Medicaid pays $130 a day for nursing home care, while home and community programs are based on a payment of $7.38 a day. This gross disparity in aid has led to a decline of 5,000 fewer seniors enrolled in the state-funded home care program in the last decade.

If we indeed believe that the elderly should have the choice of living in the most integrated setting as possible, then we have much work left to do in Massachusetts. The sad reality is that our current system makes it almost impossible for seniors to afford comparable care in their homes.

To address this critical issue, we have filed legislation to invest more of our tax dollars at home--where seniors want to be. Our "Equal Choice" bill was filed to give elders the choice between care at home or in a nursing home facility. It will begin to remedy the gross disparity in Medicaid benefits given to those individuals who choose to receive care at home, versus those who seek care in an institution.

Our bill will require that dollars be spent where frail seniors want them spent: providing them with quality care in the comfort and safety of their own homes. If an older person is eligible for nursing home care, but wants to be cared for at home, we should give them the following choice: we will spend as much to keep you at home as we are willing to spend to keep you in a nursing home. The Equal Choice bill does that.

Look at the numbers. While home care expenses can be staggering, they are far less than the cost of institutional or nursing home care, estimated at over $50,000 a year. Taxpayers will benefit when fewer people receive nursing home care. However, in Massachusetts, more than 80 percent of our long-term spending is directed towards institutional care.

The Equal Choice bill also adheres to the 1999 U.S. Supreme Court ruling which stated that the unjustified segregation and the institutionalization of people with disabilities constituted unlawful discrimination and was in violation of the Americans with Disabilities Act.

Our legislation is both a fiscally responsible and a compassionate solution for seniors and families who wish to receive home care. By failing to invest in community care, we have denied elders their fundamental right to live independently in the least restrictive setting of their choice. Massachusetts has the eleventh largest elderly population in the country. As our population ages, the demand for care at home will increase. Seniors have clearly told us what they want, and the Courts have told us what must be provided. This is a choice we should have no trouble making.


Brian A. Joyce (D-Milton) is the state Senator from the Suffolk/Norfolk district. Michael E. Festa (D-Melrose) is the state Representative from Melrose & Stoneham. Both legislators sponsored an "Equal Choice" rally at the State House on April 5th where several hundred seniors came to voice support for the legislation.