In times of shortage, it is imperative to plan carefully and spend wisely. As the current session of the Maine Legislature draws to a close, we are all painfully aware that this is one of those times. Our elected representatives in Augusta have made very difficult decisions that will have a significant impact on the health, well-being and future of the state and are now called on to complete that work.

LD 1808, An Act to Ensure Adequate Home-Based Care Services and Provide the Most Cost-effective Long-Term Care for Maine Seniors, is now up for consideration by the Committee on Appropriations and Financial Affairs. For a small investment of $1.5 million, this bill goes a long way toward controlling health care costs through judicious spending in the present, while preserving the dignity and quality of life of Maine’s elder and disabled people.

Maine’s Home-Based Care Program provides coordination and access to services such as skilled nursing, case management, respite care, and homemaking services which allow elders and persons with disabilities to remain in their homes, and which also provide needed relief for their family caregivers. Medicare only pays for these types of services over the short-term in cases when the patient is expected to recover after a hospitalization, leaving costly gaps in eligibility for those with chronic illnesses or transitioning to long term care. LD1808 provides funding to fill these gaps for essential home care services to those with the greatest need by minimizing the waiting list for services and ensuring continuous availability of this vital resource.

This preventative medicine saves hardships, saves money, and saves lives. When sick people have to wait for help, the results can be devastating. Those who are unable to pay for expensive long-term care insurance or out-of-pocket home health care often forgo the services that help them to maintain their health. Someone waits a few extra days to get help with dressing a wound and it becomes infected; another person puts off a visit to the doctor for their lung condition until pneumonia takes hold; another recovering from hip surgery falls while trying to bathe without help. These people, now even more sick, return to the hospital, enter long-term care facilities, or incur injuries or complications to their original illness which are not only more expensive, they are potentially deadly.

While federal policies favor institutional placement, Maine has demonstrated since 1984 that community- based services improve quality of life and preserve dignity for an increasingly aging population while saving money. Most elders prefer to stay at home for as long as possible, and while the average monthly cost for those in nursing facilities in Maine during FY2003 was $2,426 dollars, the Home Based Care program cost less than one-fifth as much at an average of $412.50 per person, per month.

The price difference is staggering, and it comes out of the state’s budget for MaineCare when low and middle income elders have spent down their savings to pay for medical expenses and have nothing left over for the new emergencies. It is imperative that the state continue to promote cost-saving programs such as this in order to preserve limited MaineCare resources.

The program works most effectively when it can operate with no, or a short, waiting list.

Maine closed the Home Based Care program to new applicants in October, 2002 when the money was not available to fund services for new applicants. This freeze stayed in effect until September of last year with 1,101 eligible people on a waiting list for services.

Most people who participate in the program do not ask for help until a time of crisis, and being told that there was little possibility of getting care within a year was overwhelming. Many people needing help gave up.

LD 1808 assures that elders and other adults in need of home care have access to services when they are needed rather than after the opportunity to prevent more serious complications has passed.

Earlier this year, through a coordinated effort of the Legislature and those who administer and support the Home Based Care program, the state was able to realize significant cost savings by shifting resources and issuing waivers which allowed eligible people transitioning from short to long-term care to continue receiving coordinated services at home without a break in service.

This action helped to alleviate the 300 person wait list that LD 1808 was originally intended for, but does not guarantee that such a wait will not occur again next fall when the inevitable pressure on long-term care resources returns. Passage of LD 1808 will provide the additional funding that keeps home-based care services available when they are able to do the most long-term good for Maine seniors and taxpayers.

Daryne Sandford is a graduate student of social work at the University of Maine and a member of the Maine Gerontological Society.