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Home
and Community-Based Care
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Increase
spending for Home and Community-Based Care Services as a proportion
of total long-term care spending.
Target:
25 percent of total long-term care funding.
Baseline, 1998-1999: 18.8 percent of long-term care services
funding goes for home and community-based care services.
Target Setting Method: 33 percent increase.
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Older
Adult Health-
Home and Community-Based Care
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In 1998, 12.8 percent (967,000) of the state’s
population was 65 years or older; of those 107,000 were 85 years or
older. The number of older adults is expected to grow to almost 2
million by 2020 with those 85 years and older being the fastest growing
age group. Due primarily to the increase of people age 85 years and
older, by 2020 more than 348,000 North Carolinians will have impairments
that effect their ability to live independently. This is a 57 percent
increase from 1998. Significant amounts of funding will be required
to provide long-term care services to these older adults. Long-term
care services cover the continuum from in-home and community based
services to institutional care. In SFY 1999, the amount of long-term
care expenditures reported for persons 65 and older amounted to $1.37
billion. Home and community-based care services made up nearly 19
percent of those dollars.
Chronic illnesses and old age go hand-in-hand,
requiring comprehensive and integrated services to meet the multifaceted
needs of older adults. In rural communities, where a large segment
of North Carolina’s older adults live, home care and assisted-living
arrangements are limited. At the same time, many rural communities
have excess bed capacity in their acute care hospitals and skilled
nursing facilities. These hospital beds are not an appropriate setting
for older people who are not ill enough to warrant a high level
of care; however, they are often the only available services for
low-income older adults. Significant amounts of funding will be
required to provide home and community-based long-term care services
to these older adults. The most efficient method of providing comprehensive
long-term care services to older adults is through an integrated
system of community-based services that will link health, social,
and personal care services with assisted-living housing.
Most people who suffer from a chronic,
debilitating illness prefer to stay in their own home or in the
home of a family member, if possible. Home care services and adult
day centers offer an attractive alternative to nursing homes. Numerous
studies suggest that expanding home and community care options is
cost effective. Home and community-based care services are designed
to support older adults living in their homes. However, these choices
are not always available in all of North Carolina’s communities.
The availability of long-term care services varies by county. Some
counties have developed a comprehensive array of long-term care
services including personal care services, adult day care/day health
care, home delivered meals, respite care, and skilled home health
care. Other counties are more limited in what is available.
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Disparities
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Low-income older adults have access
to fewer services than those with financial resources. Poor people
in rural counties have few, if any, home and community-based services.
Low-wealth counties face particular challenges in meeting service
needs. Lack of resources, financial and human, is a major reason for
inadequate services. Funding may not be sufficient to develop or sustain
services at the needed level. Many funding sources are biased toward
the funding of institutional care services. Having a qualified work
force is another factor that greatly impacts the availability of services.
In recent years, the recruitment and retention of qualified workers,
particularly para-professional aides, has been a challenge for many
communities. |
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Determinants/Risk
Factors
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Availability of services (often lacking
in rural areas), health status, low income level, cost of care, age,
lack of appropriately trained providers, and county financial base |
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NC
Data
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| Older
Adult Health - Home and Community-Based Care |
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