The call is getting more common as I enter my mid-40s. It generally comes from a friend, about my age, who knows I work for AARP, and hopes I can help them navigate the services available in Wyoming to help a loved one stay at home as they age.
Their question is simply, “how do I keep mom/dad out of a nursing home for as long as I can?”
The best advice is to ask for help sooner than later. Develop a plan, figure out what supports are in your community. Emily Loos of LIV Health, a home services provider in southeast Wyoming, suggests a visit to your loved one’s primary care physician, and bring a caregiver to that appointment as an extra set of ears. Their doctor will have a number of screening tools available to get baseline information and determine if a cognitive decline is stress, dementia or an underlying condition.
Then, contact a home services provider, who can walk you through what financial support might be available to talk about real numbers.
To find a service provider, call 211, and the operator will ask a few questions in order to make a “warm hand-off,” to an agency that can offer more specific help.
At the end of the day nursing home care is expensive, and for good reason - 24-hour care by trained professionals shouldn’t come cheap. In Wyoming, those who pay privately for skilled nursing homes can pay up to $98,000 per year for a private room.
Delaying that trip to the nursing home, when appropriate, through home services can help you leverage a lifetime of savings and assets.
The same can be said for the state’s budget. The longer someone in need can be treated with home services, the better for the state.
When someone in the US needs a nursing home level of care, but cannot afford it, they can enter a nursing home through the Medicaid program (not Medicaid expansion).
Currently, Medicaid, which is a 50/50 split of federal and state funds, pays for around 65 percent of all nursing home bed days in Wyoming. That cost is $4,300 per person, per month, split by the state and federal government. All told, that bill comes in around $140 million per year.
If that number seems out of control now, it will only get worse as Wyoming is aging faster than any state in the union other than Florida. Because of Wyoming’s Silver Tsunami, the Wyoming Department of Health suggests that $140 million could just about double in 10 years. That is not great news for a state struggling with a budget shortfall.
The best advice for our state in avoiding these costs is the same advice I have given those friends who have called - consider home services. A 2011 AARP survey of adults shows that 90 percent of adults, age 65 and older want to stay in their homes and communities as they age. That is great news for policy makers, because it means the least expensive option for long term care is also the option citizens overwhelmingly prefer.
Since 2014 the State of Wyoming has gotten a waiver under the Medicaid program to pay for home healthcare that helps folks stay in their home as they age. The Department of Health tells us they can treat someone still living in their home, but requiring a nursing home level of care, with home health services at an average of $1,635 per person, per month, or less than half of the cost of nursing home care. That program is called the Community Choices Waiver. A recent paper by the Department of Health suggests the state has saved up to $66 million since 2014 by using the Community Choices Waiver to provide home services.
Keeping our citizens in their home as they age feels like a win, however, two programs currently doing that were just cut. The Wyoming Home Services and the Program of All-Inclusive Care for the Elderly (known as PACE), in Cheyenne got eliminated in recent budget cuts, despite the fact they also serve seniors for far less than the $4,300 per person per month cost of nursing home care. This is a good reminder that cutting programs sometimes results in higher costs later.
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