Editor’s note: This is the first article in a second series by the Henderson County Board of Social Services to fulfill the mandate of public education and advocacy for social service needs of the county. This series of monthly articles will focus on the partnerships established with public and private nonprofits to make a difference and achieve seamless customer service.

The majority of older people would prefer to live out their lives independently and receive assistance in the comfort of their homes. Most, in fact, do so. But others (43 percent) develop a sensory, physical, mobility, self-care or cognitive disability as they age and need help with daily activities such as bathing, cooking, dressing, home repair and transportation. Without help, the needs can become a barrier.

Long-term care is assistance provided for an extended period of time to people who are unable to care fully for themselves. Most long-term care services are publicly funded. Medicare pays for short-term care services and stays while Medicaid pays for long-term care services and stays. People expect Social Security to supplement retirement income and Medicare to pay for old-age health care; many are unaware Medicare will not pay for long-term care services and don’t save, invest or insure until it’s too late. The Kaiser Commission on Medicaid and the Uninsured (Kaiser Family Foundation) report, Medicaid and Long-Term Care Services and Supports (2011), breaks out payment for long-term care services and supports as: Medicaid, 40 percent; self pay, 22 percent; Medicare, 23 percent; private insurance, 9 percent; and other, 6 percent.

Costs for long-term care are high. The national average is $19 an hour for home management, $21 an hour for home health, $38,000 per year for assisted living and $72,000 per year for nursing home. Regardless of their finances before placement, 70 percent of all nursing home residents eventually become Medicaid recipients.

North Carolina’s Medicaid program is institutionally biased with a long-standing focus on funding nursing homes rather than private home services. The John Locke Foundation report, Long Term Care Financing in North Carolina: Good Intentions, Ambitious Efforts, Unintended Consequences (2008), states long-term care providers at every level, when interviewed, told them the long-term care system pushes all Medicaid recipients toward a higher level of care (and cost) than they actually need. Medicaid is biased in favor of assisted living over in-home care and is biased to nursing home care over assisted living.

Of the total $40,121,523 in federal and state funding passed down to Henderson County through the N.C. Department of Health and Human Services for people age 60 and older, Medicaid is 85 percent of the budget; and about $19,110,000 of the $33,985,486 pays for nursing home care. This is in stark contrast to the 6 percent federal and state non-Medicaid funds ($2,490,500) for Social Services and 2 percent federal and state non-Medicaid funds ($885,869) for home-based services through the Home and Community Care Block Grant.

Simply put, North Carolina’s long-term care system keeps spending more on services people don’t want and less on services people do want. And the cost of services people do want are considerably less than the costs of nursing homes and in-patient medical care — and support the choice of an older person to remain home.

The Partnership for Independent Living, a strategic alliance between the Council on Aging and Department of Social Services, combines staff and resources to provide older people and their families choice, self-determination and capacity to stay home. Resources are maximized, and an array of COA, DSS and other community services are coordinated and duplication is minimized. The only program of its type in North Carolina, the Partnership for Independent Living was created by the Board of Social Services and Council on Aging Board as a response to Henderson County’s Healthy Aging Coalition priority for available non-medical case management services for all older people regardless of income.

Of the 225 people served by the Partnership case managers in 2010, 93 percent remained at home and 99 percent had no recurrent health or safety reports from a concerned community member. When formed in 2006, COA and DSS staff discovered 50 percent of services were duplicated; in 2010, the duplication was none.

Spence Campbell is vice chairman of the Henderson County Board of Social Services.