Like most older adults, at age 90 Anne wanted to stay in her own home when she started to need some help. Staying at home by using home care or adult day services is a realistic choice for many older adults with adequate means. For those like Anne with lower and more modest means, but not poor enough to meet the stringent Medicaid income and asset limits imposed on older adults, cost is a barrier. According to the Genworth Cost of Care 2018 study, an in-home health aide – at 20 hours weekly – costs $26,000 annually; five days of adult day health services, $21,160.
A recent study by the Gerontology Institute at the University of Massachusetts found that half of older, single Rhode Islanders are economically insecure. They live above the federal poverty line, at $12,490, yet do not have enough income to pay the estimated $25,610 needed for basic living expenses.
The study also found one in five older Rhode Island couples is economically insecure. Older women, in particular, face a significant economic hardship, as they tend to live alone and have lower incomes than their male peers. For these Rhode Islanders, in-home and adult-day-health services are out of reach, without financial assistance. The result: they will likely move out of their homes and into care facilities prematurely – quickly spending down their assets and ending up on state Medicaid rolls, at a huge cost to taxpayers.
Over the years, the state Office of Healthy Aging (formerly Division of Elderly Affairs) has helped thousands per year of older residents like Anne afford in-home and adult-day-health care through its At-Home Cost Share program. The program subsidizes the costs of these services, with participants paying no more than $7.50 hourly for in-home help and $15.00 (versus nearly $100) daily to attend an adult-day center.
Currently, the program’s income eligibility is set at 200 percent of the federal poverty level, or $24,280 for a single person. By modestly raising the income limit to 250 percent (or $24,980 for a single person) and opening the program to persons under age 65 with a dementia diagnosis, hundreds more Rhode Islanders would benefit. Over 20,000 local families are affected by dementia – a number that will only increase as the total population ages.
Investing in programs like At-Home Cost Share makes sense. It’s a smart use of state dollars and the right thing to do for Rhode Islanders. We should all have the opportunity to live well, on our own terms, and age with dignity.
It’s time for the state to make greater investments in the At-Home Cost Share program, so more older adults with modest means who have worked hard all their lives to raise families and contribute to society – stay connected to their homes and communities for as long as possible.
A former Warwick state representative and director of the RI Department of Elderly Affairs, Maureen Maigret is co-chair of the Rhode Island Long-Term Care Coordinating Council.