Despite the popularity and relatively low costs of home care, Virginia spends much more of its public money on nursing facilities.

By Beth Macy
published Sunday, April 20, 2008

Want to live out your final days at home?

If your income is low and you live in Virginia, you’re much more likely to spend the end of your life in a nursing home.

Barbara Worthy (left) hugs home care provider Cheryl Jones, who has enabled Worthy to stay in her apartment.

Virginia ranks 47th in the nation in Medicaid funding of home care. Unlike states that have tried to shift funding toward home care and away from nursing homes, Virginia spends just 27 percent of its Medicaid budget on home health and personal care. By comparison, it spends 42 percent on nursing facilities, according to the National Center on Caregiving.

There’s an obvious problem with that funding formula, home care advocates say: Not only do people prefer to live at home for as long as they can, but it’s also much cheaper for them to do so.

Because Virginia’s reimbursement rate for home care doesn’t cover all the costs of providing it, many home-care companies opt out of accepting Medicaid patients altogether. The companies that do accept Medicaid are plagued by worker shortages.

Because of low reimbursements, service providers say they have a hard time paying their aides a living wage and providing mileage. In Virginia’s rural areas especially, providers report that many Medicaid-eligible seniors simply go without home care because there’s no one willing to provide it for such low pay locally.