Domino effect

The reimbursement shortfall “creates a cycle of people who can’t afford to do the job and therefore the providers shy away from providing the service,” said Lisa Sprinkel, who directs Carilion’s Home Care Services, one of the region’s larger home-care providers.

Sprinkel was disappointed when the Virginia General Assembly did not approve recommendations this year that she and other members of Gov. Tim Kaine’s long-term care planning task force had made to increase Medicaid home-care reimbursements. Reimbursement rates for home-care services have to be approved annually by the General Assembly, and the task force estimated it would take a 40 percent increase in the rate to cover their costs and allow providers to pay their aides more, thus attracting more people to the field.

The group ended up reducing its request, asking for a 10 percent increase instead. “We knew the budget was so tight this year; we thought our chances would be better asking for less,” Sprinkel said. But even the request for a 10 percent increase died in a budgeting committee.

“Increasingly, we’re seeing more of a resistance [from seniors] to going anywhere but home,” Sprinkel said. “But unfortunately, our state budget has not been able to keep up with the demand.”

Faced with booming senior populations that are projected to grow even larger in the coming decades, many states are working toward balancing the funding of home care and nursing-facility care, according to Rosalie Kane, a health policy professor at the University of Minnesota.

Such states have reconfigured their Medicaid offerings to provide home-care training for friends and relatives of home-bound seniors — and to pay them higher wages, starting at about $9.50 an hour. (The average rate in Virginia is $7.73.) Oregon even allows nurses to delegate nursing tasks to unlicensed aides, Kane said.