Opinion: Long-term care funding crunch

Lawmakers headed to Tallahassee this year vowing to take a comprehensive look at long-term care in Florida. With fresh findings from a task force created last year, they were expected to make changes in three broad areas -- to improve nursing-home quality, relieve liability pressures and place more priority on home- and community-based care for the infirmed elderly. But with the session almost over, lawmakers have spent a lot of time on the first two areas and precious little on the third. When, exactly, do they plan to get serious about finding and funding alternatives to nursing homes?

The number of elderly citizens expected to need long-term care in Florida is exploding, as is the public cost of providing it. Over the last decade, the state has spent an ever-increasing proportion of its health-care budget on nursing homes, the most expensive and restrictive form of help, according to the Task Force on Availability and Affordability of Long-term Care. Florida was once a model in providing home-based care, but no longer.

The budget has been tight this year, to be sure. But lawmakers have shown little interest in this problem even when state monies were more plentiful.

Gov. Jeb Bush, who has made community-based care a hallmark of his administration, recommended that Florida invest an extra $54-million in nursing-home alternatives, including assisted-living facilities, adult day-care services and adult foster homes. But the House and Senate budgets included only roughly a third of that amount. While the tobacco-funded Lawton Chiles Endowment was intended to help pay for just such enhancements, lawmakers were more anxious to use a greater proportion of those endowment dollars for biomedical research than for nursing-home alternatives.

Their collective neglect will be felt. In January last year, there were over 43,000 residents, older than 60, living alone in Hillsborough County, and nearly twice that number in Pinellas. Many are already on the long waiting lists for home or community-based help -- lists that will only continue to grow because of promises made and not kept.

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