Florida may enjoy a reputation as a haven for the elderly, but the Sunshine State ranks as one of nation's worst in helping keep seniors living independently and out of nursing homes, according to a national study released today.
The new scorecard on long-term services for seniors and the physically disabled puts Florida at No. 43 overall on five measurements, including nursing home affordability, quality of care and support for family caregivers, according to the study from AARP, the Commonwealth Fund and the SCAN Foundation.
Best in the nation? Minnesota.
"Where you live really matters because there are very large differences across the states in how well they do this job," the report said.
Here's why long-term care is such a pressing need, the authors said: The leading edge of the Baby Boomer generation will enter their 80s in the next decade, and many will need help to live independently. Yet there's no national policy for how to handle the cost. The federal Medicare program covers only medical expenses, not longterm care costs. Instead, states are stuck with the job, and many aren't doing it well.
Family caregivers provided an estimated $450 billion worth of care in 2009. In Florida, according to AARP, nearly 2.8 million family caregivers help aging loved ones with everything from wound care to transportation.
Yet as boomers age, they will outnumber available caregivers in the next generation, the report says. That's not even counting the relatives who are burning out as they try to care for loved ones.
Betty Patruno of Dunedin knows that feeling all too well. At 71, she is caring for her 74-year-old husband, Sam, who has dementia. Though she needed the income, she retired from her bank teller job in April because she must spend so much time helping Sam. Like many caregivers, she has found that the financial, social and practical challenges build up until they are overwhelming.
"It's a costly disease before you even realize it's costly," said Mrs. Patruno, who will soon start attending a support group of the Alzheimer's Association's Florida Gulf Coast chapter. "You suddenly realize your feet are wet, but by then you're really up to your knees."
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Different from medical care, long-term care services refer to assistance with daily activities needed due to a physical, cognitive or chronic health condition.
Medicaid, the state-federal program for the poor, is the largest source of public funding for long-term care services. Paying out-of-pocket for these services can quickly deplete savings, meaning that middle class people who planned carefully for retirement often end up on Medicaid, the report notes. And only 10 percent of Americans age 50 and older have private long-term care insurance, which is prohibitively expensive for many.
States that have more generous Medicaid benefits, and that spend more on home-based care, did best in the rankings. Florida spends 23.5 percent of its long-term care budget on home-based care, earning it a rank of 40th in the nation. And only 49 percent of low-income disabled Floridians receive Medicaid benefits, 39th in the nation.
"If that (Medicaid) safety net is inadequate, people may rely so heavily on family caregivers that those caregivers damage their own health and well-being," the report says.
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So what are high-ranking states like Minnesota doing better than lower-ranking ones like Florida? In a conference call with reporters Wednesday, the report's authors offered several examples:
• Additional protections for workers who take time off to care for a sick family member
• More help to enable people in nursing homes who are capable of going home to do so
• Allowing professional home health aides, who are less expensive than nurses, to do more medical-related tasks.
That's a big issue for Florida, one of only four states that do not allow nurses to delegate such tasks as administering a feeding tube to an aide, the report says. Relatives are allowed to provide that care, however. So for families that can't afford a nurse, relatives must leave work and do the job themselves. The report calls that dilemma "low-hanging fruit" that state legislatures could fix.
Many caregivers decide trying to get a job while caring for a relative is not worth it. Beth Watt, a 60-year-old Dunedin resident, takes care of her 88-year-old mother, who has dementia. After she lost her job at a Nevada plant, Watt thought she might be able to find a part-time job while helping look after her mother. But her mother needs her far too much for Watt to get a job. The women are living off savings, and Watt still sometimes feels guilty she's not doing enough.
But she's determined to keep her mother at home.
"There are good facilities out there, but they're terribly expensive," she said. "As long as we can keep Mom home we will."
Jodie Tillman can be reached at firstname.lastname@example.org