A care facility will never be at home


Elderly care in Montana is in crisis. However, we disagree with the solution presented in the Dec. 27 guest column by several Montana County Commissioners entitled “Fixed Reimbursement Rate for Montana Nursing Homes.” The column states that Montana’s aged care economy is broken, and to fix it, lawmakers need to increase Medicaid reimbursement rates. Independence has always been a core belief of Montans, and it would be a farce not to support our domestic and community-based services.

Medicaid reimbursement rates fall dramatically short of what is needed, but addressing only institutional reimbursement rates ignores our important home care and independent living services. The column states that home care is very expensive and “rarely covered by private insurance or Medicaid.” While it’s true that private insurance rarely covers these costs, it’s not accurate to say that Medicaid doesn’t cover them. Not only does Montana Medicaid cover home care, but the average cost of home and community-based services is significantly less than institutional care. Genworth.com states that the national average cost of home care is $5,339 per month. Home care services provided by Ability Montana, a nonprofit organization serving people with disabilities, seniors, and veterans in southwest Montana, average $1,200 per month. Compared to Montana Medicaid’s current reimbursement of approximately $6,500 per month for home care, it’s clear who the economic winner is.

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As many Montana families know, deciding how best to care for loved ones isn’t just about money.

The freedom to choose our outcomes and determine our future is precious and should not be relinquished to often “for-profit” institutions where profit is the sole business motivation and adequate standards of care are not met. Polls of seniors, veterans, and people with disabilities, who make up a whopping 34.8% of the state’s population, confirm what Montanans have long known: people want to stay indoors. An overwhelming number of our elders have decided that their home is where they belong and where they want to receive their care. In addition, the column failed to address that people with disabilities, seniors, and veterans have the RIGHT to choose where and how they spend their lives. A federal regulation (79 FR 2947) and a Supreme Court decision (Olmstead v. LC, 1999) dictate that home and community-based services are the first and preferred choice for long-term care, reflecting the general opinion of Montans.

Medicaid reimbursement rates are a problem, but the bigger problem is our state government’s preference for funding institutional care. Better options are available. Unsurprisingly, home-delivered care is superior, as are the outcomes for self-directed home services, when the person chooses who provides their care. These community-based options that keep Montanans in their homes have been shown to result in better health levels and longer lifespans, allowing our elders to be present for the growth and prosperity of their families. Montana’s seniors, disabled and veterans all want the opportunity to live and age in the comfort and security of the homes they spent their lives building.

We are calling on Governor Greg Gianforte and members of the Montana Legislature to reimburse Medicaid benefits at the rates recommended in the study they commissioned in 2023 and to take reasonable steps to encourage the expansion of home and community-based services than those provided by Montanan the most desired option and the most fiscally responsible use of Montana’s taxpayer funds.

Scott Birkenbuel is CEO of Ability Montana, Helena.

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