States Start Shifting Focus to Help Seniors Live Independently, at Home

The Ryans“We need to ‘spring’ your mother,” Pop, who loved prison movies, told me over the phone while asking me to come home that weekend. Mom had been in a rehabilitation center for two weeks following a bad fall and a hospital stay. Both she and Pop were ready for her to go home.

My mom and pop, like most Americans, wanted to stay in their home and community as they aged. Pop became the primary family caregiver for Mom, and with help from me and my siblings, a visiting nurse, a home aide and other resources, my parents were able to live independently, at home – and Mom didn’t have to stay in a costly nursing home, where she didn’t want to be.

Many older Americans and their family caregivers rely on their state’s services provided at home and in the community to help make aging in place, at home, a reality. These services include:


  • home health services by skilled professionals like nurses and physical therapists
  • respite care and training for family caregivers
  • assistance with shopping, managing money and doing laundry
  • personal care like help with bathing and dressing
  • help with household tasks, transportation and meals


But for too many, these resources aren’t available because often states emphasize institutional care – like nursing homes – as opposed to helping more seniors live independently, at home.

That’s why AARP is fighting to get states to shift focus and funding to services provided at home and in the community. This will not only give older residents and their family caregivers the services and support in the settings they prefer, it will save states money – and allow them to serve more people.

In fact, shifting funds from institutional care to home and community-based care is one of the biggest moves policymakers can undertake, especially if they’re worried about cost: On average, home and community-based care carries one-third the cost of nursing homes.

It’s time for states to step up the pace when it comes to identifying new and innovative ways to make this shift. Some states have already begun reprioritizing, and along the way they have tapped into federal incentives to help them jump-start the process:


  • In Connecticut: Gov. Dannel Malloy (D) decided to expand service options to help older residents stay at home as they age. His strategic plan, for which AARP is a member of the evaluation team, will help nursing homes transition patients back home, among other improvements. Missouri is undertaking a similar initiative.


  • Also in Connecticut: Family caregivers will now have access to one-on-one or group caregiver education and training as part of a demonstration project.



  • California, Maryland, and Oregon now provide home and community-based attendant services through the Community First Choice option as part of their state Medicaid program, which gives states the opportunity to transform their care systems. According to the Kaiser Family Foundation, a number of other states, Arkansas, Minnesota, Montana, Texas and Wisconsin, are planning to participate in Community First Choice this year.  In addition, Washington State’s budget includes funds to design and implement Community First Choice by 2015, with plans to invest savings in home and community-based services for seniors and people with disabilities.


Even with this progress, states have a long way to go and the pace of change must accelerate to meet current needs – and to start laying the groundwork for when the leading edge of the massive baby boom generation starts hitting their 80s, in just over a decade.

For family caregivers, keep in mind: You’re not alone.



MaineGirl1 5pts

Maine needs to do more to help 70,000 who were kicked of the Maine Care rolls. We do need to do more to help seniors stay in their homes. $6,000 a month to stay in a nursing home is too expensive and we can take care of them better in the home.

DWiltsee 5pts

Hopefully the States' new emphasis on aging in place will involve 1) more State initiatives and State funding, reflecting individual State priorities, 2) more effective local government interest and involvement in senior affairs and issues 3) less reliance on federal funds and programs every time a new challenge arises, 4) (related to #3) broadened perspective to include the entirety of  the senior population in new approaches, rather than the incessant emphasis on "low income, minority, and vulnerable" populations.  Thanks to precipitous increases in seniors' cost-of-living, we're all more "vulnerable" than we were 5 years ago, and are no longer able to count on salaried income or conservative investments (thanks, "financial community") to shore up our piggy banks.

For a refreshing change, how about some consideration of the lives of the vast majority of seniors, who are neither filthy rich nor Medicaid recipients, and can't rely on heavy subsidies or charity for their existence.

It's the middle class that now needs the safety net of affordable services and supports.  Hopefully these States will keep this in mind while trying to help us live independently.

communityhost moderator 5pts

Dear mj92335970,

Thank you for the suggestion. Did you know you can go to AARP in Your State to find more local information, too?

mj92335970 5pts

Please add a state by state update as a regular feature for the AARP magazine.  Include charts for state comparisons; otherwise, states like Wisconsin will do nothing.