Advocates say the state is too willing to pay for nursing-home care and needs to divert more money to community and home-based care.

01:00 AM EDT on Friday, June 9, 2006

BY ELIZABETH GUDRAIS
Journal State House Bureau

PROVIDENCE -- Seniors donned handcuffs in the State House rotunda yesterday, in a symbolic gesture aimed at persuading the state to redirect money from nursing homes to home and community care.

"I'm not a child," Irene Santos, president of the Rhode Island chapter of the Gray Panthers, declared. "I don't want anybody to treat me as a child. I want to be able to choose."

Rhode Island spent about $471 million -- a combination of state and federal dollars -- on long-term care in fiscal 2004, according to a report from the state Long-Term Care Coordinating Council.

Of that amount, 90 percent went for nursing-home care, and just 10 percent for home and community care, yesterday's demonstrators said.

Rhode Island ranks 45th in the country in terms of the percentage of long-term care dollars spent on home and community care, the protesters said. In the top-ranking states, New Mexico and Oregon, more than half of long-term care money goes toward home and community care, a category that includes assisted living, adult daycare and visits from in-home caretakers. The national average is about 25 percent.

The demonstrators say Rhode Island would actually save money by increasing its use of alternatives to nursing homes, for which the state pays about $120 per bed per day, versus $50 to $80 a day for the various types of home and community care.

They're backing a bill that would take money budgeted for nursing-home beds and use it for home and community care, instead of letting it revert to the state's general fund, when it's left unspent at the end of the year.

The amount of money involved would be relatively small -- a few million dollars a year, the protesters said -- but it would actually save the state more money, and free up more money from the nursing-home budget, because of the cost difference between types of care.

"The savings have the potential to be enormous," Kathleen Connell, state director for the AARP, said. "The outlay is small. It makes good sense. Why isn't it happening?"

The Senate passed the measure last week; now, that bill and a House version are both before the House Finance Committee.

Finance Committee Chairman Steven M. Costantino said yesterday, "I think it's a good idea that people get appropriate care." But, he said, "I haven't done the analysis on this bill."

In an extremely tight budget year, with hundreds of millions of dollars separating projected revenues and projected expenses, any plan to redirect money from the general fund is bound to face an uphill battle. However, Costantino said he would be more likely to support such a measure if it took effect July 1, 2007.

While the advocacy groups would prefer the policy change immediately, waiting a year would be "better than nothing," Jessica Buhler, a lobbyist for the Senior Agenda Consortium, said yesterday.

"We'll keep fighting," Rep. Raymond J. Sullivan Jr., the House bill's sponsor, pledged yesterday.

Sullivan, who was also in handcuffs yesterday, recalled visiting his own grandmother, who had early-onset Alzheimer's disease, in a nursing home.

"Every single Sunday, she would always ask, 'When are you going to take me home?' " Sullivan, D-Coventry, said.

Sullivan's bill, which was sponsored in the Senate by Sen. Rhoda E. Perry, D-Providence, drew a cautious endorsement from the governor's office yesterday. Said spokesman Jeff Neal: "Governor Carcieri is a very strong supporter of home and community-based care. He has increased funding for those services every year he has been in office. He has not had an opportunity to review the latest version of this specific bill, but he will do so."

Besides saving the state money, the demonstrators said the bill would help bring Rhode Island into line with the so-called Olmstead decision, a 1999 U.S. Supreme Court ruling that interpreted the Americans with Disabilities Act to require that states place disabled and elderly people in the least restrictive possible setting.

"Rhode Island is not doing that," Buhler said yesterday. "There are people in nursing homes right now who are completely able to live in the community, and would rather be in the community. It's sad but true that the culture is 'Stick old people in a nursing home.' "

egudrais@projo.com / (401) 277-7045