Put spotlight on home care

Throughout the ongoing conversation about patients in nursing homes, the emphasis has been on improving care in the facilities we have.

But what about trying to keep more older adults and individuals with disabilities in their own homes?

A larger spotlight should be focused on the independent living centers that encourage home care. It's not the best or most appropriate solution for everyone, but advocates say there are plenty of instances where a nursing home is pushed as the only answer, when living at home is a valid or better choice. For still others, there's an opportunity to transition out of nursing homes and into their own residences, part of a publicly-funded program called Open Doors, which assisted 102 Long Islanders last year.

As state officials and lawmakers evaluate a package of proposed nursing home reforms, they'd be wise to consider the funding and policies behind independent living options. The state's 41 independent living centers, which assist seniors and those with disabilities and connect them with home health aides and other services, have a relatively tiny budget — just over $13 million. But even that was trimmed — by about $500,000 — in Gov. Andrew M. Cuomo's proposal for the year ahead. Restoring those funds, and perhaps adding more, would show the state's commitment to its most vulnerable residents — the ones who need to find the right care, with the right services, no matter where that might be based.

Making the decision to keep a loved one in his or her home isn't easy. One of the toughest hurdles is finding a home health care aide willing to do demanding, sometimes-thankless work at relatively low pay. It's difficult to attract and retain such aides, especially because, if they're paid only minimum wage, they'd rather work in a less arduous field. Lawmakers should approve the Fair Pay for Home Care bill, which would require wages for home health aides to be set to at least 150% of a region's minimum wage, which would equal an average of $35,000 a year in New York.

It might even be less costly to keep individuals at home than to place them in a nursing home, most of which is covered by taxpayer-funded Medicaid. According to the New York Association for Independent Living, recent studies showed that home health care costs hovered around $60,000 a year, compared with more than $140,000 for nursing home care. Some of that may be based on the hours of nursing care, or the fact that there are other costs not included in the at-home total, but the difference remains significant.

Reforming nursing homes and providing appropriate funding for them remains a critical goal. But state officials would be wise to consider a multipronged strategy that makes independent living a valid — and even welcome — option. The focus must be on those who are in need of long-term care, so we can determine what's best for each of them.

— The editorial board