According to a study from the AARP, Massachusetts ranks 40th out of all the states in funds expended to support low-income frail elders in their own homes instead of being placed in nursing homes. According to today's Boston Globe, “if Massachusetts improved its performance to the level of the highest performing state, Minnesota, at least 3,945 nursing home residents with minimum health care needs would instead be able to receive care in their communities.” At the same time, Massachusetts ranks the sixth most expensive place in the country for the cost of privately-paid skilled nursing care.

Although the Patrick administration says that it wants to work towards keeping more elders in the community, MassHealth is openly hostile to allowing parents to pay their children for care, and there is precious little support offered to family caregivers. The bill I testified about last May to give elders the clear legal right to pay their children remains stuck in committee. Further, the state makes it unnecessarily costly to deliver many routine health care services that would allow elders to stay home. Unlike the states that scored the highest for providing home care, Massachusetts law forces families to either hire a registered nurse to change a feeding tube or give a routine injection (like insulin) or do the job themselves, instead of hiring less expensive trained home health aides as is done in states with the highest percentage of frail elders at home.

Unless the public pressures both the Patrick administration and the legislature to improve the delivery and accessibility of community-based care, movement towards such services will remain painfully slow.