Early this month, North Carolina’s Governor Roy Cooper proposed a $25.2 billion two-year state spending plan that aims to close many of the spending gaps that currently exist in the state’s services. One of the biggest changes in the proposal would expand Medicaid coverage to as many as 625,000 low-income North Carolinians, a move that would do much to help our poorest residents to access quality healthcare services. According to state health advocates, the Medicaid expansion is a necessary step in fixing the healthcare system here in the Tar Heel State, but it doesn’t go far enough to help one critical segment of the population: the state’s growing number of elderly residents.
According to UNC demography data, North Carolina, much like the rest of the United States, is experiencing the effects of population aging at an accelerating pace. Their statistics project that a full 20.6% of the state’s population will be age 65 or older by the year 2035. That demographic shift is going to not only change the face of the state but will also put a tremendous strain on the state’s healthcare system.
The problem, as it relates to the state budget proposal, is that North Carolina’s elderly population currently has a poverty rate of 9.1%. That number, even if it doesn’t increase, is going to ramp up demands on the state’s variety of services for the elderly. Programs like Meals on Wheels, allowances for personal needs, and the Adult Protective Services system are all already facing shortfalls, and advocates say the budget proposal all but ignores the expected increases in demand.
If the budget makes no further allowances to fund additional services for the elderly, advocates project that it will create a cascade effect that places ever-larger burdens on family members, many of whom are living in poverty themselves. Without the needed resources to provide in-home care for their aging relatives, many would be forced to turn to nursing home services, which is a healthcare sector that’s already on the verge of crisis due to staffing shortfalls that show no signs of abating.
That’s a situation that’s already playing out in many parts of the nation, with disastrous consequences. In many places, nursing homes that are stretched beyond their ability to care for their charges resort to tactics like hospital dumping, which is the practice of refusing to readmit residents once they’ve been taken to hospitals for acute care. According to attorney Matthew L. Sharp, a specialist in such cases, “Hospital dumping affects mostly low-income nursing home residents who have lost the ability to pay for care, except through Medicaid. Ironically, those abandoned in expensive hospitals cost Medicaid more than twice the cost of nursing home care.”
Since the new budget proposal includes an expansion of Medicaid services in the state, an increase in hospital dumping of elderly nursing home residents would cause a corresponding spike in Medicaid costs, which would either cause a severe funding shortfall or a sharp decline in the quality of services provided to patients. Either of those outcomes would be undesirable, and would likely cause the state to have to resort to even more costly fixes to the system.
So far, the budget proposal is just that: a proposal. There’s still time for some more careful reflection and changes to the plan. Examining the projected impact that the budget would have on the state’s elderly would be an excellent place to start. By increasing funding to the necessary services, it’s still possible to avert the worst outcomes that may result from ignoring the needs of a very vulnerable population. It’s a case where the old axiom should apply, that an ounce of prevention is worth a pound of cure. Now it’s up to state lawmakers to supply that ounce.