The Counties’ Home Care Squeeze

Last week, members of Congress identified long-term health care as “the sleeping giant of all U.S. social priorities.” Gov. Gray Davis woke that giant in California in his State of the State speech in January, outlining his “Aging With Dignity” initiative, intended to “provide the services older Californians need to remain in their own homes, instead of nursing homes.”

Last week, in his budget for the coming fiscal year, he detailed plans to begin paying for the cornerstone of that initiative. He has budgeted $107 million for raising wages for home care workers, from their current $6.50 per hour without health insurance to $7.50 per hour with health insurance. He said he wants to raise care worker wages to $11.50 over the next four years.

The governor’s raises were promptly hailed by the politically powerful unions that fought for them. But as legislators and the governor finalize the state budget, they will have to sharpen some policy details that rightly trouble California’s county governments.

The biggest problem is that the state’s larger counties are balking at passing on the raises, citing reasonable concerns that the state will retreat from its commitment of last year to pay 80% of all new home care worker benefits and revert to its more typical ratio of paying no more than 65%.

Legislators should specify a commitment to paying 80%, realizing that a host of laws like the Gann Limit and Proposition 13 have hamstrung counties’ ability to raise revenues.

The financial burdens of any expansion in home care would fall especially heavily on Los Angeles County, where a whopping 7% of all of the nation’s 43 million citizens without health insurance reside.

L.A. County leaders are particularly reluctant to expand home care services at this time because the federal Department of Health and Human Services has yet to commit to long-term funding of the county’s ongoing effort to reduce its traditional emphasis on expensive hospital-based, emergency room care by building instead a network of more economical, community-based health clinics. The Department of Health has unfairly accused L.A. County of failing to reduce costs during the transition; a 1998 analysis that the department itself commissioned concludes the transition may not reduce costs “because the level of need is so great in Los Angeles County.”

Efforts in Sacramento and Washington to help Americans “age with dignity” are especially welcome given that the number of Americans requiring home care is expected to double in the next decade as baby boomers retire.

But as the dire straits of health care financing in Los Angeles County make clear, state and federal leaders will have to assure local leaders that any announcements of long-term care initiatives will be followed by stable, adequate funding.