The United States is well-equipped to provide more home- and community-based care (HCBS), a public policy expert recently told an audience of long-term care providers, including those in home care.  

Stuart Butler

“There is untapped opportunity for more home- and community-based care,” Stuart Butler, a senior fellow in economic studies at The Brookings Institution, said last Thursday during a LeadingAge coronavirus update call.

Several factors are helping to create the optimal conditions for additional HCBS. One is technology, he said.

“We have the ability to make it safer for people to age in their own homes, to have medical care in their own homes, to have smart homes,” he said.

Home design is also helping to provide the right conditions for HCBS, as there is a lot of thinking about how to make homes a more social entity and have people of different ages live there. And the expansion of senior villages — membership fee-supported volunteer organizations that can support people in their own homes and be a link with professionals — is contributing to the right environment for HCBS.  

During the conversation last Thursday with Ruth Katz, senior vice president of policy for LeadingAge, Butler expanded on ideas from a Nov. 30, 2020, report on transforming long-term care. Among those ideas are how nursing homes should be treated as a hub for other services, as opposed to an entity unto itself.

“It’s important to think of a nursing home as an important center within a community, and doing things outside the walls of the nursing home and bringing people into the walls of a nursing home,” he said.

Butler also talked with Katz about the importance of updating the Medicaid model, allowing it to pay for long-term care in various settings and increasing rates.

“The rate is too low in a lot of these settings and too restrictive,” he said.

It’s important to make the funding more flexible, he said.

“We’ve got to bite the bullet on this and see this literally as part of our infrastructure for aging,” he said.