Florida has one of highest percentages of residents over the age of 65 in the country, bringing the continuum of care for older adults to the forefront of health care discussions. Currently, a large portion of Florida’s healthcare spending for the elderly is through institutionalized care, according to a newly released study. report from Florida TaxWatch, an independent research institute.

The report, titled “Aging in Place: The Economic and Fiscal Value of Home and Community-Based Services” (HCBS) found that shifting costs to providing care at home rather than in a nursing home could enable the ‘state to save more than $745 million before adjusting for inflation.

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Image: Aging in Place – The Economic and Tax Value of Home and Community Services, Florida TaxWatch

In addition to tax savings, investments in the HCBS could lead to increased physical security for older people. During the Delta Variant surge last summer, COVID-19 infection rates among Florida nursing home staff dominated the nation and put residents at risk.

Infection and death rates among HCBS residents were significantly lower. The report cites the Journal of Post-Acute and Long-Term Care Medicine (JAMDA), which found that between March and July 2020, 37% of nursing home residents and 14% of assisted living facility residents in nationwide have contracted COVID-19, compared to 2% of HCBS residents. Eleven percent of nursing home residents and 5% of assisted living residents died from COVID-19, compared to 1% of HCBS residents.

Investing in HCBS can also lead to improved quality of life and care for older people. A 2017 study from the US Department of Health and Human Services found that people who moved from institutionalized care to HCBS reported higher levels of satisfaction with their care and greater satisfaction with the regard to life within two years. Similarly, they reported lower levels of depressive symptoms and unmet self-care needs over the same period.

Image: Aging in Place – The Economic and Tax Value of Home and Community Services, Florida TaxWatch

“We need a better investment strategy to ensure seniors have the best long-term care HCBS options available throughout their aging journey,” said Florida State Director of AARP’s Jeff Johnson in a statement on the report. “The fundamental findings of this analysis show that investing in these programs would benefit millions of Florida families and caregivers who provide unpaid medical and personal care to their loved ones.”

Florida TaxWatch offered a number of policy recommendations that would maximize investment in HCBS. These included establishing standard quality measures for HCBS services. The report mentions the Core National Indicators for Aging and Disability (NCI – AD) as a possible avenue to use for quality metrics, a program that Florida has yet to join.

The report also drew attention to the possibility of using federal funds to support HCBS, an area where Florida has made progress. In July 2021, the Agency for Healthcare Administration (AHCA) submitted a $1.1 billion spending plan at the Centers for Medicare and Medicaid Services (CMS).

The plan would use the American Rescue Plan Act (ARPA) Federal Medical Assistance Percentage (FMAP) increase over three years to fund provider payments and reduce waiting lists for HCBS programs.

CMS approved the spending plan at the end of December 2021, and the AHCA open applications for vendors to apply for funding. Applications are due in February 2022, and additional applications for other forms of HCBS support under the spending plan are expected in April 2022.