Home nursing: Rethinking elderly care

New Hampshire's county nursing homes exist for what purpose? If you listen to some county commissioners and nursing home administrators, you'd think they exist for the purpose of existing.

Last week Health and Human Services Commissioner John Stephen received approval from the Joint Legislative Fiscal Committee to transfer $3 million from nursing home care to home-based care, and the nursing home administrators were not happy. They wanted that money. They also want the state to significantly increase what it pays homes for Medicaid patients. The administrators say the state refuses to pay the full 25 percent of Medicaid costs it has agreed to pay, and that amounts to an unfunded mandate that increases local property taxes.

The dispute over Medicaid payments is too complex to address in full here. It probably will have to be settled in court. Not complicated, however, is Stephen's plan to save the state money by keeping elderly Medicaid recipients at home. It's already saved money, and the more people it keeps out of nursing homes, the more it will save.

That upsets nursing home administrators and some county commissioners who see their clout shrinking with every patient lost to home-based care.

Though county nursing homes do serve a purpose, Stephen is right to rethink their usefulness. The goal should be to get Medicaid recipients the best care at the best price. That usually means bringing care to their homes, not the other way around. And that means shrinking the role of county nursing homes. The day of the big, full county nursing home is over. Everyone will be better served when nursing homes house only those who absolutely need to be there and everyone else is cared for in the comfort of their own home.