A CRS Review of Ten States: Home and Community-Based Services States Seek to Change the Face of Long-Term Care: Oregon

Publication Date: October 2003

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: Health

Type:

Coverage: Oregon

Abstract:

Demographic challenges posed by the growing elderly population and demands for greater public commitment to home and community-based care by persons with disabilities of all ages have drawn the attention of federal and state policymakers for some time. Spending on long-term care in both the public and private sectors is significant. In 2001, spending for long-term care services for persons of all ages represented 12.2% of all personal health care spending (almost $152 billion of $1.24 trillion). Federal and state governments accounted for almost two-thirds of this spending. By far, the primary payor for long-term care is the federal-state Medicaid program, which paid for almost half of all long-term care spending in 2001.

Many states have devoted significant efforts to respond to the desire for home and community-based care for persons with disabilities and their families. Nevertheless, the financing of nursing home care, chiefly by Medicaid, still dominates most states' spending for long-term care today. To assist Congress in understanding the issues that states face in providing long-term care services, CRS undertook a study of 10 states in 2002. This report, which will not be updated, presents background and analysis about long-term care in Oregon.

Oregon is a recognized leader in home and community-based care and has more than 20 years of experience in moving long-term care clients from institutional settings to home and community-based settings. In 2002, 82% of Oregon's Medicaid long-term care clients were served in the community. Additionally, Oregon was the only state in the nation whose spending for institutional care was less than half of the state's total Medicaid long-term care spending in 2000, with only 37.2% spent on institutional care compared to the national average of approximately 70%.

In 1981, a clear preference for home and community-based services was established by the state legislature in Senate Bill 955. This legislation streamlined the administrative structure and established a clear vision for a long-term care system that embodies the values of independence, dignity, privacy, and choice. It also mandated that any cost-savings from reductions in institutional spending be reinvested into a system that promotes home and community-based care. The various functions of Oregon's long-term care system are administered by a single division (Seniors and People with Disabilities) housed within a single state agency (the Department of Human Services). This centralized administration shares a common vision to promote care in the community over institutions.

Oregon officials recognize that with the aging population and increasing costs, they may need to rethink the design of their current system. They hope to incorporate a concept of "bounded choice" where a person's wishes are considered within the boundaries of service capacity and fiscal constraints.