The United States of America is still one country. But if you are looking for financial help to pay for dementia care services, it may not seem that way. Each state determines its own spending policies for elder care programs and many states distribute funding in ways that make no obvious sense. Differences between states are often compounded by variations across rural and urban districts. One factor, however, seems to be true across all geographies: Benefits for dementia care improve in locations where elected officials are sensitive to the issue.
The financial policies of your county and municipality can have a big impact on the types of services you can afford to buy for your loved one. These policies are typically formulated as the state’s response to the Older Americans Act which was passed in 1965 as a framework to provide community services that guarantee seniors’ access to a “retirement in health, honor, dignity — after years of contribution to the economy”. Each time this federal legislation is re-authorized, it is subjected to a national review with requests for community input. Once it is re-authorized, each state must then review its own policies and determine how it will comply with the updated federal legislation.
This state-by-state review can result in wide disparities between states with different economic conditions — and those that have a larger aging population. Pennsylvania, for example, provides better benefits for elders than those offered by some other states. This is partly due to the fact that Pennsylvania is home to Philadelphia, which has the highest proportion of senior citizens among the 10 largest cities in the United States. But the state also adds resources to programs for seniors through funding generated by the Pennsylvania Lottery to Benefit Older Pennsylvanians.
After the PA Department of Aging incorporates its funding recommendations into a plan for statewide implementation, each county of the state must review trends and needs of its residents and determine local spending priorities. But there are big regional differences in the amount of money available to spend on senior services. If you live in Pittsburgh or Philadelphia, your region has more money to spend on senior services due to the “hold harmless” clause protecting the large number of seniors in these two urban areas. If you live in a rural part of the state, the budgets for caregiver support programs are much smaller and in some cases, seem very unfair.
What does all this mean for your family’s healthcare budget? Funding differences across geographic lines may provide another opportunity for joint family planning. If there is more than one person in your family who can provide care for your loved one with dementia, you may want to do some research on the kinds of programs and funding streams available to support care in each person’s municipality. Siblings may be living in counties with very different funding pools available to pay for adult day services, caregiver respite, prescription medications, and even elder transportation. You can use information about these programs to develop a long term plan for how you will pay for care over the course of the disease. Learning more today may help you plan better for tomorrow. And don’t forget to “remind” elected officials to protect funding for programs and services that really help your family.