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Supporting Home-Care Services in Missouri

Home healthcare nurse with senior adult patient. Medications.

After 20 years as a paid care provider, Vicki Bates, of St. Louis, sees how much happier most older adults and individuals with disabilities are staying in their homes, instead of moving to a long-term care facility. 

Bates, 61, helps people bathe, she cleans and cooks, and she provides companionship.

One of her clients is bedridden, so Bates contributes to round-the-clock monitoring when his family can’t. Without her, the family told her, he would have to be in a nursing home. 

“I think it’s better that the clients get to stay in their own home,” Bates says.

With many such residents eligible for Missouri’s Medicaid program, MO HealthNet, the state can save money by helping people be cared for in their own homes. 

The nonprofit Missouri Budget Project research group estimates that the state pays about $42,250 per person annually for care at a nursing facility. But under the state’s Home and Community Based Services (HCBS) program, in-home care costs roughly $11,900 per person.

Over the next year, the Missouri Department of Health & Senior Services plans to transition more nursing home residents home—where they want to be—with help from the HCBS program, which will lower costs, says Jay Hardenbrook, advocacy director for AARP Missouri.

Cuts threatened

Funding for the $436 million program was in question, however, after Gov. Mike Parson (R), in his January budget proposal, sought to transfer money to other priorities.

Missouri lawmakers were able to reach a deal to continue fully funding the home-care program in the 2022 fiscal year, which began July 1.

According to the Missouri Budget Project, during the past fiscal year, more than 59,900 Missourians took part in the HCBS program, which offers homemaking, personal-care services and respite help to families.

The program was bolstered by an additional $250 million in federal funds from the American Rescue Plan Act of 2021. That money can be used to help providers raise wages for their workers and to improve information technology services to better coordinate care, Hardenbrook says. 

“People want to age in their homes and their communities and not in nursing homes, if they can avoid it,” he says. “And this program makes it possible.”  

The federal funds will also help program providers pay off COVID-19 expenses for essentials like personal protective equipment and to fight high turnover rates through more competitive wages, Hardenbrook says.

Parson vetoed funding for a similar program called Consumer Directed Services, which also offers care opportunities, but they are coordinated by the beneficiary or a loved one, not the state. Hardenbrook points out that more Missourians use the HCBS program. 

Bates, who previously worked in a nursing facility, says working out of her clients’ homes helps her get to know them better. At the nursing home, she shuttled from patient to patient. Now, she says, she can focus on the few clients she has and develop relationships with them. 

“You get to know each other, and it’s just a joy to work with a person one-on-one,” she says.

Katie Buehler is writer living in Dallas.

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