A National Academy for State Health Policy study found that 35 states now cover or plan to cover assisted living services that help low-income, frail older persons remain in their communities. Among states with the most flexible policies are Kansas, Maine, Nebraska, Oregon , and New Jersey , with Arizona, Hawaii, and Vermont moving in that direction. Oregon was first to institute such a program actively relocating nursing home residents to community settings. Cost have been well below the national average, less than half that of the most costly states like New York, Massachusetts and Minnesota . Active case management, through which consumers receive information, assistance, and assessment, is essential to such an effort.
Some states help families care for frail elderly at home.
Colorado provides a home care allowance that can be used not just to purchase care but also to reimburse friends and relatives. Pennsylvania 's award-winning Family Caregiver Support Program helps families who care for an older person on their own. Services including even home modification are provided based on a sliding-scale of the total income of all family members living in the household. As in the broader health context, truly managing care is believed to be not just better for the client but also more cost-effective. The leader, again, has been Oregon , which in 1981 created a single long-term care state agency to administer consolidated state and federal funding for services to the elderly and disabled.