Indiana is in the top 10 states in its number of nursing homes, but a new federal rating system places the state in the bottom 10 for nursing home performance. The statistics provide ample proof that Indiana should support lower-cost services that keep the aging and disabled in their own homes, AARP Indiana and other older adult advocates argue.

Nearly 28 percent of Indiana’s more than 500 nursing homes earned the lowest ranking of one star from the Centers for Medicare & Medicaid Services, compared with 22 percent nationally. Only 10 percent of the state’s nursing homes earned five stars, the highest rating. About half of Indiana nursing homes rate below average.

Yet Indiana has historically put most of its Medicaid long-term care funds for older people into nursing homes. An AARP study showed that Indiana spent 98 percent of those dollars on nursing homes in 2006, and just 2 percent for home- and community-based services. The U.S. average for the latter is 25 percent.

“We’ve made some improvement, but Indiana is behind the rest of the country,” said June Lyle, AARP Indiana director.

Lyle is concerned about losing more ground, particularly if less money goes to Community and Home Options to Institutional Care for the Elderly and Disabled (CHOICE)—a state-funded program that provided home care and related services to nearly 11,000 older and disabled adults last year.

In across-the-board budget cuts, Republican Gov. Mitch Daniels planned to chop CHOICE’s appropriation by $4 million each of the next two years, down to $44.7 million.

“It’s absolutely a step in the wrong direction,” Lyle said, noting CHOICE’s waiting list of 3,000.

The cuts would amount to 8 percent at a time more money is needed, said Joan Cuson of South Bend, REAL Services aging director for five north central counties. “We hope legislators see the value,” Cuson said. “It fills so many gaps.”

Through CHOICE and other programs—including Medicaid waivers that allow nursing home dollars to be spent for home care—Cuson’s staff has been successful in moving people such as Harriette Barnes of Elkhart out of nursing homes.

“It feels great,” said Barnes, 63, of the new, two-bedroom apartment she moved into with her son after six months in a nursing home recovering from a fall. With her left side incapacitated from multiple sclerosis, she requires daily visits from a home health aide while her son is at work, meal delivery, and other services covered by CHOICE and Medicaid.

Barnes’ apartment has plenty of room for her walker and wheelchair, a sliding chair in the shower and a nearby exercise room. “I’m doing pretty good. I’m learning to stand and to keep my balance,” she said. Barnes enjoys the freedom to attend church and go out for physical therapy. While Barnes had no issues with her nursing home, her advice is: “If you can stay out of those places, stay out.”

No one will be removed from CHOICE and no services reduced because leftover 2008 federal funds are bridging the gap, said Elizabeth Surgener, an Indiana Family and Social Services Administration spokeswoman. But no new clients are being added, so the waiting list will keep growing.

AARP and the Indiana Home Care Task Force are advocating at the Statehouse to keep current CHOICE funding although all the money set aside in 2008 was not spent.

This summer AARP will bring together stakeholders to outline what Indiana requires to balance its long-term care system in order to recommend regulatory changes and legislation for 2010.

“I do believe that we are making progress from our reliance on institutional care,” Lyle said. “We need to hold steady so when the economy improves we are in a position to take the next step.”

Marti Goodlad Heline has been a journalist and writer in South Bend, Ind., for more than 30 years.