Texas’ population is as diverse as its geography, but one thing remains constant: Texas, like the nation at large, is growing older. Among the 50 states, Texas has the third largest population of adults 60 and older, a number approaching 3.1 million. Demographers predict that the older population of the state could grow to more than 8 million by 2040.
As a consequence, Texas will face serious challenges in providing for an older population. Texas lawmakers need to take notice.
Older Texans, some with few resources, will place new demands on publicly funded health and long-term care programs, as well as other social services.
And the growth will occur at a time when fiscal strains on state budgets will inevitably increase, and programs for elderly people will compete for funding with programs focused on children and poor families. Ongoing increases in the relative cost of health care for elderly people, especially prescription drugs, will exacerbate legislative priorities for Medicaid financing and other funding in the future.
Hispanics may bear the biggest impact. Older Hispanics comprise 7.5 percent of the population age 60 and older but account for 16 percent of Medicaid enrollees. Given relatively low levels of wealth among Mexican-origin families, their capacity to pay for long-term care is limited, and their reliance on Medicaid could potentially increase in the future.
With costs looming large and tax revenue stable, Texas wrestles with the critical issue of how to offer and pay for an array of health and social services that balance client preferences with the real-world necessities of cost containment.
The preference of many older people in need of long-term care services is to have those services delivered in their own homes. To support this choice, states such as Texas are using Managed Medicaid waivers, federally funded, community-based services that are an alternative to institutional care, as a way to control costs.
These community-based long-term care services cost a fraction of the cost of nursing home care in Texas. According to the Department of Aging and Disability Services, the state spends less on community-based care than it does on institutional care in 2016.
Texas is also unique in that the state has a large fraction of dependent elderly Mexican Americans who do not use nursing homes, a costly alternative in the event that an individual needs assistance with personal care.
What is clear is that a growing frail and vulnerable population will need long-term care services and supports.
How might we prepare to finance and deliver services of the frailest in Texas? The social safety net in Texas, as in the U.S. as a whole, consists of several services provided to different population groups by different agencies.
In order to optimize the welfare of the population of the state, as well as to ensure equity in access, those services should be directed on an equal basis to those in greatest need. The issue of cost relates not only to the number of services provided by the state, but the ways in which those services are provided. Long-term care for elderly people, for example, can be provided in assisted living or skilled nursing facilities or in the community.
Providing services in nursing homes may be cost effective under certain circumstances, but given the option, many older individuals prefer to remain in their homes.
This option is particularly salient for older Mexican-origin elders who have community supports but find that those are inadequate to provide all of the care they need. Growing marital disruption, smaller family sizes, and female labor force participation will further constrain each family’s ability to provide all of the care an older parent needs even if they would like to.
Texas is aging at a time when informal family-based support structures are coming under greater strain. Long-term care financing must occupy an important place on the state’s public policy agenda in the future. Because Mexican-origin elders have far fewer resources to use to pay for long-term care, the role of Medicaid and other programs deserves serious public attention.
Next year, the Texas Legislature must engage in thoughtful debate. Otherwise, it will be at the peril of the most vulnerable populations in the state.
Jacqueline Angel is a professor in the LBJ School of Public Affairs and a professor of sociology at The University of Texas at Austin.
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