Gov. Jane Swift got it right on Home Care


By Al Norman

In the middle of January 2015, a group of six elder advocacy groups wrote a letter to Gov. Charlie Baker, urging him not to cut the state’s home care budget for seniors. The governor has the option to use what are known as his “9c” powers to reduce funding without legislative approval. The letter was sent to Gov. Baker around two weeks before any cuts would be announced.

alnorman_headshotI was asked by a reporter who saw our letter to the governor, “How do you know that home care is on the cuts list before the list comes out?” I replied: “Because we’re always on the list.”

Unfortunately, this is the history of programs to help seniors live at home:

•In July of 1990, Gov. Michael Dukakis cut $7 million from the home care program, and the following December, another $4 million.

•In 2002, Gov. Jane Swift proposed cutting $6.5 million from home care in 9c cuts — but later withdrew the plan.

•In October of 2008, Gov. Deval Patrick cut $7 million from home care, and in November of 2014, he cut another $1.5 million from home care.

Of all these governors, Jane Swift was the one who realized that cutting care at home made no sense from a financial point of view. In 2002, I led a group of seniors to meet with Gov. Swift’s Secretary of Administration and Finance, Mike Sullivan. We met in his office for 45 minutes. A few days later, Gov. Swift released a list of 130 budget items that were being cut — but home care had been removed from the list. Swift told the media: “Cuts to direct services to folks in home care eventually show up on your balance sheet in a more expensive way.” She understood that investing in home care provides an immediate return: a senior today who is eligible for nursing facility care — but who is kept at home instead — saves taxpayers the cost of a nursing facility today.

Since the year 2000, a total of 4.5 million patient days have been cut from the MassHealth nursing facility budget. This year, the reduced level of nursing facility use will save state and federal taxpayers $853 million. We call that “the home care dividend.”

The federal government for several years has been begging states to shift their spending away from institutions, and towards home care. They have a vested interest, because they pay for half of the MassHealth program. Massachusetts will receive roughly $110 million in new federal funding this year because the Commonwealth has agreed to invest more funding in home and community-based services. But at the same time, Gov. Patrick cut home care just three months ago. It makes no sense to tell the federal government we will spend more on home care, and then cut home care. But that’s what the Patrick administration did.

The first governor to use the phrase “community first” was Mitt Romney. In 2006, it was Romney who signed legislation I helped write, the “Equal Choice” law, which says that people on MassHealth have the right to be care for in the “least restrictive setting.” Gov. Patrick was prepared to file a federal waiver to increase home care funding. At one point in the budget process, Patrick had requested $41 million for a so-called “1115 waiver” to encourage “flexible service options in the community for those who might otherwise need to seek services in a facility setting.” But by June 2009, the 1115 waiver had been abandoned, and home care was facing cuts. The recession had started — a downturn from which the home care budget has still not fully recovered. The home care accounts today are lower than they were in fiscal year 2009 — seven years ago.

Home Care is a smart investment that attracts more federal revenue, and gives seniors the care they want, where they want it. For the cost of one nursing facility bed, we can keep six elders at that same level of care at home.

Gov. Swift was right: Cutting home care “eventually shows up on your balance sheet in a more expensive way.”

I believe that Gov. Baker will recognize a good return on investment when he sees it.

Al Norman is the Executive Director of Mass Home Care. He can be reached at, or at 978-502-3794,