By Thomas Goldsmith

A trim of the thousands of older people’s names on waiting lists for Meals on Wheels and in-home care.

A helping hand to an underfunded Adult Protective Services system.

A boost in the stretched allowances meant to cover personal needs of North Carolina’s long-term care residents.

These were among initiatives that advocates for North Carolina’s burgeoning older population have been advocating for and still hope to see emerge in the 2019-2021 budget plan that’s being crafted at the General Assembly in Raleigh.

But in the $25.2 billion budget plan he rolled out on Wednesday, Gov. Roy Cooper mostly gave these proposals short shrift.

“We would have hoped that there would be more money in there,” said Mary Bethel, executive director of the nonprofit North Carolina Coalition on Aging. “We are very disappointed and it just means we have to work that much harder.”

Mostly level funding

Advocates for older people recognized the importance of Cooper’s larger proposals, including the expansion of Medicaid to cover anywhere from the 208,000 estimated by the Kaiser Family Foundation to as many as the 625,000 low-income North Carolinians noted in Cooper’s budget documents. That number likely includes about 80,000 of the state’s uninsured population who are 55 and older, according to Kaiser Family Foundation data.


Cooper’s budget is far from the final word on the two year spending plan, as he and legislative leaders from both parties will likely spend coming months battling over and fine-tuning proposals such as Medicaid expansion. Nelson Dollar, a former state representative and an adviser to House Speaker Tim Moore (R-Kings Mountain), said at a House Aging Committee meeting Wednesday that leaders wanted to get more information on costs of the proposals on aging issues.

Millie Veasey stands in the doorway of her home, a smiling man in the doorway looks in. .
Millie Veasey gets her meal from Wake County Meals-On-Wheels volunteer Chuck Galle in 2013. Photo credit: Rose Hoban

Cooper’s office noted in an email Thursday that his budget recommends $969,549 in state spending for the Home and Community Care Block Grant, known as HCCBG. The amount is the same as what was appropriated in 2018-2019, although Cooper recommends that it come from state instead of from federal funding.

The HCC block grant money goes to counties, whose leaders can decide whether to offer residents services including home-delivered meals (Meals on Wheels), adult day care and adult day health, home management services, general and medical transportation, and family caregiver services. Statewide, more than 10,000 people are on waiting lists for these services.

“The Division of Aging and Adult Services, where the HCCBG services are scattered throughout along with adult protective services and other services for the elderly, has a base budget of $115M in total requirements and $45M in net state appropriation,” the unsigned email said.

Cooper’s recommended funding for the division represents a 1 percent increase in the first year of the two-year plan, then a 0.1 percent increase in the second year.

“Poor people’s relatives are poor”

That’s not enough, advocates said. The need for help, reported throughout the state, is growing along with the 65-plus population, which is projected to increase from 1.6 million to more than 2.5 million in 2037.

Cooper’s budget chair Charlie Perusse acknowledged the rapid growth in the older population to reporters Wednesday.

“This is something we’re paying close attention to,” Perusse said. “Our 65-plus population is growing at a much faster rate than our under-18 population.”

“That has a lot of impacts as far as services in the health care area.”

With that in mind, advocates have been pushing for a $7 million increase in the Home and Community Care Block Grant, less than .0003 percent of the overall budget. No dollar value has been set on the plan to put state dollars, instead of only county funds, into Adult Protective Services programs that aim to keep vulnerable populations safe from neglect, abuse and exploitation.

Bethel described a “perfect storm’ of factors that will touch older people and families — level funding in aging services, population growth of people older than 65, and inflation in the cost of delivering care.

Bill Lamb, president of the nonprofit advocacy group Friends of Residents in Long-Term Care, said that it won’t be just older people who are affected by fewer per-capita resources in the budget.

“I think the impact of not adequately funding those services, it’s going to start putting a burden on working families in terms of caregiving,” Lamb said.

“Poor people’s relatives are poor. If you are not providing supports to augment what family caregivers are already providing, people have to seek other levels of care, like nursing homes.”

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...