November is National Family Caregivers Month, which focuses attention on the unpaid care work of family members.

The care provided by families often is enabled and supported by state-funded wrap-around services.

Over the last few decades, Missouri and other state governments around the nation have funded Home and Community Based Services - or HCBS - as a cheaper alternative to nursing-home care.

The turn towards HCBSs has meant that aging Americans are more often able to stay in their homes.

The kind of support they provide is broad, and includes visiting and live-in nursing care, in addition to other services such as transportation, home repair, and remodeling to ensure accessibility.

Recent state budget cuts to these programs threaten the availability of in-home care. Jay Hardenbrook, advocacy director with AARP Missouri, said funding HCBS sufficiently benefits all involved.

"It winds up saving the state a lot of money," said Hardenbrook. "It makes families stronger, especially if it's an unpaid family caregiver who's doing that, and it keeps that person receiving the services in the place that they want to be."

Hardenbrook said in Missouri alone, unpaid family caregivers are providing more than $8 billion worth of care. He called them an essential part of the system that doesn't get enough attention.

Funding for HCBSs in the state has declined over the last decade, with the nonprofit Missouri Budget Project reporting a 40% cut in community-based programs in 2018.

Last year the General Assembly injected $200 million from the American Rescue Plan into the system as a one-time payment to support care workers' wages.

Hardenbrook said the state needs to fully fund these programs.

"The state decides how much money goes into these programs," said Hardenbrook. "And if we let them stagnate for a long time as we did until last year, then fewer and fewer people will provide those services. Now that we've done this increase, if we can just keep it up, really we'll have a larger workforce and we'll have more people who are able to stay in their homes because they're able to get the services they need."

Hardenbrook said when aging seniors can't get the care services or home repairs they need, the state often ends up paying more for them to live in a nursing home.

He said while some people utilizing HCBS programs are doing so daily, others may only need occasional help.

"One of the things that has been very helpful, especially among our dementia enrollees, is that a family caregiver can get a day off," said Hardenbrook. "One day of respite is what we call it. But really, 'Can I just have a day where I don't have to be a caregiver all day long?' "

The Missouri Budget Project reports that on average HCBS support costs less than one third of institutional care.

In her fifth State of the State address this week, Gov. Gretchen Whitmer emphasized policies designed to put more money in Michiganders' pockets.

The second-term Democrat included several proposals, including a plan to cut the tax on retirement income, that played well with Michigan seniors.

Melissa Seifert, associate state director for government affairs at AARP Michigan, said the governor's speech set a positive tone for the new legislative session. She said her group's priorities include more funding for long-term care and help for the state's caregivers.

"Right now, 68% of Michigan's Medicaid dollars actually go to nursing homes," she said. "We want to see a rebalancing of those dollars, to put back into resources for home and community-based services."

Seifert said AARP is also watching legislation to lower drug prices, expand access to affordable housing and make it easier for people to save for retirement.

Republican lawmakers, in the minority for the first time in years, have said they'll wait for the governor's proposed budget before passing judgment on her programs.

Seifert said lawmakers need to find a solution to the crisis in Michigan's direct-care industry, where she said poor wages and working conditions have led an annual employee turnover rate of up to 80%.

"We want to see Medicaid wages increase for direct-care workers by $4," she said. "And we're also asking for an investment from the American Rescue Plan Act to provide retention bonuses for direct-care workers."

Seifert said she believes home is the best place for seniors to get care, but said that it often leads to long hours and high stress for family members doing the caregiving. She said it's important for the state to develop and provide resources for these families.

"It's estimated that 1.73 million Michiganders are family caregivers," she said. "So, we're looking at a very large chunk of Michigan's population. We want to create Caregiving Resource Centers to provide information and resources for those that need it."

The Michigan Legislature opened on Jan. 12 and will meet periodically through Dec. 28.

A grant program that helps with projects that benefit local communities is back. The AARP Community Challenge program selects projects for small, one-time grants. The aim is to fund projects that will make cities and towns better for people of all ages - with an emphasis on folks age 50 and older - and can be completed in a few months' time.

Marie Bonaminio, a volunteer with AARP Idaho who looks through applications, said the project's feasibility is one area they focus on.

"Sometimes just the smaller dollars is all they're looking for to finish a project, sometimes just start the project. Maybe we're just a piece of it," Bonaminio said. "But it's all about making the communities more livable."

Bonaminio said applications from nonprofit organizations and government entities are prioritized. The deadline for applications is 3 p.m. Mountain time on March 15th. Once they're funded, the projects must be completed by November 30th. Since it began in 2017, AARP has awarded $12.7-million to more than a thousand projects, including 20 in Idaho.

The Community Challenge program is adding two new grant programs this year. One is a capacity-building micro-grant for improving walkability by starting or expanding a community garden. The other is a demonstration grant, which will focus on transportation improvements and the benefits of accessory dwelling units as a housing solution. While some of the projects funded as part of the Community Challenge's flagship program may only last a short time, others are there for much longer.

Bonaminio said these are big wins for communities.

"These are actually projects that they put together and they stay there," she said. "This is to improve their community forever."

Last year, three projects in Idaho were funded. They included funds to install a permanent sound system at the Anne Frank Human Rights Memorial in Boise, a remote locker system for the Emmett Public Library, and an electric cargo bike that carried games and other items around Boise over the summer.

AARP Maine said it is hopeful lawmakers will find common ground on issues to support older Mainers this legislative session, including establishing a paid family and medical leave policy.

Surveys show more than 75% of Mainers support a plan to help those providing unpaid care to older parents or spouses while often working full-time jobs or raising children themselves.

Noël Bonam, state director of AARP Maine, said a paid family and medical leave program is needed so caregivers do not have to choose between caring for a loved one and their job.

"We know that there are over 180,000 unpaid caregivers in the state who are making all sorts of changes to their lives to support and take care of a loved one," Bonam reported.

An AARP study found unpaid caregivers in Maine provide more than $2 billion worth of care each year. Bonam argued a paid family and medical leave policy would help offer some balance and support to people working to keep their families healthy and together.

Broadband is another important issue for older Mainers, yet less than 50% of households in the state have access to reliable high-speed internet.

Bonam emphasized the pandemic revealed the importance of reliable internet service for older Mainers to access telehealth services and avoid the health risks stemming from isolation and loneliness.

"It's important for people living in remote places in the state to be able to live life in a way that feels fulfilling," Bonam contended. "In a way that feels connected to what is really going on in the rest of the state."

Bonam noted AARP is encouraging its members to regularly contact their lawmakers to share their struggles as well as hopes for impactful legislation for older Mainers this session. He added Mainers are fortunate to live in a state where residents can easily pick up the phone and give them a call.