Bolstering home-based services in Maine is a compassionate solution to the problem of long-term elder care. Allowing seniors to stay home, rather than move into nursing facilities, allows important continuity in their lives and their communities.

It’s also a cost-effective solution, as at-home care is less expensive – and a slower-growing expense – than nursing centers. Home-based care advocates point to efficiency as a strong argument for directing resources toward them, instead of nursing programs.

Compassion and cost, though favorable, are not enough to make home-based care the right solution. Maine needs both – vigorous programs to aid seniors who can stay at home, and potent, available nursing facilities for those who require a greater level of care.

Yet right now, there are waiting lists, as the number of nursing beds in Maine has shrunk and availability of home-based care has suffered under budget constraints.

Sen. Margaret Craven, D-Lewiston, has submitted legislation to improve home-based care. Her bill, LD 400, directs significant investment – about $2 million, in total – for expanding at-home services, such as basic homemaking and medical care.

Seniors need more options, she argues sensibly, to meet their needs. It is a sound notion, as the waiting lists for care won’t go away by themselves. Not everyone on these lists likely needs full-time care; rather, they need practical options to preserve and ensure their quality of life.

Her legislation does that and deserves support. Yet providing expanded services shouldn’t come at the expense of nursing homes, whose place in the universe of long-term care is critical. They must be empowered to provide what home-based care cannot.

The Legislature should not pick sides. Instead, lawmakers should ask for concessions from both, to dovetail their priorities while building cost savings into their operations.

Restoring home-based care in Maine, which waned over eight years, can’t be done quickly. A phased approach seems a good compromise, given the deficit. This should target waiting lists in the short term, while pouring foundations for sustainable programs over the long.

Nursing centers must do more to reduce costs of their operations. In October 2008, a study of nursing homes by insurer MetLife’s Mature Market Institute revealed the average cost of a semi-private room in the United States was $191 per-day.

That cost is unsustainable regardless of who pays: Medicare, private insurance, home equity or savings. As costs increase, embrace of lower-cost alternatives becomes a necessity.

LD 400 signals that long-term care in Maine must change, because current trends – in cost, and state demography – cannot co-exist. By finding agreeable middle ground on the bill, and effecting its passage, the providers of this care will accept their role in fixing it.