COLUMBIA - Advocates for the aging say the state has handled a dramatic rise in its nursing home population and appears headed in the right direction with more home and community care.

The state had roughly 16,000 people 65 and older in nursing homes in 1990, but that number jumped to more than 19,000 by 2000, according to a Census report on America's elderly released this week. The 19.2 percent increase was the highest recorded in the country.

By contrast, the number of people in nursing homes across the U.S. during that decade decreased by 2.1 percent.

The increase for South Carolina can be attributed to an aging population boom as well as people living longer and needing more long-term care. There also were simply more nursing home beds created.

"The General Assembly authorized 1,500 more nursing home beds" in the late 1980s, said Randy Lee of the S.C. Health Care Association. "Many of those beds did not come online until the 1990s. That would account for the number of people coming in, plus some facilities have been built that were totally private-paid."

The state Health and Human Services Department has seen a decreasing number of people on Medicaid in nursing homes' beds in recent years. There were 14,670 people in taxpayer-funded beds last summer compared with 17,521 in 2002.

That could be attributed to the community long-term care program, which has a waiting list of more than 3,400 people, agency spokesman Jeff Stensland said. Some may be forgoing nursing homes for home-based care, and the agency hasn't added nursing home beds since 1999, Stensland said.

Of the 200 licensed nursing home facilities in the state, about 150 have contracts with Medicaid.

While it's not clear whether the number of nursing home beds since 2000 has increased, there is definite demand for home- and community-based care.

Advocates such as the Health Care Association and the AARP, as well as the state agency, support the program. The AARP has made it a top priority this legislative session to get more funding, and Health and Human Services has requested an additional $1.2 million, which could trim the waiting list by about 500 people.

"We've been advocating that this year in order to avoid people going into nursing homes," AARP's state legislative director Teresa Arnold said.

Arnold said the state could save thousands of dollars per person with expanded community-based care, in some cases upward of $20,000. Those types of savings could help control spiraling Medicaid spending increases, which have plagued states throughout the country.

But there's a strong nursing home lobby and Medicaid's community care is optional, not mandatory like nursing homes, Arnold said.

And some people just can't be treated in their own home.

"I think that the nursing home beds we have now are adequate," Lee said. But "there will be, now and probably always, some waiting lists."

Randy Lee | S.C. Health Care Association