"Nationally, I don't think anybody is prepared for what is going to happen with the boomers," Anderson said.
The agency spends about $857 million from Medicaid each year on institutional care, more than 81 percent of the total Medicaid dollars earmarked for the elderly and disabled in Kentucky. The rest, about $198 million, goes to the type of home and community-based services that can help people avoid nursing facilities at about one-third the cost.
"What we want is that when someone goes to the nursing home, then it is because they absolutely need skilled nursing, not because they don't have anyone there to help them take a bath," Anderson said.
More than 13,000 people remain on waiting lists at the Department for Aging for meals, transportation, home-based services and caregiver services, with some applicants waiting as long as five years.
And census figures indicate that, from 2015 to 2030, the number of Kentuckians aged between 70 and 74 will climb from around 166,460 people to 262,534 — a 58 percent increase. Meanwhile, since 2009 the department has faced a 26 percent reduction in its $72 million budget.
Officials are aiming to have regulations rewritten and approved by next spring. Part of the discussion has centered on integrating services like Meals on Wheels and nursing support, into Kentucky's Home and Community-Based Waiver program, which allows the state to use Medicaid funds for non-medical assistance.
Kentucky's Medicaid cost for a nursing home bed is around $48,000 per year, while the cost of maintaining someone at home with waiver services is only $15,000 annually.
Additionally, officials want to streamline similar programs that non-Medicaid clients receive through the department, often free of charge or at a discounted rate depending on their income.
Jim Kimbrough, president of AARP Kentucky, says a successful transition will require the state to consider ideas like tax credits for caregivers and reforms that will allow family members to take over more medical practices, such as administering shots to loved ones.
In Louisville, 87-year-old Fyrne Gentry receives services through the Kentuckiana Regional Planning and Development Agency, which contracts with a program called ElderServe in Louisville. For 2 1/2 hours each week, it provides a personal assistant who performs light housekeeping, picks up groceries and medicines and aids Gentry in tasks like taking a shower.
She was placed on a waiting list for nearly a year before getting the services.
"I don't know what I would do without it," she said. "I couldn't stay here alone."