In an important new study, Lynne P. Snyder and Christopher Baker show the importance of energy assistance for elders living at home. The paper, Affordable Home Energy and Health: Making the Connections, was published by AARP. It is another example of why it is not enough for states to provide Medicaid waiver programs to help people receive long-term care at home. Without additional supports, such as energy assistance, the dream of aging in place can easily become a nightmare.

The problem is that rising energy costs put low-income seniors at serious physical risk. About 900 older adults suffer either heat-related or cold-related deaths each year. But those killed directly by extreme weather are only a fraction of those who die as a result of their inability to manage very high or very low temperatrues.

Seniors are at greater risk for death from respiratory or cardiovascular disease in the high heat of summer and from heart disease in the cold of winter. Not surprisingly, those with access to central heat and air conditioning are far less likely to die than those who do not.

Snyder and Baker report that 80 percent of housholds receiving federal energy assistance through the program known as LIHEAP have at least one member who suffers from a disease that puts them at risk of extreme temperature.

This study is yet another example of why states must do a far better job of managing all the needs of low-income elders who require long-term services. These people need more than a Medicaid-paid home health aide. They need an accessible home, transportation, good nutrition, companionship, and, as this study shows, assistance with energy bills. Without a full package of assistance–and without the ability to find and access that help–aging in place is doomed to fail, despite our wishes.

Some of this help, such as transportation and companionship, can be provided by neighbors helping one another. But other services very likely will have to come from government. And unfortunately, Medicaid dollars can normally not be used for supports such as energy assistance. The Snyder-Baker paper is more evidence of why policymakers must think outside of their narrow silos if they are going to do their part to keep frail elders safe at home.