Today’s Wall Street Journal has a long (3000+ words) front page article on a year-old Vermont program called Choices for Care which allows the use of Medicaid and other sources of funding to be used to pay for personal care givers in the home.   While it has always been possible to create a nursing home environment in a person’s home or apartment, cost is the issue.  For seniors that do not require round-the-clock care or supervisions, in-home care options are more attractive and programs like Vermont’s make it more attractive.  Here are some excerpts from the article:

[ . . .]

Mr. Blow, a former security guard felled by a heart attack and stroke, had gone to the nursing home for what he hoped would be a few months of rehabilitation. Paralyzed in an arm and a leg, his stay grew to more than a year. He feared he would never live independently again.

Now Mr. Blow, 71 years old, is back in his own place, thanks to an unusual Vermont experiment that seeks to shift government money from nursing homes into private homes. The state pays for his ex-wife to care for him.

In an effort being watched around the nation, Vermont is trying to give elderly people a choice of where they want to be cared for: in an institution or at home. To create more home-care workers, the state has been paying for family members to care for aging relatives, at about $10 an hour. If Vermont’s program works, it could influence a wider change in the multibillion-dollar industry that cares for the aged.

[. . .]

As the number of older Americans — and the cost of caring for them — soars, the federal government is pushing efforts like the one in Vermont. Advocates say in-home care could improve the lives of many seniors, while saving the government money. But the idea faces huge hurdles, including opposition from the nursing-home industry and a culture of dispersed, busy families that has become accustomed to having others care for their loved ones.

[. . .]

Vermont is one of the first states to get federal approval to offer home care as an option equal to nursing-home care under Medicaid, the government program that subsidizes health care for the poor. The state is calling home care an “entitlement.” Under Vermont’s “Choices for Care” program, Medicaid sets a budget limit for the state to care for seniors and people with disabilities. Vermont then uses a combination of federal and state money to reimburse in-home caregivers.

[. . .]

With help from the nonprofit agency, Mr. Blow moved out of the nursing home. His Social Security and pension money now go to pay for a one-bedroom apartment geared to the disabled. The state uses Medicaid funds, distributed through a home-health agency, to pay Charlene Anair, 56, his ex-wife, to care for him.

[. . .]

Yet, as a former licensed nurse, she was moved to see the man she had known as tough reduced to helplessness and despair. She now earns $9.27 an hour caring for him. Ms. Anair helps him dress, escorts him to cardiac therapy twice a week, shops for groceries, and even takes him to visit his parents’ graves. Asked why she devotes herself to his recovery, she laughs: “I really don’t know — the nurse in me.” She adds: “It is like this is where I am supposed to be.”

[. . .]

Under the Vermont program, elderly people typically receive 25 to 30 hours of care a week. If caretakers live with an elderly relative, they aren’t compensated beyond a set number of hours. Seniors who live on their own may be unattended for significant stretches, including nights or weekends, because of limits on the number of hours of care they can receive or because of a shortage of available home-care workers.

The state says that not every elderly person needs 24-hour care. Officials contend that even in a nursing home, residents don’t get around-the-clock attention. A state analysis found that nursing homes provide one-on-one care only a couple of hours day, if that, says Bard Hill, a state official who works closely with the Vermont commissioner.

[. . .]

So far, Vermont has found it isn’t easy to change the flow of dollars. One year into its “Choices for Care” program, Vermont has achieved incremental results: There are 2,131 residents in nursing homes, 155 fewer than in October 2005. There are 1,111 people receiving home care, or 123 more than last year at this time. Another 500 or so Medicaid patients — who aren’t quite eligible for nursing homes yet need help — were able to get care at home under this program, according to the state.

 

Olden Days
Seniors in Vermont
Are Finding They
Can Go Home Again

In Shift From Nursing Homes,
State Has Family Members
Care for Elderly Relatives
Helping Gram at $9.25 an Hour
By LUCETTE LAGNADO
Wall Street Journal
October 23, 2006; Page A1