New long-term care program in Tennessee allows low-income elderly or disabled people to stay in their homes

From The Tennessean. In the picture, Lula Hale, left, and Bettye Garner paint ceramics during the Knowles Adult Day Care program.

Ruby Brown enjoys settling into a big chair in a bedroom of her Bordeaux home to watch daily court shows on television.

Her daughter, Gail Brown, says the familiar surroundings and routine are important to her mother's quality of life. She brought her 78-year-old mother, who has early-onset dementia, to live with her and her husband.

"That's the best thing for her right now," Gail Brown said. "I want her with us while she still knows me and where she is."

A new long-term care program will allow more low-income elderly and disabled people to stay in their homes or live with family instead of moving to nursing homes.

Under the Long-term Care Choices Act of 2008, eligible people can choose to get services such as bathing, medications and meals at home. Because home care is less expensive than nursing home care, more people will be able to receive services, officials said. The Choices program kicks off today in Middle Tennessee and on July 1 statewide.

Tennessee ranks dead last in the country for spending on home- and community-based care. Of the $1 billion that Tennessee and the federal government spend on long-term care in the state, more than $900 million, or about 95 percent, goes to nursing homes.

"Choices changes how we deliver long-term care and makes home- and community-based care services more available," said Patti Killingsworth, chief of long-term care for the TennCare Bureau, the state's Medicaid program.

"People will have freedom of choice between home-based care and facility care as long as care can be safely provided and doesn't cost more than a nursing home."
To qualify for TennCare Choices, people must be older, blind or disabled and must meet income and other eligibility criteria.

Forms will be filled out by a representative from the local area agency on aging and submitted on behalf of the person in need. That is a new element of the program designed to streamline the process and get people approved for services within 10 days.

"This program has been a long time coming," said Rebecca Kelly, state director of AARP Tennessee. "We know people want to stay in their homes and community as long as they can."

People in nursing homes will also be able to look at other care options, she said.
"Until now, nursing homes have been the default for people who need care," Kelly said. "They want more choices."

The Choices program, when fully rolled out in July, will be able to serve almost 9,500 people, giving 3,500 more people access to long-term care.

Killingsworth said serving more people is important because the long-term care population is expected to triple in the coming years.

"We will be able to rebalance how we spend our long-term care dollars," she said. "It's not going to make us first, but we're not going to be 50th. This is a huge step forward in a long journey."

The state has also awarded almost $2.6 million in one-time grants to long-term care facilities statewide to diversify the options they offer, such as adult day care, meal delivery and home care services.

Bordeaux Long-term Care, in North Nashville, received more than $127,000 to expand its care to include home-delivered meals and personal care services at home, such as bathing or light housekeeping. The facility also has a nursing home, adult assisted living and an adult day care.

"The Choices program will in some ways mean a new way of doing business in the long-term care industry," said Barbara Morrison, administrator at Bordeaux. "It will help more people to be able to access different kinds of services."

On the Bordeaux campus, the Knowles Adult Day Care serves about 40 people a day. It provides activities, physical care and a place to socialize for people who live at home but need a place to go during the day, said Rhonda Dunn, Knowles administrator.

"Our goal is to keep them at home as long as possible until they no longer are able," Dunn said. "They are able to stay at home or with family but get the additional quality of care they need."