Friday, April 23, 2010

People with disabilities finally escaping nursing homes through Money Follows the Person program

From Kaiser Health News:

PEACHTREE CITY, Ga. — Richard Hasselbach and Deborah Kadlec (pictured) met in a nursing home and dreamed of a life together outside its walls.

Their health conditions made living on their own a challenge: Hasselbach, 63, is disabled from a stroke and lost a leg to a blocked artery. Kadlec, 52, has multiple sclerosis. They both use wheelchairs and need help with basic chores such as bathing, cooking and remembering to take their medicines. Most of their relatives live in other states.

Despite those obstacles, Hasselbach and Kadlec got their own apartment and a personal care aide last summer through the help of a federally funded program run by the state. The program, known as Money Follows the Person, is the nation's most ambitious effort to move people out of nursing homes and other long-term-care facilities. It aims to help them live on their own and also save tens of millions of dollars for Medicaid, the state-federal health insurance program for the poor and disabled that pays for two-thirds of nursing home bills in the U.S.

Nationally, nursing home care averages about $75,190 per patient each year. Care in the home, through such services as meals-on-wheels and daily visits by a health aide, averages $18,000 a year, according to the AARP Public Policy Institute.

The program gives nursing home residents personal and financial help to live on their own or in small group settings, as well as payments for costs such as apartment security deposits, household furniture and alterations to make homes or cars accessible to the handicapped.

Georgia is one of 29 states and the District of Columbia participating in Money Follows the Person. Its experience shows both early successes and an illustration of the program's slow start nationwide. Georgia had hoped to move 1,312 people from nursing homes and other long-term-care facilities by 2013. Through the end of last year, though, it had moved only 221.

Congress established Money Follows the Person in 2005, and states set a combined goal of moving out more than 37,000 residents from nursing homes and other facilities by 2013. Most states, including Georgia, started their programs in 2008. Two years later, just 5,774 residents have moved nationally.

Most states are moving slowly for various reasons: problems finding affordable housing, resistance from nursing homes and stringent federal rules that limit who is eligible and what types of community settings they can move into, according to a study by Mathematica, a Princeton, N.J.-based think tank that is evaluating the program for the federal government.

Alice Hogan, the Money Follow the Person director in Georgia, says she considers the program a success. "Like most states, we wished things were going along faster, but implementation has been more difficult than expected," she says. "I am very happy with those that we got out."

State data show wide-ranging progress on goals:

• Texas has moved 2,029 people out of nursing homes and other long-term care facilities. That's more than one-third of the national total.

• A dozen states have moved fewer than 60 people. States moving the fewest: Louisiana (10), North Dakota (19) and Delaware (22).

• Illinois, which set the highest goal, is furthest from its target. The state had set 3,357 transitions as its goal by 2013, but through last year has done just 58. "Meeting that goal by 2013 appears nearly impossible," said Jean Summerfield, the Illinois project director.

The new health care law extends the program to 2016, adds $900 million to what was a five-year, $1.3 billion initiative and loosens eligibility rules.

"The impact could be very significant," said Debra Lipson of Mathematica.

Georgia this year cut its 2013 target to 618 people. Joye Burton, spokeswoman for the Georgia Community Health Department, said the updated goal is more realistic given early problems finding housing and arranging funding for community-based services.

While dozens of people have been helped by the program, advocates for the poor and disabled say the program's slow start highlights the state's lack of investment to help people live on their own.

"I'm discouraged," says Ruby Moore, executive director of the Georgia Advocacy Office, a non-profit agency that works with the disabled. "We have a disproportionate number of people in nursing home facilities who do not need to be there."

The state has contracted with a private company, B&B Care Services, to handle the nursing home transitions. The firm's employees visit nursing homes to identify residents who might be interested and work with family members and nursing homes to smooth the way.

One sign of the program's value, says Lynnette Bragg, CEO of B&B Care Services, is that of the 107 nursing home transitions, only 10 people have returned.

Nursing home officials say most of their residents are happy where they are. "The advocates feel like every person in a nursing home could go home and live successfully. That is not realistic," says Norma Jean Morgan, CEO of Effingham Extended Care Center in Springfield, Ga. Yet she adds, "You do not want a person staying in an institution if he or she can be viable at home."

Christine McDaniel, 50, has been trying to move out of an Atlanta nursing home for about a year.

McDaniel, who has HIV and has been treated for hepatitis, qualified for a Medicaid waiver to help cover her cost of care but hasn't been able to get a place she can afford with her $675 a month Social Security check in northwest Georgia. She wants to be there to be close to her family.

"I didn't come here to live," she says. "I came here to get better, and I'm ready to move on."

The transition back home has not been seamless for Kadlec and Hasselbach. They've had trouble accessing public transportation, and Kadlec is unable to maneuver her wheelchair to use the apartment shower. Still, neither wants to return to the nursing home.

"I'm much happier here," Hasselbach says, sitting by Kadlec in the living room of their one-bedroom apartment that overlooks a golf course in this leafy Atlanta suburb. "We're free."