Helping seniors return to the comforts of home

Until now, the doors to most assisted-living and nursing homes swung only one way: from the outside in.

Once inside, the vast majority of nursing home or assisted-living residents stayed put, permanently, until death.

But a new North Carolina program that rolled out Jan. 1, called Money Follows the Person, allows some institutionalized elderly to return home, providing transition funds to make that possible.

"It's designed to bring home some of the people who have been living in nursing homes, who have some family support system," said Richard Gottlieb, president and chief executive officer of Senior Services of Winston-Salem.

Experts on elderly issues agree: As the United States evolves into a nation with a higher proportion of seniors, institutions' waiting lists will grow, and more pressure will fall on family members of the elderly to provide them with care, money or both.

Government officials, doctors, elderly experts and social workers emphasize that more of the elderly will have to stay at home, made possible with help from home health-care workers and relatives. A U.S. federal government already running trillion-dollar deficits will not be able to pay for nursing-home care for most of its seniors, experts agree.

On Jan. 24, Doris Hire, 79, became the first Forsyth County person to come home from a nursing home in the new program. After two years in a nursing home, she is once again living with her husband, Ray Hire, 83, in their home off Peacehaven Road in Clemmons.

"I never intended to stay (in the nursing home) that long," she said. "I am grateful to the program for bringing me home."

A home-health worker comes to her home every day from 8 a.m. to 1 p.m. Her helper, Karen Hanchock, who works for Tender Care of Winston-Salem, assists the wheelchair-using woman, helping her bathe, groom and exercise. Hanchock also cooks for her and does light housekeeping.

The Money Follows the Person program has several eligibility requirements, including that the person must have lived in a nursing home for at least three months.

Up to $3,000 can be spent for the person to receive items and services needed for the transition. For example, the money could be used to construct a wheelchair ramp at the home; to buy a hospital bed, wheelchair or appliances such as a washer or dryer; or to pay a security deposit on an apartment. The money can be used in the 60 days prior to leaving the institution, or up to a year after the move out.

Beginning last fall, nursing homes must conduct an annual assessment of each patient. As a part of that assessment, staffers must ask each resident: "Where do you want to live?"

Those who answer that they want to live at home, and who have a support system to come home to, now have more options to make that happen, said Angie Wall, a case manager with Senior Services who is the transition coordinator for various Medicaid programs in Forsyth County.

"Some of these people went to a nursing home or rehabilitation center and got stuck," Wall said. "Some of them say, 'I'd like to go back home, but I don't know how to do it.'"

Doris Hire's life changed two years ago when she came down with a urinary tract infection. It got worse, and she eventually developed a serious septic condition. After a hospital stay, she went into Clemmons Nursing and Rehab Center to recuperate.

"She's been there since April 2009," Wall said. "She always wanted to come home."

The couple's son, Steve Hire, worked with Winston-Salem lawyer Bailey Liipfert, who helped them apply for the program.

"It has worked out well," Steve Hire said. "I'm glad. I think everyone wants to be at home."

Courtesy of Medicaid programs, Doris Hire receives one visit per month from a nurse, and Hanchock's in-home aid.

She is also eligible for 100 hours of respite care each year (to give her husband and son a break from her care), free incontinence supplies, a lifeline alert system, and some equipment such as a hospital bed and a tub transfer bench.

"All of this support still costs less than what Medicaid would have paid for a bed in a nursing home," Wall said, adding that there is no way to put a price tag on informal family care and support.

"Her husband is there overnight with her," Wall said.

According to the N.C. Division of Medical Assistance website, the average Medicaid reimbursement for a skilled nursing facility (nursing home) in the state is $161 per day, or $4,846 per month, regardless of the level of care.

By contrast, the maximum reimbursement for a package of at-home or community services through Medicaid's Community Alternatives Program for Disabled Adults (CAP-DA) is $91 a day, or $2,730 a month for immediate care. For skilled care, the maximum is $117 a day, or $3,537 a month.

"In most cases, with informal support from family caregivers and some combination of community services, it is less expensive and safe to maintain a person in the community setting rather than in a skilled nursing facility," Gottlieb said. "And in most cases, this is much preferred by older adults."

However, the Money Follows the Person program does have limitations. For some elderly, living at home is not an option. Some people — those who require 24-hour care and extensive medical equipment and supplies — cannot be safely cared for in their homes at less cost than a nursing home, Gottlieb said.

But for Doris Hire, the program has led to many happy hours at home, watching television with her husband, and eating delicious cabbage, potatoes and cornbread prepared by Hanchock.

Ray Hire said he never lost hope his wife of 63 years could come home. In the two years she was at the nursing home, he went to visit her almost every day, missing only five days due to sickness or bad weather.

"If I live to be 90, I've still got seven more years to go," he said. "I'd rather spend those years with my wife."

afuller@wsjournal.com

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