Saturday, April 11, 2009

Key Choices For Seniors
Story from

While Trying to Save Money, Ohio Seeks to Bridge Gap Between Nursing-Home Care and Assisted Living Care

As a former businessman and member of President Richard Nixon's administration, Fred Rouse is used to being in charge.

But when the 82-year-old lived in the nursing-home section of St. Luke Lutheran Community in North Canton, he couldn't even set his own thermostat.

Thanks to a special state program that lets some low-income seniors use Medicaid to pay for assisted living, Rouse recently moved into the assisted-living portion of St. Luke's after recovering from intestinal surgery and completing therapy.

Now he can set his own schedule — and his own thermostat — while saving the government money.

Assisted-living costs an average of $2,106 per month, compared with $4,231 for nursing-home care, according to the Ohio Department of Aging.

''I'm a conservative, and I don't like wasting money,'' Rouse said. ''And I don't see wasting people's talents to come in and blow my nose.''

Faced with an aging population and rising costs to provide care, the state is trying to expand the options between home care and nursing homes for Ohio's seniors.

The Ohio Department of Aging has been working to enhance its existing community-based programs and develop new options for long-term care, Director Barbara Riley said.

Among the choices that could be added or expanded in the coming years:

• Enhanced community-living programs, which would allow Medicaid recipients in subsidized senior houses to get on-site help 24 hours if needed, similar to assisted-living facilities.

• Adult foster care, which would bring together a small number of seniors who need help with the tasks of daily living to live in a home with 24-hour care available.

• The ''Choices'' waiver program, which allows Medicaid recipients to hire their home-care providers, who could be trained relatives. The program is only available on a limited basis in central and southern Ohio.

• PACE (Program of All-Inclusive Care for the Elderly), which allows one provider to coordinate a recipient's medical care, home care and, if needed, adult day care. There are two approved sites statewide, in Cleveland Heights and Cincinnati.

''We haven't done what we're doing now, which is make a full-force public education effort to help people understand what choices are available and to make sure we have the choices available that people want,'' Riley said.

Burden on Medicaid

Most of the burden for providing long-term care to the state's elderly and disabled population falls on Medicaid, a state-run health insurance program for the poor and disabled that is supported with state and federal tax dollars.

About 74 percent of Ohio residents who received long-term care through Medicaid in 2004 lived in nursing facilities, compared with 61 percent nationwide, according to the most recent estimates available.

Ohio's population is graying — and that's expected to cost the state a lot more green. Each month, about 12,000 Ohio residents turn 60, according to the Ohio Department of Aging.

''The big picture is there's a huge problem and it's getting worse,'' said Joseph L. Ruby, president and chief executive of the Greater Akron-Canton Area Agency on Aging.

The agency coordinates Medicaid long-term care services for residents of Summit, Stark, Portage and Wayne counties.

''The best way to address the long-term care issue is to provide long-term care options,'' he said.

Oregon, for example, has developed a system that provides seniors and disabled residents covered by Medicaid a variety of options outside nursing homes for care, said Barry Donenfeld, executive director of the NorthWest Senior Area Agency on Aging in Oregon.

Donenfeld was among several state and national speakers during a recent seminar in Fairlawn organized by the Greater Akron-Canton Area Agency on Aging.

Oregon residents can get care while living in assisted-living facilities, their own homes, foster-care homes and even with relatives, who can get paid to provide the care, Donenfeld said.

As a result, Oregon ranked second in the nation in 2007 for the percentage of Medicaid dollars spent on community-based services (almost 73 percent) compared with nursing homes, according to data from the U.S. Centers for Medicare & Medicaid Services.

Levels of care

''What Ohio would need to do is make a commitment to developing this middle of the continuum,'' Donenfeld said. ''Just because you leave home doesn't necessarily mean that the next stop is the nursing home. There are other levels of care that allow someone a much more home-like setting.''

Ohio could save about $900 million a year in Medicaid costs if the state could achieve the average balance seen nationally between patients in nursing homes versus home and community settings for long-term care, according to estimates by the Ohio Business Roundtable.

Ohio's skilled nursing facilities ''are supportive of the continuum of long-term care and the ability of consumers to make choices from different settings of care, depending on what their needs are,'' said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents nursing homes and assisted-living facilities statewide.

However, he said, nursing homes need to be appropriately funded, because they will continue to be the right choice for many consumers.

Riley said the state already is taking steps to provide more options beyond nursing homes.

In recent years, the state has eliminated waiting lists for PASSPORT, a program that lets Medicaid recipients who otherwise would require nursing-home care to get services in their homes.

In addition, Ohio is making efforts to sign up more facilities for the assisted-living Medicaid waiver program, Riley said.

In Rouse's case, the former chairman of the Great Lakes Basin Commission under President Nixon got strong enough to move out of the nursing home but still needs help.

He said he has been very satisfied with the care he received in the nursing-home section when needed and now in the assisted-living area.

''I'm in good health, but I need help,'' he said from his new assisted-living room, which soon will be equipped with a recliner chair and personal-sized refrigerator and freezer.

His wife of 58 years, Barbara, has Alzheimer's disease and lives in the nursing-home portion of the facility.

''I want to stay here,'' he said. ''This is where I want to be.''

By later this year, the state also might approve more PACE sites. Participating programs get a set amount of money from Medicare and Medicaid each month to provide and coordinate all the medical care and home assistance that enrollees need.

Summa Health System in Akron is considering establishing a PACE program, possibly tied to its adult day-care program at Cuyahoga Falls General Hospital, said Patricia L. Troyer, Summa's executive director of post acute and senior services.

''Clearly,'' she said, ''people like to get services at home.''

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