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Home-Assisted Care May Replace Long-Term Care Institutions

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(Credit:  Joe Radele/Getty Images)

(Credit: Joe Radele/Getty Images)

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By STEPHANIE REITZ,  Associated Press

HARTFORD, Conn. (AP) _ In decades of working with senior citizens, Marie Allen has never met any who told her they wanted to grow old in a nursing home or other institutional setting.

But their wish, to age at home with the right medical and social support programs, can depend heavily on whether Connecticut changes how it allocates its Medicaid payments for many of those long-term care services.

A legislative committee, seniors’ groups and their advocates are hoping Connecticut starts serious work this year toward shifting more Medicaid dollars to community-based programs and away from traditional nursing facilities.

The home-based programs usually cost less than nursing homes, which officials say could help Connecticut slow its Medicaid spending. Seniors’ advocates say it also gives aging and disabled residents what they want: independence for as long as possible.

“In all of the counseling I’ve done in 20 years, that is the number one question: ‘How do I remain home?”’ said Allen, executive director of the Southwestern Connecticut Agency on Aging and Independent Living.

The Connecticut General Assembly’s Aging Committee is considering a bill to set up a study group to help promote what’s known as “aging in place.” Allen was among several people who testified last week on the bill, which would require the full General Assembly’s approval to go into effect.

If created, the study group would examine everything from rebalancing the Medicaid spending priorities to quality of life issues like better transportation options for non-drivers, more oversight of home care workers and ensuring elderly and disabled people living at home have access to healthy, fresh foods.

The goal: to suggest ways to change policies, improve programs and reallocate spending to make “aging in place” become the norm for those who are able to remain in their homes and do not want to live in nursing facilities.
“This is, I think, the new wave of the future in how we treat our elderly,” said Connecticut state Rep. Joseph Serra, a Democrat from Middletown who is co-chairman of the legislature’s aging committee. “There’s potential for tremendous savings for the state of Connecticut in how services are provided, and the bottom line is that seniors want to stay in their home or apartment as long as possible.

“How we treat our seniors is a testimony to who we are as a people,” Serra said.

Officials say that while there will always be a need for nursing homes and other kinds of congregate living for people who need more supervision and intensive care, many people who could stay home with proper help are ending up in nursing homes simply because that’s what Medicaid pays for.

Connecticut spends 35 percent of its Medicaid money on community-based programs, close to the national average for the states. The rest goes for nursing home care and similar institutional-style living.

About a dozen states spend more than 50 percent of their Medicaid money on programs to help people age at home. Oregon, Washington and New Mexico spend the largest percentage –about three of every four dollars– on community-based programs to promote aging in place.

A survey released this week by the Connecticut chapter of the AARP shows four of every five people polled supported the idea of shifting more money to community-based services and away from traditional nursing home care.

The respondents, who were all 50 and older, also overwhelmingly said growing old in their own homes was extremely or very important to them.

The Center on Aging at the University of Connecticut said about 188,000 state residents needed long-term care as of 2008, the most recent figures immediately available. That was expected to reach at least 240,000 by 2030 as baby boomers age.

Many of the people surveyed for UConn’s report said that as they age at home, they expect to need help in everything from personal care to transportation, lawn maintenance, snow removal and handyman services.

Yet most also said they expect to have very little or no money to pay for it _ and they wrongly assume Medicare, private insurance and Medicaid cover far more for at-home help than they actually do.

(Copyright 2011 by The Associated Press.  All Rights Reserved.)

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