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July 21, 2005
More Home-Care Options
There are currently 8,310 people in Massachusetts nursing homes who don’t want to be there. This is based upon a questionnaire from the Center for Medicare and Medicaid that each nursing home resident is supposed to fill out within 14 days of entering the nursing home, and every three months there after.
A few weeks ago I wrote about Bill #H2893, Nursing Home Relocations, also known as “Money Follows the Person”. That Bill, if passed, would allow seniors that are healthy enough to leave their nursing home and move back into the community. The State would then redirect the money that was being used to pay the nursing home to follow the person. This Bill is a copy of a law that has been in place since late 2003 in Texas and in one year has allowed over 3,200 Texans to leave their nursing home and go back to the community to live with family or on their own, with assistance.
Now, I’ve learned about a Massachusetts program called “Caring Homes”. This started as a pilot program back in March and has enrolled 21 participants thus far. This program received an additional 2 million in funding as part of the budget that was signed into law a few weeks ago. It is anticipated that the program will expand to about 100 people by this fall.
The Massachusetts “Caring Homes” program will allow for family members to be paid in return for housing and care for frail elderly family members. The caregivers receive about $1,500 per month for taking care of their family member and there is about another $1,500 allocated towards the elder’s other medical needs. The goal of the program is to allow seniors to be able to stay in the community for as long as possible and to reduce the cost of Medicaid for the state. Each placement would save the state about $20,000 because the cost of running the program is about 65% of the cost of a nursing home.
This program is based on a similar program that started in Oregon. Oregon has been one of the leaders to provide housing with services in the community for elders. In Oregon approximately 20% of the Medicaid budget is used to provide care for people living at home. Last year they spent 44.8 million dollars to keep people at home instead of in a nursing home.
These initiatives to help the elderly stay at home for as long as possible are the result of American Disabilities Act and two mentally retarded women who sued the state of Georgia in 1999.
In 1999 the United States Supreme Court heard the case, Olmstead v. L.C. and E.W. In this case, L.C. and E.W. were mentally retarded women who were institutionalized primarily because there was not sufficient funding to allow them to live in the community, even though their doctors said that they could exist in a less restrictive setting. Olmstead was the Commissioner of the Georgia Medicaid department. Justice Ginsberg said that states are required to place persons with disabilities in community settings rather than in institutions when:
1. the state’s treatment professionals have determined that community placement is appropriate
2. the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and
3. the placement can be reasonably accommodated, taking into account the resources available to the state
We will continue to see the expansion of these programs as well as the development of new programs designed to provide care to seniors in their home. The benefits of being able to stay home, when appropriate, and the cost savings to the Medicaid budget will drive the expansion of programs like these.
This article gives general information and not specific advice on individual matters. Persons wanting individualized advice on matters discussed should contact an advisor experienced in those matters. To the extent this article provides information on legal matters, it is based on law in effect in Massachusetts on the date of posting (laws in effect in other states are often quite different).
Ronald H. Surabian is a CPA and attorney who works at the Elder Law Center in Saugus, Massachusetts. He also holds masters in accounting and a masters in tax law. He currently serves on the board of directors of the Massachusetts Chapter of the National Academy of Elder Law Attorneys. If you have any questions please call me at the Elder Law Center, One Essex Street, Saugus, MA 01906 (781)233-4444. To view this or any prior article, please visit our web site at www.elderlawcenter.org