Granny Snatching: Ct Expanding Program Allowing Elderly To Live At Home, Instead Of Nursing Homes

Some state lawmakers finally seem to be grasping the concept that Medicaid is going bankrupt because the program is designed to direct most resources to institutions like nursing homes, and precious little to much less expensive home- or community-based care.

But efforts are underway to change the flow of tax dollars away from institutions, which could save Connecticut hundreds of millions of dollars while keeping the elderly and disabled in more familiar settings. In fact, in Connecticut, the Money Follows the Person concept already has moved more than 500 former residents of extended care facilities back into the community.

The Money Follows the Person program has quite lofty goals under the administration of Gov. Dannel Malloy. The initial goal was to de-institutionalize 890 nursing home residents, and thus far 530 have transitioned back to the community. But the new goals are now expanded to 2,251 residents by June 2013, and up to 5,200 by 2016 – a significant undertaking.

The average cost to Medicaid in today’s dollars is approximately $100,000 per year per nursing home resident, which means the 5,200 people – elderly and disabled – now cost Connecticut’s taxpayers $520,000,000 annually. Returning more than five thousand institutionalized residents to their homes will not mean all of that money will be saved – many people will still need assistance in their homes and that still costs money, but nowhere near as much as it does for nursing home care.

I interviewed Connecticut’s Commission on Aging Executive Director Julia Evans Starr on this issue this week, in addition to Communications Director Robert Norton, and Legislative Director Debra Polun, and they made a salient point – “Most nursing home residents didn’t need Medicaid at first.”

But the cost of nursing home care is so steep that just about everyone runs out of their own funds eventually – and more people are living longer every year. In Connecticut about 70 percent of nursing home residents, some 20,000 people, are funded through Medicaid. Currently the cost is split evenly between the state and federal governments.

However, Connecticut’s Department of Social Services received a Systems Change grant to restructure Connecticut’s long-term care system and now we are seeing the first signs of improvement. For starters, with the systems change underway the federal government will increase its reimbursement rate to 75 percent, while the state funds 25 percent.

Meanwhile an effort to “right size” nursing homes also is ongoing, with the aim of “engaging nursing homes as stakeholders” in the process, Starr said. The number of nursing homes that will be needed in the near future, especially with the Baby Boomer generation now turning 65 in ever increasing numbers, “will be contingent on what we do now,” Starr said.

Nursing homes must diversify and offer a broad range of services to remain viable and competitive, she added, noting that the Masonicare facility in Wallingford and the Hebrew Home in West Hartford are two good examples of facilities that are prepared for the changing dynamics.

If there are to be cost savings and if critics of government over-spending are to be pacified big changes are needed. For instance, even though the Money Follows the Person program will provide Medicaid funds for former nursing home residents who return to the community, those funds are not available unless a person has spent at least 90 days institutionalized.

Thus, there is a movement among elderly caregivers to institutionalize some of the state’s elderly for the 90-day minimum so they can then be transitioned back to the community with Medicaid funds available for their care. What’s wrong with simply making the money available on a need basis, rather than spending $300,000 per person in some sort of a qualifications game?

And, as Norton pointed out, not everyone who is in a nursing home is elderly. Disabled people also can be institutionalized in the same facilities as the elderly, but in some cases they could be there for decades.

As I noted at the outset of this column some state Legislators “get it.” This means that there are others who don’t get it.

But Polun keeps a close eye on the progress of relevant legislation as it works through the system, including SB 1065, regarding fear of retaliation in nursing homes; SB 1185, regarding nursing homes in receivership; and my personal favorite for this legislative season, SB 365, regarding investigations by protective services. If she’s watching this legislation, so am I.

There also is legislation needed to increase funding for adult day care centers, whereby working families would be able to keep an elderly relative with them longer. Considering how much hollering has been going on for years about the state budget and the state and national deficits you’d think the legislature would be on a mission to rectify this situation as quickly as possible what with the hundreds of millions in savings possible.

You’d think. I’ll keep you posted.