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Vincent Mor, Jacqueline Zinn, Pedro Gozalo, Zhanlian Feng, Orna Intrator, and David C. Grabowski Prospects For Transferring Nursing Home Residents To The Community Health Affairs, November/December 2007; 26(6): 1762-1771. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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The Need For Community-Based Alternatives

Linda P. Robinson   ( 12 June 2008 )

More On Community-Based Alternatives

Kimberly A. Hughes   ( 15 December 2008 )

The Need For Community-Based Alternatives 12 June 2008
Linda P. Robinson, Social Worker Lapeer Regional Medical Center Send comment to journal: Re: The Need For Community-Based Alternatives robin679{at}msu.edu Linda P. Robinson	Thank you for your important research, which points out the need for long-term care reform and for considering alternatives for nursing home care. I was particularly interested in your finding that states with less investment in community alternatives have higher rates of low-level persons in nursing homes. I have been employed as a hospital social worker in Michigan for over 20 years, and a large part of my job is helping seniors and disabled adults plan for their care needs. The current policies limit choice and result in higher costs to the Medicaid system. Current Michigan Medicaid policy does not allow residents of adult foster care homes or assisted living homes who would otherwise qualify for the MI Choice Waiver services to receive services in those settings. The result is that consumers who could reside in these settings are prevented from considering these options. The average cost of nursing home care in Michigan in 2008 is almost $6,200 per month. Adult foster care homes typically cost $1,500 to $3,000 per month. While this is significantly less than a nursing home, these costs are out of the reach for many disabled adults or seniors. As a result, those consumers who require care on a 24-hour basis and cannot afford the adult foster care option have little choice but to enter the more expensive nursing home, where there is help in the form of Medicaid. Benefits to consider in advocating for this change include considering the less expensive alternative of assisted living over nursing home care, client choice and autonomy, and providing a real alternative for low-level consumers who currently live in nursing homes. For individuals who are able to afford to pay privately, many will choose an assisted living option, as it is less expensive, care is often offered in a more homelike and less institutional setting, and there are generally more local choices allowing closer proximity to friends and family. In Michigan, Governor Grahnholm's long-term care task force recommendations include consumer-driven choices, money follows the person, and amending current Medicaid policy to allow MI Choice waiver funds to be used in adult foster care and assisted living homes. These reforms would promote equity of choice and services to low-income seniors and disabled persons while also allowing self-determination and promoting less expensive and less restrictive alternatives.
More On Community-Based Alternatives 15 December 2008
Kimberly A. Hughes, Adult foster care home provider Hughes Care Home Send comment to journal: Re: More On Community-Based Alternatives hughes6035{at}chartermi.net Kimberly A. Hughes	The elderly who are poor are being discriminated against by this lack of alternatives (i.e., forced into institutionalized care). I own/operate an adult foster care home and take pride in the personalized care my small home can offer. In other words, I know my people, and my people know me. This vulnerable population should be allowed the alternative of a small home in which their need for more personalized care is met and a bonding relationship with their caregiver is offered. While the elderly may need more medical attention and visiting physicans and nursing care is available to adult foster care homes, including hospice care, old age is not, in and of itself, a medical condition requiring institutionalized care. Oftentimes when an elderly person is allowed to connect with his or her caregiver and made to feel safe within a less chaotic environment, he or she is healthier, and medication for behaviorial purposes is not needed (e.g., Alzheimer symptoms). To keep our elderly institutionalized, and to justify this policy based on the medicalization of our elderly, is not only backwards in that it sounds a great deal like the orphanage for old persons, but this cold-hearted policy denies these citizens one of their basic human rights/needs: to feel safe in a home-like environment! We need to advocate not just for a change in this policy but for homes that are small (6 persons or fewer) ON PURPOSE!