Comments

Health Affairs encourages readers to engage in discussion via comments on our Web site.

• To RESPOND to a particular article: Click on the link "Submit a response to this article" in the box at the top right-hand corner of the article.
• To READ responses to a particular article: Click on the link "View responses" in the box at the top right-hand corner of the article.

Comments to:

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]

Comments:Submit a response to this article

Comments published:

The Need For Community-Based Alternatives

Linda P. Robinson   ( 12 June 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.