Thursday, November 02, 2006

Vermont gives seniors more options for care

In this experimental program the State pays family, friends, or aides to assist seniors at home. This keeps them out of a nursing home. If successful this program could serve as a model for the entire nation.


Vermont gives seniors more options for care


November 2, 2006

WINOOSKI, Vt. -- At 93, Florence (Tubby) Parsons has a lot going for her. She has her cat, Buddy, the plants in her one-bedroom apartment to tend to and a weekly 25-cent poker game with neighbors.

Best of all, she doesn't have to live in a nursing home. Instead, she gets daily visits from a longtime friend who makes $10 an hour from the state to care for her.

She is part of a unique experiment in Vermont. Under the Choices for Care program, older adults who are eligible for Medicaid and need someone to tend to their needs can be cared for at home by a relative, friend or neighbor paid by the state.

"A nursing home? They sit there and moan and holler and sit in a chair and sleep. I don't want that," said Parsons, who has heart and thyroid problems and uses a walker to get around her apartment building.

Experts say the closely watched project could spur dramatic changes in the way the United States handles long-term care for elderly people.

One year after enacting it, Vermont officials say it is reducing the number of people sent to nursing homes, cutting the cost of taxpayer-funded care and improving the quality of life for people such as Parsons.

The nursing-home industry and other critics say subsidized home care by family members and other nonprofessionals is far from a panacea. They say the care isn't as good.

Parsons' former tenant, Penny Walsh, 41, gets paid $10 an hour for 35 to 40 hours of work a week. She said she took the job of caring for Parsons because she was already doing some of her cleaning and other chores for free.

"It's like seeing my grandmother every day," she said, sitting by Parsons' side during a Monday morning visit.

Previously, Walsh was a clerk and a worker at a day-care center.

Elder-care experts say the Vermont program could help blunt one of the longstanding criticisms of Medicaid -- that it shunts people into institutions without regard to what they really want.

Medicaid, which spent $38 billion on institutional care last year, wants to shift more toward home care and community-based systems, where "the medical dollars follow the needs of the patient, rather than the other way around," said Mary Kahn, a spokeswoman for the Centers for Medicare & Medicaid Services, the federal agency that administers the programs.

It costs Vermont about $122 a day for Medicaid-covered senior citizens who live in nursing homes, compared with about $80 a day for those being cared for in their homes.

Mary Shriver, executive director of the Vermont Health Care Association, a nursing home trade group, said that in-home care works for some but that it cannot match nursing home care for quality.

"Good intentions can cause some damage sometimes," she said.

Sometimes, good intentions are not enough.

"Typically, a family says, 'Sure, we can do this' and brings their grandparent into the home and starts into the role of caregiving and the state is paying them," said J. Churchill Hindes, president of the Visiting Nurse Association of Chittenden and Grand Isle Counties, a nonprofit home health care agency.

"And after a few months or a year, they realize how exhausting the work is, how emotionally draining it might be and just how hard it is."

Parsons' caregiver said the arrangement is working out great so far. Parsons said she likes the company and the help.

"She's been as close as family for a long time," Parsons said of Walsh. "You know what they say: You have to put up with your family, but you choose your friends. I chose her."