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Money Follows the Person - moving seniors out of nursing homes?

Wow, does this sound like a good idea for seniors in nursing homes in Connecticut. Or maybe not for seniors. Connecticut has found $56 million of state and federal money for a program called "Money Follows the Person" to help 700 seniors and people with disabilities, including mental illness, who have been in nursing homes more than 6 months and on Medicaid assistance to re-enter the community over the next five years -- either to homes, apartments, assisted living, or elsewhere. All kinds of support programs are available to make it work, so says the press release and related sites.

And the motivation is certainly compelling. It costs $60,000 in Medicaid dollars today to keep a person in a Connecticut nursing home.  Medicaid money up to now has not been available for home care for the disabled, forcing them into nursing homes. Nursing home shortages are predicted for the growing population of baby boomers as a result of slow growth in the number of nursing home beds, resistance to moving to a nursing home, and a future shortage of nurses and nurses aides. So this is a demonstration federally-assisted program that may be imitated in other states. Dated 12/04/08 from the Connecticut aging services website:

   "Individualized care plans will be created based on need. While participants will direct the transition process themselves to the greatest extent possible, transition coordinators will be available to provide one-to-one assistance. They will assist with community supports, navigating the systems and accessing resources. If people need housing, coordinators will assist by locating acceptable apartments or other living arrangements.

            Some funds may be available to assist individuals with setting up a household in the community. Rental assistance will also be available for those who qualify. In addition, six different service and support packages will be available to meet the individual needs of those who transition to the community."

Sorry. This program is for disabled who want to go back to their spouses and homes and today don't qualify for Medicaid assistance outside of a nursing home. It's not (as I read it) for frail seniors who have spent down their assets in order to qualify for Medicaid. By the time they've been in a nursing home for 6 months, they have sold their homes or transferred their assets to their children in order to reach the $2000 spend-down for eiligibility.

If they have been thrown out of expensive assisted living facilities that don't accept Medicaid and into Medicaid-eligible nursing homes, this won't get them back into those ALFs and besides, they have already dispositioned the furniture and other keepsakes from those residences.

If they are in a nursing home due to dementia, the transition to another location is going to traumatize and make their dementia permanently more severe.  If they're in a nursing home because they have no one to advocate for them, how will the application process work properly and through to completion? And if they're in a nursing home because they need 24x7 care, how will this program guarantee that anything resembling 24x7 care will be available to them in any of those other environments?  And let's just forget about whether this program will include any sort of monitoring technology.

For seniors, the target of the program should be reversed -- if you're not yet in a nursing home, this program will help you stay where you are, even if you've outlived your money. Today, residents of upscale ALFs or independent living residences are discharged when their funds dry up, even if they are 97 years old!

Or, perhaps, if a particular nursing home is a care disaster, this program should help familiies relocate their loved ones to better facilities or bring in incremental services to them in the facilities that they're in. Anyway you look at it, the concept sounds good, but the implementation doesn't work. I would not be surprised if it took Connecticut the full 5 years to find 700 residents (of the 18,000 in nursing homes) to transition under the stated conditions.




Laurie, I agree. This type of program may be great for older people who want to Age in Place. Unfortunately I think benefits are limited to people IN nursing homes, so will not help people avoid the move.

Money Follows the Person is in the wake of the Olmstead Supreme Decision. This is one place where the interests of senior consumers and the disability rights community coincide but unfortunately do not gel into a working relationship.

Washington, DC, June 22, 1999 -- In rejecting the state of Georgia's appeal to enforce institutionalization of individuals with disabilities, the Supreme Court today affirmed the right of individuals with disabilities to live in their community in its 6-3 ruling against the state of Georgia in the case Olmstead v. L.C and E.W

Aug. 12, 2003 -- The Money Follows the Person Act introduced in Congress last month by Sens. Tom Harkin (D.-IA) and Gordon Smith (R. - OR) is an effort to put into bill form the President's 2004 Budget proposal to encourage states to allow the money to follow the person, so people who are living in nursing homes or other institutions could have the money "follow them" as they move out into the community onto community based services. The bill is S. 1394.

Cash and Counseling is another.

They fall under the grand title of 'rebalancing'. Texas is a leader.

My mother has been in a nursing home facility for several months. I ran across this information about MONRY FOLLOWS THE PEOPLE. However, I can not seem to find out where and how you fill out an application to apply for this program. I have been searching for several days on the computer. But so far I have not been successful. If anyone knows how to fill out the application, please forward on the information to me. Thanks so much

Actually since the program began in December 2008 Money Follows the Person in CT has received 2000 referrals with an average of 10-20 referrals coming in each week to the state. 250 people have transitioned already since December 2008 out of skilled nursing facilities back to homes in the community under CT Money Follows the Person. I agree we need to begin to address keeping people out of nursing homes in the first place.


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