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From nursing homes to homes -- money follows the person -- but so late

Why does this bug me? It sounds so good. Another state as described in today's NY Times article, this time Pennsylvania, uses federal funds and state Medicaid money (totaling $1.75 billion) to move individuals from a nursing home out into the community. Hopefully, this will save $44,000/year in nursing home costs, although that is unproven and in the process of being researched.  Money follows the person, as I described in January, is the result of a 2003 Congressional act to assist states in moving long-time nursing home residents back into the community. But I am uneasy because it addresses the housing issue after all property is lost.

Qualifying Medicaid recipients must have lived in nursing homes for at least six months. This means they have spent down their assets to the Medicaid limit in their state and lost title (or lease) for any home they lived in. They had to rid themselves of nearly all of their possessions in order to qualify for Medicaid -- as well as fit themselves in a nursing home room. They were usually pushed there after post-hospitalization rehab following a stroke or other disabling event because that is what Medicaid has historically reimbursed. Don't misunderstand -- it's great that Medicaid recipients can leave a nursing home if they want to and are capable of making that decision.

Money follows the wrong people. But what bothers me is that these same funds could be directed to helping individuals go back to the homes they know after their rehab reimbursement expires -- and before they ever spend that minimum of six months in a nursing home. Before they liquidate and lose all of their furniture (as in the NY Times article). They could continue to live in their own homes -- or if they're unsafe, move into subsidized housing, but with their familiar possessions. So 'money follows the person' out of rehab into their service-enabled home.

These funds should apply to independent living residents. Let's imagine a different use of funds. For example, in New York State, let's apply them to serve residents who become disabled while living in low-income housing -- supported, in one example, by Selfhelp Community Services. This 73-year-old organization was originally founded for victims of the Holocaust as I learned from Vice President of Senior Communities, Leo Asen.

As Leo describes Selfhelp: "We help low-income seniors remain in their homes in six low income apartment buildings in New York. Selfhelp provides on site supportive services to NORCs (Naturally Occurring Retirement Communities) as well as its own buildings. The NORCs are funded by the coop boards and state and city funding. For both housing and NORCs, Selfhelp provide services designed to keep residents living independently in their homes and include for example community nursing as well as social services and technology."

Escalate the services with state Medicaid funds. The Queens apartment residents, whose average age is in the 80's, benefit from access to services as they age and become frail. These include tech possibilities --  for home monitoring (with QuietCare), cognitive fitness programs (with Dakim workstations), and diagnostic monitoring devices for blood pressure or diabetes -- all overseen by nurses and social services who are either in the building -- or are able to participate in any of Selfhelp's senior centers.

Maybe I just don't get the big picture about 'Money Follows the Person'. But I do look forward to reading an article that studies the long-term impact about the Medicaid program and highlights, perhaps, how 'Money Follows the Person' stays with the person while they are still at home.

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