Online Extra... Vermont's Caregiving Program Spells Success
By: Barbara Basler; Source: AARP Bulletin Date Posted: 2006-12-01 10:53:00-05:00
Donna Harrington lives in a mobile home outside Burlington, Vt., where she cares for her 81-year-old mother, Peggy, who has Alzheimer's. Harrington bathes, dresses and cooks for her mother, and when Peggy is sick, she sits beside her, feeding her fluids with an eyedropper. There is a nursing home "right around the corner," but Harrington says home is the best place for her mother, and the state of Vermont agrees: it is now paying Harrington for the care she gives Peggy.
In a bold new experiment, Vermont is giving older and disabled residents and their families a choice—care in an institution or at home—and paying family members and friends about $10 an hour for what can be a grueling labor of love. The program, Choices for Care, is part of a larger push by federal and state governments to shift Medicaid money from expensive nursing homes to less expensive care at home, where most Americans would prefer to be—and where many family members are making great sacrifices to keep them.
Harrington had to quit her job at a restaurant to devote herself to her mother's care. And when her husband, an office manager for a bakery, comes home from work each night, he helps with that care too.
"We were on our own for the first year and then this program started," she says, "and it's been a help. It's made a difference." Through the program Harrington is paid for 40 hours of care a week, and her husband is paid for 16 hours of care.
"I promised my mother we would never put her in a nursing home," Harrington says, "and this helps us keep our promise." The program also pays for community care for her mother, who goes to adult day care several times a week.
A number of states are watching Vermont's program with great interest—officials at its Department of Disabilities, Aging and Independent Living say they are constantly besieged with questions from other states—and the national Council of State Governments, a nonpartisan organization of state officials, is honoring the fresh approach with an award this month.
Vermont officials say that since Choices for Care began a little more than a year ago, 200 more Vermonters have been able to receive care in their own homes, and the state has 156 fewer nursing home beds in use. A nursing home bed costs an average of $156 a day, compared to $80 a day for home care, officials say, which means the state is saving money as well as winning friends among the families the program touches.
"We hope never to have to build another nursing home," Gov. Jim Douglas, R, said in an interview. "Never is a long time, but that's our hope."
Last year Medicaid spent a total of $38 billion on institutional care, while only $8 billion went to more popular programs that provide care in the home or community. Traditionally, those programs have been viewed as minor options and were allocated smaller amounts of money.
Older Americans who qualify for Medicaid because they have limited incomes are entitled to nursing home care under federal guidelines. But in the Vermont program, they are equally entitled to care in the home or community, a sharp change, but one which federal officials approved for this model program.
More states are expected to follow Vermont's lead with their own for Choices for Care programs, says a spokesperson for the federal Centers for Medicare & Medicaid Services. And with the recent passage of the Deficit Reduction Act, Congress has given states the flexibility to make significant changes like this in their Medicaid programs.
While aging experts are enthusiastic about the Vermont experiment, critics question the quality of care provided by friends and family compared to the skilled nursing care in a nursing home. But for some Vermonters there is simply no question about which is preferable.
Gail Dezotelle, age 63, has a chronic lung condition so severe that doctors said she should be placed in a nursing home where she could get constant care and monitoring. But under Choices for Care, Dezotelle elected to have the state pay her daughter to care for her at home—in a stone house in rural Vermont where Dezotelle and her ailing husband live with their daughter, three grandchildren, two dogs, a cat and several rabbits.
Dezotelle has trouble walking, but from her bedroom windows she can look out over her flower garden in the spring and summer and watch the birds that flock to the feeders in the yard, something she couldn't do from a nursing home more than 10 miles away.
"When they said nursing home, I said absolutely not," she says firmly. "I have my cat and plants and grandchildren and a husband. We're all here in our big old stone house in the middle of the cornfields. And this is where I want to stay. This is where my life is."
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