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Getting Help to Age in Your Home

Money Follows the Person expansion to help Medicaid patients live independently

Dennis Boughton's new apartment near the waterfront in West Haven feels like a college campus compared with the nursing home where he spent six years living behind a barbed-wire fence.

"That place had no freedom," Boughton, 68, said of New Haven's West Rock Health Care Facility, closed by the state last year for multiple patient-care violations.

Boughton, who uses a wheelchair because of a stroke, found Edgewater Towers last fall through Money Follows the Person, a federally funded program that helps residents move out of nursing homes and live independently while still receiving the services they need.

Money Follows the Person helps Medicaid participants get assistance such as help with meals, chores and medication — services that help them stay at home.

In one of his first acts after taking office, Gov. Dannel P. Malloy, D, announced a dramatic expansion of the Money Follows the Person program.

Malloy's administration has asked the federal government to approve up to 5,200 nursing home-to-community care placements over the next five years. Nearly half of them — 2,251 — would make the shift by June 30, 2013.

The state's Money Follows the Person program now has approval for 890 people, said Anne Foley, undersecretary for policy development and planning at the Office of Policy and Management. So far, Boughton is one of 411 who have received services that allow them to live independently.

Nearly 90 percent of older Connecticut residents prefer to live at home as they age, according to an AARP survey, because they want control over their sleeping, eating and socializing schedules.

New policy is 'a no-brainer,' AARP says

"It's far less expensive to support people in the community — which is what they prefer — than in nursing facilities. It's a no-brainer from a policy standpoint," said Brenda Kelley, AARP Connecticut state director. She said Malloy's plan is "a bold vision that over time will save the state money, while providing thousands of older residents with what they want — the ability to live independently in their homes and communities as they age." Home care is two to three times less expensive than nursing home care, according to a state advisory commission. But Connecticut has lagged among states that are shifting funds to home care.

AARP research shows that in 2007, institutions received 91 percent of the state's long-term care Medicaid dollars for older adults and adults with physical disabilities.

Lawmakers say overhauling that spending model makes sense.

"I think there is certainly an urgency that exists this year," said state Sen. Anthony Musto, D-Trumbull, cochairman of the Human Services Committee. "We're very cognizant of the fact that we need to look at ways to trim expenses."

The projected state budget deficit is $3.7 billion, about a fifth of its spending.

Malloy's announcement piggy ­ backs on the recommendation from his transition team that Connecticut broaden access to community-based services.

In addition, a state commission reported in December that long-term care spending on roughly 40,100 clients — now $2.4 billion or 13 percent of the state budget — will more than double by 2025 if no action is taken. It recommended that Connecticut aim to rebalance its Medicaid funds so that 75 percent goes toward community-based care by 2025.

While the expansion of Money Follows the Person is a great step, Kelley said, "this isn't the end of the line. The larger challenge is to continue to expand home- and community-based services in Connecticut so fewer people end up in a nursing facility in the first place."

Cynthia Scott, special program coordinator for the Area Agency on Aging of South Central Connecticut, helped move Boughton and 34 other people into home- and community-based settings last fall when the New Haven nursing home was closed.

"Being part of the closure of the nursing home was one of the most stressful things I've ever done," she said, "but it was also the best experience I've ever had. Just the look of joy on the faces of the clients when they first stepped foot into their new homes, I can't put it into words. Once they are in control of their own environment again, they just thrive. Their quality of life improves immeasurably, and they love being part of a broader community."

Boughton said he's happy to be in a neighborhood. "They got a helluva steak dinner for 10 bucks across the street," he said.

Tom Puelo is a freelance writer in West Hartford, Conn.

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