State Pilot Program Tests Alternative to Nursing Homes

Adult Family Care, or AFC, is akin to foster care – but for elderly people eligible for Medicaid-funded nursing homes.

Providers can be strangers, neighbors, or relatives.

They can't be a senior’s adult child or spouse.

Robert and Carolyn from Hudson are part of an AFC pilot program in New Hampshire.

They've offered space in their home to 81-year-old Bob.

Robert showed off the shower and bath area he designed to accommodate Bob - who uses a wheelchair to get around.

(Shower curtain sound.)

“He’s got the adjustable shower head the seat he can raise it and lower it. He’s got the seat. Everything he could possibly want to control. Grab bars. He won’t fall he has the bars to hold on to. He can get in and out no problem.”

Since Bob moved to Robert’s house in November, he’s been hospitalized twice.

He’s recovering from surgery now – and has been
in the hospital this time for over a month.

But he says that he considers Robert’s house----home.

“Anybody that can go and live like I was living – Go Man Go. I mean, cuz, if you’re capable of being able to take care of yourself, you know, who wants to be in a nursing home.”

Bob says his experience in a nursing home wasn’t pleasant.

He says he didn’t belong there.

“They put me in and they put another guy there and all he did was cry. I mean I didn’t get sleep at night and the nurse’s aid I say can I have some ice water ‘oh ya I’ll get ya some’ and you never see them again.”

Nursing homes charge the state about $140 per patient per day…on average.

In contrast, the State pays Robert and Carolyn about $60 dollars a day to act as Bob’s caretaker.

That $60 covers rent, food, transportation and time spent helping Bob with daily life.

Not all homes offer as much privacy and space as Robert’s.

Bob's basement apartment has its own galley kitchen, living room, bedroom, bathroom and space for a desk.

The home is licensed to house two seniors – but so far -- only Bob lives there.

Other settings offer only a bedroom and tend to integrate the senior more into the family.

But a year into the program - only four homes HOUSE elders like Bob.

A few more have passed inspections and are ready to start.

Rosie Sampson manages the adult family care homes for the pilot run by the Area Agency of Greater Nashua.

She says that licensing includes thorough inspections and background checks - and that's one of the reasons for the slow start.

“Licensing is the same as a nursing facility. It’s very extensive. Health record check. Pets in the home have to be checked and shots up to date. Driving check. Auto insurance. You name it and they go through it. Just as if you were working at a nursing facility and your home has to be licensed as though it is a nursing facility.”

Red tape isn’t the only issue, says John Porier.

He’s president of the New Hampshire Health Care Association – whose members include nursing homes.

Porier agrees that some seniors currently in county facitilites would be happier in private homes.

But he doubts that as many as 600 are healthy enough to leave nursing homes.

He says that seniors eligible for Medicaid-funded nursing homes generally need medical supervision

Porier is also concerned about freedom of choice.

“Our biggest concern as healthcare providers is that are we getting to a point where state is telling people where they’re going to be getting care and are we taking people who really should be in nursing homes or should be in assisted living and making them receive a limited amount of homecare to make it affordable to the Medicaid program?”

And he questions whether the tax dollars are saved once medical costs are factored in.

AFC pilot project managers echoed that view by stressing the importance of individual choice.

They agree that some seniors wouldn’t be a good fit.

Nancy Rollins is the Director of Community Based Care Services at the Department of Health and Human Services.

Her agency oversees the pilots.

She says the state created mechanisms to help seniors determine whether they can or should go to the Adult Family Care program.

“There is a nurse there who can actually institute the medical eligibility determination process which is a screening process to determine if the person’s needs are at nursing home level of care and through this process determine if they would be better served through home and community-based care waiver or if indeed at this point in time they really do need to be in a nursing home circumstance.”

Rollins adds that seniors would take part in the decision process – and that her agency hopes to streamline the licensing process.

The governor’s budget proposal adds about $70 million over two years to community-based care – - including AFC.

The state and counties are expected to save about $1.9 million over 2 years through AFC and other alternatives to nursing homes.

Bob said he would have moved sooner if he had known about adult family care.

“When you say nursing home to me it’s practically putting you beside a casket. Where the hell are you going to go from a nursing home?”

But he admits that not all seniors are healthy enough to live in private homes.

“I can’t wait for spring so I can go outdoors and see if somehow I can get me a scooter or something for the summer to be outdoors so I can mosey around you know.”

And he hopes to gain some weight and strength so that he can get out of the hospital, go back to his new home and find that scooter.

FOR NHPR News, I’m Dianne Finch