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Money follows the person: moving out of group homes
April 26th, 2010
Richard Hasselbach and Deborah Kadlec met in a nursing home and dreamed of a life together outside its walls.
Their health conditions made living on their own a challenge: Hasselbach, 63, is disabled from a stroke and lost a leg to a blocked artery. Kadlec, 52, has multiple sclerosis. They both use wheelchairs and need help with chores such as bathing, cooking and remembering to take their medicines. Most of their relatives live in other states.
Despite those obstacles, Hasselbach and Kadlec got their own apartment and a personal care aide last summer through the help of a federally funded program run by the state. The program, known as Money Follows the Person, is the nation’s most ambitious effort to move people out of nursing homes and other long-term-care facilities. It aims to help people live on their own and also save tens of millions of dollars for Medicaid, the state-federal health insurance program for the poor and disabled that pays for two-thirds of nursing home bills in the U.S.
Nationally, nursing home care averages about $75,190 per patient each year. Care in the home, through such services as meals-on-wheels and daily visits by a health aide, averages $18,000 a year, according to the AARP Public Policy Institute.
The program gives nursing home residents personal and financial help to live on their own or in small group settings, as well as payments for costs such as apartment security deposits, household furniture and alterations to make homes or cars accessible to the handicapped.
Georgia is one of 29 states and the District of Columbia participating in Money Follows the Person. Its experience shows both early successes and an illustration of the program’s slow start nationwide. Georgia had hoped to move 1,312 people from nursing homes and other long-term-care facilities by 2011. But through the end of last year it has moved out only 221.
Progress On Goals Wide-Ranging
Congress established Money Follows the Person in 2005, and states set a combined goal of moving out more than 37,000 residents from nursing homes and other facilities by 2013. Most states, including Georgia, started their programs in 2008. Two years later, just 5,774 residents have moved nationally, according to state data collected by Kaiser Health News.
The new health overhaul signed into law last month extends the program to 2016, adds $900 million to what was a five-year, $1.3 billion initiative and loosens eligibility rules.
“The impact could be very significant,” said Debra Lipson, a senior researcher at Mathematica Policy Research, a Princeton, N.J. based think tank that is evaluating the program for the federal government.
Most states are moving slowly for various reasons: problems finding affordable housing, resistance from nursing homes, stringent federal rules that limit who is eligible and what types of community settings they can move into, according to a recent study by Mathematica.
Alice Hogan, who heads the Money Follow the Person program in Georgia, said she considers the program a success. “Like most states, we wished things were going along faster but implementation has been more difficult than expected,” she said. “But personally I am not disappointed because I am very happy with those that we got out because each of them is a real person who is now in the community.”
State data show wide-ranging progress on goals:
- Texas has moved 2,029 people out of nursing homes and other long-term care facilities. That’s more than one-third of the national total.
- A dozen states have moved fewer than 60 people. States moving the fewest: Louisiana (10), North Dakota (19) and Delaware (22).
- Illinois, which set the highest goal, is furthest from its target. The state had set 3,357 transitions as its goal by 2013, but through last year has done just 58. “Meeting that goal by 2013 appears nearly impossible,” said Jean Summerfield, the Illinois project director.
Many states blame their slow start on the program’s requirement that people live in nursing homes and other institutions for at least six months to qualify for transition assistance. State officials said those residents are hard to move because they often have the most complex medical conditions and have typically lost their home and family support system.
Congress last month lowered the requirement to a stay of three months that is paid by Medicaid.
In addition, the program’s rules bar participants from moving into group homes that house more than four people, which effectively shuts out most assisted-living options.
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