Seniors Housing Weekly Update-- The Path of Home and Community-Based Care

April 17, 2012

60 Seconds With Steve Monroe 

April 17, 2012. With so much emphasis on letting the elderly stay in their homes with a push towards home and community-based services, has anyone considered how we are going to pay for it......


The Path of Home and Community-Based Care

We all know that most elderly want to stay in their homes for as long as possible.  Who wouldn’t?  But sometimes it may not be the best option. When Medicaid funds were “waivered” for use in assisted living, the intent was to 1) save on costs as assisted rates were much lower than skilled nursing rates, and 2) have a more appropriate setting for many of the elderly.  On the cost front, all that happened was that the pie got bigger, and more people wanted access to care paid for by someone else.  Now, take the case of the current push for home and community-based care, mostly to keep the elderly out of SNFs. A wonderful concept, but aren’t we going down the same path, funding more people? For those elderly residing full time in a skilled nursing facility, staying at home is usually not cheaper, nor is it safer or healthier, if they actually need the level of care that is provided in a SNF, but need it every day.  So, just like with assisted living Medicaid waivers, aren’t we setting ourselves up for creating a larger pool of recipients of state and federalaid, at a time when more money just isn’t available? Do the math, it just doesn’t work.


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Another Solution

You're right, the math doesn't add up. But what about having seniors take an approach similar to what many disabled middle-aged people do? They can have live-in roommates who pay very low rates for house shares (instead of renting apartments). Nurses can come and go for certain times of the day, which is far less costly than having constant care. At other times, the roommates can help do things around the house, cook, clean, and help their elderly housemates when necessary.

Wilber, I have talked with

Wilber, I have talked with people who like the concept of co-habitation, but if you can't live safely on your own, how are you going to be able to cook, clean and do other household chores with your new roommmate? I think I was talking about something who was much less independent. And then you have the problem of personality conflict, and can the "host" person kick the roommate out at any time?

Community based care

"nor is it safer or healthier..." I have an eighty nine year old mother with extreme dementia in very good physical shape (on no medication) that fits exactly what you're talking about. Go spend some time in a nursing home...I'm talking days not hours and let me know if you still feel the same way. The reality is this is a tidal wave size problem that we as a country aren't even close to addressing. I just had to move her out of her independent living environment because of her dementia issues and was lucky to find an individual willing to have her move in with her (can't live with us because of our work demands of travel). I preferred this option above institutionalizing her based on others experience. I can think of at least 10 ideas to make this an attractive arrangement for people to consider vs. long-term care facilities that are no bargain. Until we recognize this as a huge social issue we will continue to warehouse the elderly where they are out of sight and kinda out of mind...

Jay, You are correct, I would

Jay, You are correct, I would not want to live in a skilled nursing facility, but have you seen some of the assisted living communities that are out there? How about CCRCs? My point had to do with total cost and safety and health. I think it is great you found someone to take your mother in, but if she has "severe" dementia, that would seem to be a full time job for that person. I would want to know if that person is trained in dementia care and what happens when your mother is left alone? Is she safe alone in a house or apartment if she has severe dementia? I am not trying to put an unnecesssary burden on you, and I think if a situation like this works it can be great, but there are not many people who can or will take in a stranger with severe dementia, so I don't think it is a solution for the greater population. My parents live in a CCRC by choice and have certainly not been warehoused. But I agree, they don't want to live in a skilled nursing facility.

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