Money Follows the Person - moving seniors out of nursing homes?

Wow, does this sound like a good idea for seniors in nursing homes in Connecticut. Or maybe not for seniors. Connecticut has found $56 million of state and federal money for a program called "Money Follows the Person" to help 700 seniors and people with disabilities, including mental illness, who have been in nursing homes more than 6 months and on Medicaid assistance to re-enter the community over the next five years -- either to homes, apartments, assisted living, or elsewhere. All kinds of support programs are available to make it work, so says the press release and related sites.

And the motivation is certainly compelling. It costs $60,000 in Medicaid dollars today to keep a person in a Connecticut nursing home.  Medicaid money up to now has not been available for home care for the disabled, forcing them into nursing homes. Nursing home shortages are predicted for the growing population of baby boomers as a result of slow growth in the number of nursing home beds, resistance to moving to a nursing home, and a future shortage of nurses and nurses aides. So this is a demonstration federally-assisted program that may be imitated in other states. Dated 12/04/08 from the Connecticut aging services website:

   "Individualized care plans will be created based on need. While participants will direct the transition process themselves to the greatest extent possible, transition coordinators will be available to provide one-to-one assistance. They will assist with community supports, navigating the systems and accessing resources. If people need housing, coordinators will assist by locating acceptable apartments or other living arrangements.

            Some funds may be available to assist individuals with setting up a household in the community. Rental assistance will also be available for those who qualify. In addition, six different service and support packages will be available to meet the individual needs of those who transition to the community."

Sorry. This program is for disabled who want to go back to their spouses and homes and today don't qualify for Medicaid assistance outside of a nursing home. It's not (as I read it) for frail seniors who have spent down their assets in order to qualify for Medicaid. By the time they've been in a nursing home for 6 months, they have sold their homes or transferred their assets to their children in order to reach the $2000 spend-down for eiligibility.

If they have been thrown out of expensive assisted living facilities that don't accept Medicaid and into Medicaid-eligible nursing homes, this won't get them back into those ALFs and besides, they have already dispositioned the furniture and other keepsakes from those residences.

If they are in a nursing home due to dementia, the transition to another location is going to traumatize and make their dementia permanently more severe.  If they're in a nursing home because they have no one to advocate for them, how will the application process work properly and through to completion? And if they're in a nursing home because they need 24x7 care, how will this program guarantee that anything resembling 24x7 care will be available to them in any of those other environments?  And let's just forget about whether this program will include any sort of monitoring technology.

For seniors, the target of the program should be reversed -- if you're not yet in a nursing home, this program will help you stay where you are, even if you've outlived your money. Today, residents of upscale ALFs or independent living residences are discharged when their funds dry up, even if they are 97 years old!

Or, perhaps, if a particular nursing home is a care disaster, this program should help familiies relocate their loved ones to better facilities or bring in incremental services to them in the facilities that they're in. Anyway you look at it, the concept sounds good, but the implementation doesn't work. I would not be surprised if it took Connecticut the full 5 years to find 700 residents (of the 18,000 in nursing homes) to transition under the stated conditions.