For Thousands In Ohio, Nursing Homes Are No Longer The Only Option
Donna Giron has lived in a Barberton, Ohio, nursing home since May.
During a recent visit, she quickly rolled her wheelchair down the aisles, stopped to get some ice water from an attendant and waved hellos to her friends as she sped past.
"I'm a very independent woman, I have been for most of my life, I mean I've had to be," Giron says.
Giron is 65 years old and has Crohn’s Disease. She was living with her sister, but a particularly bad episode put her in the hospital and ultimately the nursing home. Now, months later, she’s stronger and medical staff agree that with the right community supports, she’s ready to move out.
But Giron can't. She can’t move back in with her sister and she doesn’t have a home of her own. Even if she did, her government backed health coverage for low income folks , Medicaid, wouldn't necessarily be of any use.
Medicaid was created in 1965 with a bias towards paying for care in nursing homes, says Kaiser Family Foundation's MaryBeth Musumeci.
"There are a number of services that states are required to cover and one of those is nursing facility services. So there is an entitlement to institutional services… if you qualify for a nursing home and you qualify for Medicaid you are entitled to receive it," Musumeci.
But you are not entitled to care and support that keeps you in your home.
On my first visit with Giron, I asked her what her ideal home would look like.
"I just want my own place, I don't want anything fancy, I just want something to call my own, I just want to be in my own home," Giron says, beginning to cry. "Sorry. I just want to live my life normally like most people do. I want to be on my own. I want to be happy."
Giron is not alone in her desire to have a home. And funding is beginning to shift to support folks who want to live in the community.
Musumeci says Ohio ranks as one of the top three nationally along with Texas and Washington in using money from a special federal demonstration project to move older and disabled residents from nursing homes back into the community.
The reasons are financial as much as emotional.
"It is less expensive to care for someone at home or in the community and that's a big financial incentive for federal and state policy makers to try to create the appropriate incentive so that we are saving money and at the same time fulfilling beneficiary preferences to be in a home and community based settings," she says.
Since 2008, Ohio has moved more than 5,400 residents.State leaders say the average first-year costs for an individual to participate in the program is $49,000. It costs about $64,000 a year to live in a nursing home.
Ohio's Medicaid Director John McCarthy says the program - called Home Choice - is trying to help people like Giron as quickly as possible.
"It is a lot of work, these are not easy cases to deal with. It's not like you just find somebody and move them. It takes a lot of time and effort to make this happen," McCarthy says.
The Home Choice program assigns a transition coordinator who helps connect people to services, such as home health workers. It also pays for the costs of setting up house - deposits for rent, and the purchasing of household items like furniture and pots and pans.
The program is incredibly popular with beneficiaries, policy makers and even some nursing homes. But there are two big challenges: First, funding for the program was extended under the Affordable Care Act in 2010 but it expires in September 2016.
And, secondly, those waiting to get a home like Giron are finding it very difficult to actually find an affordable home.
"It's the housing that's the hard part, because Medicaid itself, the program, will not pay for housing costs, meaning room and board," McCarthy says. The state has even hired housing experts.
Giron has a small pension to help her pay rent, and her transition coordinator has looked at a handful of places. Some had stairs, others were too small. So, last month, when the coordinator called with a new option, arrangements were made to go look at the home.
Even with some chipped paint and one broken basement window, Giron quickly fell in love.
"Oh, we even got a dishwasher! Oh my goodness gracious," Giron says. She is nearly breathless from the effort of walking.
"Yeah, I want this one. I want this one."
However, the market is competitive and Giron didn't get the home. So, she's still at the nursing home.
She hopes to have her own place by Thanksgiving.