From Michigan:

The federal My Choice program allows someone who needs a nursing-home level of care to remain at home and receive needed care, Justice said. Medicaid covers the costs if the consumer meets the income and asset guidelines, said Jim McGuire, director of planning and advocacy for AAA 1-B.

“To be eligible for My Choice, a consumer must be 65 or older and medically eligible for a nursing home or 18 and older with a disability and also medically eligible for a nursing home,” Justice said.

A consumer also can be a nursing home resident and be “assessed to return home” to receive My Choice assistance.

However, an individual’s monthly income cannot exceed $1,869 to receive My Choice assistance. Assets also are limited to $2,000, excluding a home.

Under My Choice, a consumer can receive personal care, homemaking, respite for caregivers, adult-day service, home-delivered meals, private duty nursing, personal emergency response systems, chore services such as cleaning out gutters or snow removal, counseling, home injury control, such as putting in bathroom grab bars, medical equipment supplies and training of caregivers, Justice said.

Those eligible for My Choice, “may need to supplement the costs of the services” based on ability to pay, she said.

After the eligibility evaluation process, a care plan is formulated and discussed with the consumer and his or her family.

Programs of All-Inclusive Care for the Elderly- AKA PACE- has set up services in the state of Virginia. This is very good news.

Kirby Turner uses a walker to get around, but that didn’t stop him from doing a spirited dance to celebrate his 66th birthday recently.

Turner, who also has a mental disability, might have ended up in a nursing home, away from family and friends. But he’s able to live with his nephew, thanks to a day center that provides him with transportation, home care, meals, doctor visits, and yes, even a birthday cake.

The center, called Sentara Senior Community Care, has been around since 1996. Next month, it will become Virginia’s first official site for PACE - Programs of All-Inclusive Care for the Elderly.

There are 40 other such sites in the country.

The federal designation will mean expanded services for the 130 people at the day center, and will help Sentara Life Care Corp. launch a second center in the region next year.

The second center could provide as many as 130 more people with an alternative to institutional care.

The PACE model is considered to be the wave of the future, as interest in “aging in place” grows among the elderly and the baby boomers coming behind them.

“Our research shows that 80 to 85 percent of older Virginians want to stay in their homes as long as possible,” said C.D. “Tony” Hylton III, communications director for AARP Virginia, which advocates for people 50 and older.

The participants at PACE centers are frail enough to qualify for nursing home care. But rather than pay for services in institutions, government funds the necessary tools - transportation, health care, home-health aides and recreational activities - to help participants stay at home.

Riverside Health System is awaiting approval for a PACE center to open in Hampton in January. The health system also plans to open a center in Richmond in late 2008. Three sites in the western part of Virginia are in line to become PACE centers next year as well.

The programs are funded by Medicare and Medicaid, government’s two main insurance programs for the elderly, poor and disabled.

There’s lot more to read HERE.

PACE Web Site.

Good news:

Despite the graying of the nation, the percentage of elderly living in nursing homes has declined, according to Census data released today. The downturn reflects the improved health of seniors and more choices of care for the elderly.

About 7.4% of Americans aged 75 and older lived in nursing homes in 2006, compared with 8.1% in 2000 and 10.2% in 1990.
[…]
The nursing home numbers do not include assisted-living facilities. “There’s no federal definition of assisted living and that’s a void in the data,” Bolda says. “Fortunately, communities are taking responsibility for addressing the needs of older adults rather than waiting for federal policy solutions.”

Let’s hope the numbers continue to go down…and that includes assisted living. Community housing is not home- no matter how pretty it looks. Bring the money to the families, who can take of their elderly loved ones at home. The best solution and also the least costly.

From a Press Release:

EDWARDS UNVEILS DECLARATION OF INDEPENDENCE FOR OLDER AMERICANS

Des Moines, Iowa - Senator John Edwards today unveiled a new agenda for older Americans based on the values of security, dignity and choice. Edwards’ Declaration of Independence for Older Americans will help older Americans get the health care they need and the financial protection they deserve while allowing them to live as independently as they desire.

From the Actual Declaration:

LIVING WITH DIGNITY

9. OFFER CHOICE IN LONG-TERM CARE: Our long-term care system is poorly equipped to give independence to older Americans and forces many families to juggle elder care, child care, and their jobs or spend themselves into poverty to pay for nursing homes. Edwards will reform Medicaid and Medicare to let people to choose home-based care in their communities and test innovations such as asset and income protection programs. He will also support states and communities offering much-needed and often less expensive alternatives - like adult day care and senior villages - that allow seniors to live at home with their loved ones.

10. IMPROVE NURSING HOMES AND CRACK DOWN ON ELDER ABUSE: Independence is the goal, but we also need to strengthen quality and safety protection in nursing homes. Edwards will establish national standards for nursing home care, increase national enforcement against abusive nursing home chains, expand inspections and increase penalties for homes that fail to provide decent care. He will also help improve quality of care with measures like reducing patient-staff ratios and improving care provider training.

11. PROMOTE LIVABLE COMMUNITIES AND ACCESSIBLE TRANSPORTATION: Too many seniors are forced to move from their private homes because they lack supportive services or reliable transportation. Edwards will promote livable communities to make sure every American has the right to age in the setting of their choice. He will create new supportive housing options that give older Americans the choice of community-based living, vigorously enforce civil rights laws to ensure that federally-funded housing is accessible, and protect supportive services like meals-on-wheels and senior centers that sustain independent living. He will also meet the special needs of senior drivers by helping health professionals educate their senior patients about the interaction between health and driving and encourage automakers to make affordable, wheelchair-accessible vehicles. In the Edwards administration, the Department of Transportation will prioritize transportation access requirements, fund accessible mass transit like “kneeling buses” that are easier to board, and support paratransit services in rural areas.

There is much more; this is the last section of this declaration.

Utah advocates for elderly citizens are starting to educate others about the alternatives to nursing homes.

MIDWAY — Home is not only where the heart is for aging Americans; that is where they are better off and state funds for senior care programs are better spent — six times better at least.

So say Utah senior advocates, government-agency representatives and care providers. They are so sure that promoting independence of individuals is healthier to both seniors and to state coffers that they want a freeze imposed on any public funds spent on long-term care facilities.

A special panel of lawmakers reviewing state spending on Medicaid and other programs for senior and disabled Utahns will receive the proposal at its next meeting Oct. 3. The lawmakers will make a recommendation by November, and the full Legislature would still have to act on it during the 2008 general session beginning in January.

“This is simply recognizing that the traditional skilled nursing at a care center model of caregiving is on the way out,” Alan Ormsby, director of the state Division of Aging and Adult Services, said Tuesday. “I would never say there isn’t a place for long-term care centers. But when you can provide safe and often more effective services at home and at less than a sixth the cost for most seniors, we have to at least begin moving in that direction.”

I like that statement: …”traditional skilled nursing at a care center model of caregiving is on the way out”– and I think it’s starting to come to reality. Almost everyone would benefit from a change of this model; nursing homes are not a HOME no matter how hard they try. The culture changes we see within nursing homes, the Eden type models, are good. But nothing replicates being at HOME. In control of your own destiny and in charge of your own life. The more resources that are fed into this the better off we all are.

A breakdown of how much money some states are spending on alternatives to nursing home admissions.

More problems in NY State. This is about Home Health Service contracts.

New York State Attorney General Andrew Cuomo last week sued and obtained a restraining order against a Pennsylvania based company and its owners for preying on New York’s elderly by selling expensive home health services agreements and not delivering on the promises. Homeward Bound Services of North America and its owners, Marc Orth and Thomas Muldoon, are accused in the lawsuit of using deceptive and fraudulent practices to sell agreements to more than 600 New York seniors. They would promise services meant to help keep the seniors out of nursing homes and in home-based care settings and then didn’t deliver on their agreements.

Upon request of the attorney general’s office, a temporary restraining order barring Homeward Bound from selling or renewing agreements across the state was signed on August 14 by state Supreme Court Justice Joseph D. Mintz in Buffalo.

“This company misled and fleeced hundreds of New York state’s elderly citizens with a fraud that won’t be tolerated under my watch,” Cuomo said. “They exploited the fears of elderly consumers of being placed in nursing homes. Too often, disreputable businesses and individuals look to the most vulnerable in our society to line their own pockets, and I am committed to using the full force of my office to come down hard on anybody who tries to get away with it.”

Trouble with some NY State Home Health Aide Training schools:

ALBANY, Aug. 23 — Attorney General Andrew M. Cuomo announced guilty pleas on Thursday from the former operators of two schools for home health aides who sold state certifications to hundreds of people who never received proper training.

The pleas, which were agreed to in May and July, stemmed from an investigation by the attorney general’s office into the rapidly growing — but relatively lightly regulated — field of home health care.

In a statement, Mr. Cuomo’s office described the two schools as “certification mills” linked to what he called a widespread and elaborate scheme to defraud Medicaid of millions of dollars in billings for federally subsidized home health care. Both schools were licensed by the state.

Earlier this week, Mr. Cuomo announced the convictions of 10 people who had illegally billed Medicaid for work as home health aides using the tainted certificates, some of them obtained from the schools involved in Thursday’s announcement, and in some cases claiming to have worked for more than 24 hours a day.

He has issued subpoenas to dozens of the state-certified agencies that hire aides and bill Medicaid for their services, to determine whether any of them have been involved in such fraud.

The (non) aides involved with these cases are not innocent. They have been convicted as well:

Under state law, home health aides, who may administer medication, dress wounds and perform some other procedures, must go through 75 hours of training at a school and 16 hours of practical training with a registered nurse.

Schools must be licensed by the Department of Health or the Department of Education to administer certification tests for their students.

Because there is no central registry of those certifications, state officials do not know how many people are working as home health aides in New York.

Several of the home health aides convicted earlier this week received their documents from On Time Home Care Agency or Smalls Training and Counseling School.

This could be much bigger than it appears right now. What caliber of person would pay for a certificate and go to work as a Home Health Aide, with ZERO training?

Some older people are taking matters into their own hands. Setting up small communities that will provide services and care on as needed basis. They call this AGING IN PLACE…and it’s very different from those complexes where Assisted Living and Nursing Homes are on a campus.

WASHINGTON — On a bluff overlooking the Potomac River, George and Anne Allen, both 82, struggle to remain in their beloved three-story house and neighborhood, despite the frailty, danger and isolation of old age.

Mr. Allen has been hobbled since he fractured his spine in a fall down the stairs, and he expects to lose his driver’s license when it comes up for renewal. Mrs. Allen recently broke four ribs getting out of bed. Neither can climb a ladder to change a light bulb or crouch under the kitchen sink to fix a leak. Stores and public transportation are an uncomfortable hike.

So the Allens have banded together with their neighbors, who are equally determined to avoid being forced from their homes by dependence. Along with more than 100 communities nationwide — a dozen of them planned here in Washington and its suburbs — their group is part of a movement to make neighborhoods comfortable places to grow old, both for elderly men and women in need of help and for baby boomers anticipating the future.

“We are totally dependent on ourselves,” Mr. Allen said. “But I want to live in a mixed community, not just with the elderly. And as long as we can do it here, that’s what we want.”

Their group has registered as a nonprofit corporation, is setting membership dues, and is lining up providers of transportation, home repair, companionship, security and other services to meet their needs at home for as long as possible.

This is a good idea for those who don’t have a lot of medical needs. And given the spirit of these people of this generation, I fully expect them to overcome that issue as well.

Urban planners and senior housing experts say this movement, organized by residents rather than government agencies or social service providers, could make “aging in place” safe and affordable for a majority of elderly people. Almost 9 in 10 Americans over the age of 60, according to AARP polls, share the Allens’ wish to live out their lives in familiar surroundings.

Many of these self-help communities are calling themselves villages, playing on the notion that it takes a village to raise a child and also support the aged in their decline. Some are expected to open this fall on Capitol Hill; in Cambridge, Mass.; New Canaan, Conn.; Palo Alto, Calif.; and Bronxville, N.Y.

“Providers don’t always need to do things for the elderly,” said Philip McCallion, director of the Center for Excellence in Aging Services at the State University of New York at Albany. “There are plenty of ideas how to do this within the aging community.”

The rest of this article explains the ways and means of this idea; the costs and problems. While it’s a new idea, I bet it catches on all over the country. This is where Home Health Agencies could do a lot of good work as well.

Americans don’t utilize Hospice Services enough. For many reasons.

WEDNESDAY, July 25 (HealthDay News) — Too few Americans entering life’s final phase are availing themselves of high-quality hospice care, despite the fact that Medicare covers the expense, experts say.

The situation is only going to become more problematic as the nation’s “baby boomers” reach the end of their expected life spans in coming decades, according to two articles in the July 26New England Journal of Medicine.

“Hospice care is underutilized — only a third of Americans die under the care of hospice, and hospice care is free,” noted the author of one article, Dr. Gail Gazelle, assistant clinical professor at Harvard Medical School. “Far too often, patients end up in an ICU, rushed to the emergency room, and they end up dying there, when really they would much rather have died in their own home,” she added.

According to Gazelle, many of these patients avoid hospice, because they — and often their doctors — believe end-of-life care means they have “failed” in the face of disease. “They often view it as, ‘OK, someone is telling me to crawl into my bed and die,’” she said. In reality, many hospice patients lead full, mobile and high-quality lives for months, Gazelle said.

There’s also the misperception that hospice is expensive. Too often, terminal patients don’t realize that Medicare and private insurance cover the full cost of hospice care.

Read the rest of this article to learn why people don’t seem to want to have Hospice care.