Program Aims to Keep More Low-Income Seniors Out of Nursing Homes

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California is expanding a program that allows low-income elderly and disabled people eligible for care in a nursing facility to stay in their own homes instead.

Between now and 2021, the Department of Health Care Services plans to expand what’s known as the Home and Community-Based Alternatives waiver program from just under 4,000 slots to almost 9,000. The program, funded through the federal Centers for Medicare and Medicaid Services, pays for skilled-nursing care, home health aides, personal care services and case management to patients in their homes or in a community setting.

Anthony Cava, a spokesman for Department of Health Care Services, said the goal is to meet growing demand for nursing-home type services among seniors and disabled people covered by Medi-Cal, the state’s health insurance program for low-income residents. Almost 3,500 people are currently enrolled in the Home and Community-Based Alternatives program, and another 2,600 are on a waiting list. The program is expected to reduce costs and improve the health of people enrolled, he said.

“The Department’s vision is a continued reduction in costly hospital and/or skilled nursing facility placements, expanded access to home- and community-based services, and improved health care outcomes,” Cava said in an email.

California’s senior population is growing rapidly as Baby Boomers reach retirement age. The state’s Department of Finance predicts the population of people ages 65 and older will jump by 2.1 million between now and 2026. According to the AARP, the vast majority of Americans want to live at home or with a relative for as long as possible, rather than in a nursing home. However, an estimated 10,000 Californians are currently in nursing facilities even though their care needs are low and they probably don’t need to be there, a report by the organization suggests.

It’s about 50 percent cheaper to manage people’s care in the community rather than sending them to nursing facilities, according to the San Francisco-based Institute on Aging. The organization currently runs two programs in San Francisco and San Mateo counties focused on keeping people out of nursing homes and transitioning people out who are already there.

The Department of Health Care Services is now contracting with the Institute on Aging and eight other local agencies to administer the expanded waiver program, rather than running the program itself as it has in the past.

Dustin Harper, the Institute on Aging’s Vice President of Strategic Partnerships, said the waiver will allow his organization to support its current efforts in San Francisco and San Mateo, and also expand services to San Bernardino and Riverside counties, eventually reaching around 600 Medi-Cal recipients in those areas.

Other agencies taking over administration of Home and Community-Based Alternatives are Access TLC in Santa Barbara county, Centers for Elders’ Independence in Alameda and Contra Costa counties, Home Health Care Management in mostly northern California, Libertana Home Health in central and some of southern California, Partners in Care in Los Angeles County, San Ysidro Health in San Diego County, the Sonoma County Human Services Department and the Ventura County Agency on Aging.

Harper said returning to or staying in the community can encourage elderly and disabled people to take better care of their health.

“When you start telling (people in a nursing home) about transitioning back to the community sometimes that means oh, maybe I can be closer to my grandkids, or maybe I can get to church on a regular basis,” he said. “They actually have more motivation to get up out of their wheelchair every day and walk the 50 steps their doctor or physical therapist is asking them to do… It’s a real motivating factor.”

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