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Staying home long term

By: Emily Bregel
(Contact)

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Patti Killingsworth

Tennessee’s long-term care system is undergoing reform that state officials hope will give better — and cheaper — options to the state’s elderly and disabled population.

Gov. Phil Bredesen promised $12 million in new state money for home and community-based services in next year’s budget that will bring Tennessee closer in line to other states that fare better at providing and funding nursing home alternatives, he said.

“The stuff I’m proposing on long-term care, I’d like to tell you it was leading edge — it’s not. It’s catching up with the trailing edge,” the governor said in a recent meeting with the Chattanooga Times Free Press.

Tennessee ranks last out of the 50 states in the proportion of long-term care funds devoted to home and community-based care, said Patti Killingsworth, TennCare chief of long-term care.

This year 98 percent — or almost $940 million — of the state’s $1.1 billion in long-term care funds went to nursing homes.

The new money will provide coverage for 2,300 more people on the state’s home and community-based care Medicaid waiver, which currently can cover 3,700 Tennesseans.

Gov. Bredesen also wants to streamline the process for residents to be approved on the home and community-based care Medicaid waiver and to make it easier for nursing homes to expand services into clients’ homes.

Staff Photo by John Rawlston — Mary Lisa Smith of Rosewood Support Services performs housecleaning duties for Angel Lumpkin, foreground, who has cerebral palsy and uses a wheelchair. Mrs. Lumpkin recently was approved to receive the services under a Medicaid’s waiver.

“To the extent to which (nursing homes) develop these services ... you’re going to see it as a rich new source of business,” Gov. Bredesen said.

The new state funds are a step in the right direction, said Rep. Dennis Ferguson, D-Midtown, chairman of the Joint House and Senate Committee on Long-term Care.

“I would like to see more, but it’s a start,” he said. “We want people to stay home as long as they want to stay home. Down the road and around the corner services is what I want to give them.”

Nursing home industry officials said they support at-home services for those who don’t need 24-hour-a-day care. They also want to ensure that nursing homes don’t lose money they need to operate.

“We have encouraged home and community-based services, but not at the expense of nursing home patients,” said Ron Taylor, executive director of the Tennessee Health Care Association, which represents nursing homes in the state.

The $12 million promised for nursing home alternatives is new money and is not taking anything away from nursing homes, but as more people sign up for home-based services, the state will reallocate more of those long-term care funds to nursing home alternatives, Ms. Killingsworth said.

paving the way for cost-effective care

The wait to be approved for home and community-based services can be months, said Patrick Willard, director of advocacy for the Tennessee AARP.

“There are a lot of roadblocks out there to finding providers and to being able to get on the program quickly. Those roadblocks need to be removed,” he said.

For East Ridge resident Caren Krasno, 50, full-time nursing home care would be “a waste of money.” Ms. Krasno is partially paralyzed on her left side because of epilepsy encephalitis as a child. She gets homemaker services three times a week through the home and community-based services waiver, but is self-sufficient otherwise.

“They’re just helping me on an as-needed basis here,” she said. Independence “ is vitally important to me.”

State officials expect to face an increasingly unmanageable financial obligation to cover the long-term care needs of an aging population that will continue to grow in the Volunteer State.

Home and community-based care can be a much cheaper alternative to nursing home care, state officials said.

The average cost for a Level 1 nursing home resident here is more than $50,000 a year, compared with the $20,000 that TennCare budgets for each person receiving home and community-based services, and most people end up using less than that, Ms. Killingsworth said.

“Not only is it more cost-effective to keep people at home, but it’s a more cost-effective solution that people want,” said Marilyn Wilson, spokeswoman for TennCare.

Medicaid pays for 22,000 of the state’s 30,000 nursing homes residents — about 73 percent, Ms. Killingsworth said.

“When we look at the fact that the 65-and-older population is going to more than double and the 85-and-older population is going to more than triple as baby boomers come of age, we can’t sustain those kinds of costs if the primary model that we continue to use is nursing home care, even when people really could and would prefer to receive care at home,” Ms. Killingsworth said.

Chattanooga resident Angel Lumpkin, who has cerebral palsy and uses a wheelchair, began receiving at-home services through the home and community-based care waiver in January.

“I want to stay as independent as possible,” said Mrs. Lumpkin, who has a 5-year-old daughter. “I take care of my daughter, I take care of myself, but the vacuuming and stuff like that I need help with.”

The waiver program “allows me to stay in my home and be a vital part of the community,” Mrs. Lumpkin said. “If I had to go to nursing home right now, it would just be devastating to me.”

lower THRESHOLD in TENNESSEE

Under federal law each state must define the level of care needed to be approved for nursing home care, using criteria such as mobility and ability to feed and bathe oneself, Ms. Killingsworth said. Tennessee has a lower standard to approve nursing home care than most other states.

Here, if someone needs assistance in just one of these so-called “activities of daily living” categories, on most days of the week, that person will qualify for nursing home care, Ms. Killingsworth said.

Almost every other state requires deficiencies in at least two or three categories, she said.

The result of Tennessee’s lax standards is that people are approved for nursing home care when they may be better — and more cheaply — served in a more independent setting, said Steve Witt, of the Southeast Tennessee Area Agency for Aging and Disability, which administers the area’s home and community-based services.

“As our elderly population continues to grow, there’s just going to be no end to the need for nursing home care, but we’ve got to provide these other alternatives so that people have a choice and so that they get the care they need and it’s also a money-saver for the state,” he said.

* 73 percent: Percentage of the state’s 30,000 nursing home residents that Medicaid pays for

* 2 percent: Percentage of long-term care funding that goes to nursing home alternatives:

* 98 percent: Percent of long-term care funding to nursing home facilities

* $50,417: Annual cost of Level 1 nursing home resident’s care ($138.13 per day)

* $20,000: Annual budgeted cost for someone receiving home and community-based waiver services

Source: TennCare Bureau

LONG-TERM CARE SEMINAR

* What: Stephen Moses of the Center for Long-Term Care Reform will speak about awareness on long-term care issues, financial planning and the future of Medicaid and Medicare.

* When: Today at 7 p.m.

* Where: The Brainerd Baptist Church’s Brainerd Crossroads building, 300 Brookfield Ave.

* Cost: The event is free and open to the public.

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