Seniors may be at home, but they're not alone
The Tampa Tribune - December 20, 2009 | Mary Shedden
"Get me out of here."
That's all Bill Moore thought as he lay in a nursing home bed a few years ago. An aneurism had sidelined him, and he hated being there, waiting 15 or 20 minutes for a nurse to help him get to and from the bathroom.
Sure, he needed some help, the longtime traveling trophy salesman thought. But there was plenty he could do solo.
"I went just berserk over it," said Moore, 83. "I had a nurse there convinced if I wasn't out (soon) I was going to crawl across the street and over to the 7-Eleven and call my ex-wife to get me out of here."
He didn't need to escape; the nursing home released him soon after. But Moore, like a growing number of elderly Americans, couldn't live alone at home or afford a private room in an assisted living facility, which can cost more than $36,000 a year.
Friends helped him land in a program offered within Tampa's Palm Avenue Baptist Towers. It's part of an emerging segment of affordable housing: assisted living facilities that allow low-income seniors to remain partly independent in an approved housing complex. Residents get help with daily living activities such as preparing meals, bathing, dressing, housekeeping, and managing daily medications and doctor appointments. What doesn't take place is full-time medical care, something mandated at nursing homes.
Though assisted living facilities are popular in the private sector, up to a third of the people needing this help can't afford it, national surveys show. So those who rely on government Medicaid support often are stuck, attempting to remain independent or being prematurely placed in an expensive and emotionally debilitating nursing home environment, affordable-housing advocates maintain. "It's very easy to get lost in the shuffle," said Conchy Bretos, chief executive of the for-profit MIA Consulting, which manages affordable assisted living programs in 24 states, including the one at Palm Avenue Towers.
Elderly people qualify for this program by applying for Medicaid waivers designed to support full-service nursing home care. This fiscal year, Florida has $33 million set aside to assist, said Mark Benson, with the Pinellas/Pasco Area Agency on Aging.
Popularity is rising
Today, there are 2,723 Floridians and 282 Hillsborough County residents receiving Medicaid waivers for programs such as Palm Avenue Towers, said Katie Parkinson, program manager for the West Central Florida Area Agency on Aging. The agency has money to add 120 more Hillsborough residents to the program, she said.
"This is a viable option for them if they are no longer able to care for themselves," she said.
The concept of diverting elderly adults from nursing homes is increasingly popular. In September, AARP settled a class-action lawsuit when the state agreed to spend up to $23 million next year shifting qualifying low-income seniors from nursing homes to assisted living facilities.
Locally, there are several programs operating in subsidized housing complexes in cities including Tampa and Pinellas Park. The state recently agreed to increase the number of Palm Avenue Towers apartments for assisted living services to 60 from 48. The rest of the 199 units are for low-income seniors living independently.
"They need assistance, but we want to encourage and foster their independence, not to just stick them in kind of a warehouse setting," said Michelle Capurso, administrator of the Towers program, which provides a first-floor dining hall for meals and activities such as crafts and bingo.
Moore, who has trouble remembering his age, said he is far healthier now that he has someone cooking for him and keeping him busy. He is motivated to stay active and is excited that physical therapy has him nearly able to move without his walker.
"Right now, due to the work of these people right here ... I'm almost ready to walk without any help," Moore said. Not everyone qualifies for the program, which requires residents to get a state Medicaid waiver to help cover long-term health care costs. Residents must be at least 65, make less than $23,000 a year - about $1,900 a month, in pay, pension or other support - and cannot own a home. More importantly, they must show a clear need for help in at least three daily activities, such as bathing.
At Palm Avenue Towers, 30 percent to 40 percent of the assisted living residents rely only on a monthly Social Security check for $674; the rest get no more than $1,000 a month, Bretos said. The program receives all but a small portion of each resident's monthly support in exchange for the housing, food and other services.
This type of long-term care saves significant money for government agencies accustomed to paying for nursing home care, said Bretos, who served as Florida secretary for aging in the 1980s. She estimates that nursing home care costs Medicaid $120 a day, on the average. She said her program costs Medicaid $28 a day.
Private sector comparisons
Assisted living is far less expensive than nursing home care, even in the private sector. The National Center for Assisted Living estimates that a private unit at an assisted living facility costs $3,022 a month on the average, or about $101 a day. By comparison, a private room at a nursing home's average cost is $6,390 a month, or $213 a day.
Although there may be savings to be had by shifting people out of nursing homes, it is not a cure-all for every elderly person needing help with their daily routine, said Kristen Knapp, spokeswoman for the Florida Health Care Association, which represents private facility providers.
She said it's critical that each person be properly assessed for care, and that many may best be served in a medically staffed nursing care facility.
It's also a concern that legislators are not increasing the financial support for long-term health care for the elderly. Instead, money is being diverted to take care of what is a growing population of seniors needing some level of care.
"You should not take money away from one sector and give to another," she said. "That affects the level of quality care."
That concern is magnified as lawmakers in Washington debate health care reform. Two weeks ago, a Senate revenue estimate conference predicted that Medicaid expenses would rise 17.4 percent next year. The potential budget shortfall in that same period: $1.6 billion, Knapp said.
The issue, however, is about far more than money to people such as retired Tampa beautician Mary Herttell, 93. She thrives on the activities at Palm Avenue Towers, where she has lived for almost four years and still cooks eggs or pasta occasionally in her tiny, tidy kitchen.
She loved living on her own, but her mobile home grew lonely, the widow said. Although family in town still visit and help her with trips to the doctor, she knows she needs someone coming by every morning, without fail.
"I love when they come in and say, 'How are you? Are you OK?'" Herttell said. "It makes me feel good because maybe they find me gone or something."
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