Despite Funding, Moving from a Nursing Home Back to The Community is Difficult

The Deficit Reduction Act of 2005 was created to reduce barriers that allowed people to move from nursing homes back to the community. The biggest allocation of funds by Medicaid in 2007, The Money Follows the Person program, allocated $1.7 billion to 30 states with the goal of transitioning 38,000 individuals away from nursing homes. As of June 30, 2011 only 15,818 individuals had actually moved to community care despite the fact that the funding was increased to $4 billion in 2010 and 13 additional states were included in the program. With this additional funding, participating states have until 2019 to meet their targets and until 2020 to spend the funds. Florida was among the 13 states that were approved under the program but failed to secure the needed administrative funds for implementation of the program. In fact, states are given great flexibility by the federal government to use these funds to reduce waiting lists, conduct research and other activities that help rebalance their long-term program. Rebalancing means increasing the funding for community care and decreasing the amount spent on nursing home care.

With so many seniors currently living in nursing homes and wishing to go back to the community it’s a wonder why so little progress has been made. The numbers of transitions vary sharply by state. Some like Texas and Ohio have transitioned thousands back home or to assisted living facilities. Others like North Carolina, Missouri and Kentucky have moved fewer than 500. Our firm has worked in North Carolina and Kentucky and these states have very strong nursing home lobby’s preventing the increase in community care. Some states have found it hard to move the elderly with only 1/3 of transitioning individuals being 65 years and older. 900,000 individuals living in nursing homes are in fact eligible to be transferred. Barriers to transfers reported by the states are the lack of state funds (federal funds must be matched by state funds) and the absence of affordable housing and community care providers.

Our experience, having worked with the program, is that other barriers exist which include very strict requirements by the federal government as to eligibility of both the individuals and the place they are transitioning to. For example, in order for an assisted living facility to be eligible to take clients they must offer full apartments with kitchens, a separate bedroom and dining space. The client must have lived in the nursing home for 90 days. But more importantly is the reluctance of some states to stop relying on nursing home care for the growing number of seniors; a reason that is more political than financial.

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