Keeping People at Home, Out of Nursing Homes

Anita Cole knows that her life of 75 years is coming to an end.

Still, she says from the hospital bed near the DVD player she uses to watch “The King and I” in one of six bedrooms in the Blackstone home of her daughter and son-in-law, “I’m lucky” because there are so many people who are worse off.

She did not feel so lucky during the year she spent in a nursing home just over the state line in Woonsocket. By the time she left it and arrived nearly two years ago in the six-bedroom home of Jackie and Alan Morrissette, with the help of Tri-Valley elder services in Dudley, she had bedsores you could put your hand in, said Jackie Morrissette, Mrs. Cole’s daughter.

Mrs. Cole, who used to fix knitting machines in the mills, said that some aides and nurses were kind and attentive, but Mrs. Morrissette said that some of them abused her mother.

Tri-Valley was a godsend, Mrs. Morrissette said. Even though Mrs. Morrissette used to work as a certified nursing assistant in nursing homes and as a certified medical technician, clearing the trail through paperwork by herself and coming up with a proper plan to bring her mother home would have taken far longer without the agency’s help, she said.

The Morrissettes sold their pizza restaurant and Mr. Morrissette became a personal care assistant about two years ago. Now he makes a living from the paid shared living arrangements they have taking care of Mrs. Morrissette’s mother, who has latter-stage Parkinson’s disease; a 74-year-old woman with physical ailments and mental disabilities; and a 37-year-old Vietnamese woman with severe physical and cognitive problems.

Mrs. Cole and her two housemates are benefiting from the home atmosphere and family-style care that the Morrissettes provide, but so are taxpayers.

Albert Norman, executive director of Mass Home Care, an association of 30 nonprofit agencies serving the elderly, said that “somewhere around 15 percent of people in nursing homes today could come out” if there were proper support. That would be about 5,000 of the 30,000 nursing home residents on Medicaid, he said.

Many nursing homes charge $58,000 a year, Mr. Norman noted. The annual cost of serving disabled elderly people in the community averages $26,000, less than half the cost, he said

Already support programs enable 10,000 Massachusetts nursing home-eligible people to live in homes in the community, Mr. Norman said. That saves the state and federal governments $580 million a year.

Massachusetts Senior Care Association, whose members include nursing homes, questions whether 5,000 nursing home residents could live in the community, according to Scott Plumb, senior vice president. The state, with its “cataclysmic budget” is not adding services but cutting back adult day health and other programs, creating waiting lists to get community services, he said.

“If somebody can be cared for safely and effectively at home, that’s where they should be cared for. Nursing homes are not in the business of taking care of people who don’t need to be there,” Mr. Plumb said. “There are some people in nursing homes, particularly with mental illness, who if the state were to make a strong, funded commitment to community care, that they could be cared for in the community.”

Since February or March, five agencies in the Worcester area have formed the Aging and Disabilities Resource Consortium, according to Ellen M. Messier, director of programs for the Center for Living & Working in Worcester. Besides Center for Living & Working, they are Central Massachusetts Agency on Aging, Elder Services of Worcester Area, Montachusett Home Care and Tri-Valley Inc.

“The point is to have no wrong door,” Ms. Messier said. The agencies are collaborating, so they know each others’ services.

If an elderly person or someone with disabilities who needs help living on their own calls the “wrong agency,” that agency will connect the right agency to the caller, she said.

Mr. Norman said the 11 consortiums across the state will fight the “silo” concept of service provision that separates services for elderly people from those for people with disabilities, when some people may need both. “Individuals don’t age in silos,” he said. The same person may need services to transition from middle age into old age.

Ginger Wills Howe, Tri-Valley program director for home and adult family care, said that long-term options counselors under the consortium will be an important addition to the outreach work the agencies already do. With a $2.5 million infusion from the state Legislature, the options program will go to people, usually when they are in a hospital, to counsel them on how they can return to the community rather than enter a nursing home, Mr. Norman said.

There has been a 20 percent drop in nursing home patient days in Massachusetts over the past nine years, he said. He’d like to see that trend continue, believing the state can reverse its ratio of 61 percent of Medicaid money — $1.5 billion — going to nursing homes and 39 percent spent on community care, much as he said Oregon and Washington state already have done.

Sometimes all that people who are not nursing home-eligible need is three hours a week of personal care services, the Mass Home Care executive director said.

Karen S. Monroe, 60, spent three months in UMass Memorial Medical Center — Memorial Campus after a motor vehicle accident that left her in a wheelchair, and then 3-1/2 years in the Odd Fellows Home. She said that her daughter’s home in Dudley, where she lived before the accident, was not accessible, and that she languished in the Odd Fellows home 2-1/2 years longer than she thinks she needed to be there. Finally on June 1, with the help of the Center for Living & Working, she got an apartment on Pleasant Street from the Worcester Housing Authority.

While Ms. Monroe said she was well taken care of at Odd Fellows, “I have more freedom here,” she said. She can cook for herself or sit outside or go to the nearby CVS, she said.

Ms. Messier of Center for Living & Working said the tragedy of living in a nursing facility when you don’t need to is that “You’re isolated, when you can be out in the community and doing things and living independently. There’s nothing better than being able to live independently.”
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