AppId is over the quota
The intensifying federal effort to move people out of nursing homes and into the community has brought both consternation and applause among readers here.
On the one hand, some family members clearly dread the new requirement that residents be asked, once each quarter (unless they opt to hear the question annually instead), whether they’d like information on how to move back into “the community.”
I could practically hear Curios from Brooklyn groaning: “How many of us have pleaded, negotiated with our elderly parents to move into a situation where their physical and emotional safety is better cared for?”
And I can almost picture Susan in Washington State nodding vigorously: “It can only cause confusion, anger, and/or other hard feelings if the answer, as can be expected, is ‘Yes!’” A number of commenters also lamented that the very support services required for such transitions — transit, meal delivery, adult day programs — are being cut back in their cities and states.
Yet the saga of 92-year-old Edwin Murphy, back home in his Albuquerque apartment, happily reading his Bible and watching “Jeopardy!,” drew some cheers. Maybe some folks can pull it off.
It’s encouraging to begin to see the larger picture as several national studies indicate that Money Follows the Person, the official name of the federal grants underwriting many of these transitions for Medicaid recipients, does appear to allow some older nursing home residents to move out successfully.
After a slow start in 2007, when the federal money began flowing, the program’s pace is picking up. Some 43 states and the District of Columbia now receive Money Follows the Person grants, which, according to a survey by the Kaiser Commission on Medicaid and the Uninsured, have helped nearly 17,000 people move out of nursing homes. (Community living, by this definition, includes assisted living and small group homes.)
Most of those exiting aren’t elderly; they’re younger people with disabilities, say both the Kaiser survey and a series of reports by Mathematica Policy Research in Cambridge, Mass., a nonpartisan research firm. Only about a third of those moving out are over age 65. They’re not the oldest old, either: Mathematica’s report last summer on about 1,300 elderly Money Follows the Person recipients found that the greatest number were under age 75 and only 20 percent were over age 85. So Mr. Murphy was an outlier.
It’s also true that older people are somewhat more likely than younger adults to find that they can’t manage the transition and to move back into nursing homes. Mathematica found that almost 14 percent of the elderly returned to institutions within a year (and about 11 percent died), compared with a rate of about 9 percent for the whole sample.
“The elderly tend to be more frail, perhaps, and more difficult to put services in place for,” Carol Irvin, a Mathematica senior researcher, told me in an interview. “There are lots of reasons why people can’t continue to live in the community.”
Such problems tend to appear early in the experiment. Elderly participants who moved back into nursing homes did so within four to five months on average, this early data shows.
Over all, though, Dr. Irvin saw evidence that local agencies working on transitions for older adults are doing a decent job. “To keep 75 percent in the community for a year, they should congratulate themselves,” she said. And the Kaiser report found that supporting the elderly participants after their transition proved quite economical, costing on average $2,130 a month. Even in low cost-of-living states, nursing home costs far outstrip that.
But are the older people happy in their new quarters? Despite our national conviction that nursing homes are hellish places anyone would want to flee, most of the 803 participants surveyed in another Mathematica study said they had been satisfied with their lives in nursing homes: 58 percent over all, and 53 percent of the elderly. “I was somewhat surprised,” Dr. Irvin confessed.
Still, they were happier after they’d moved out. A year later, the older people reported greater satisfaction with their lives, better care and a greater sense of control and choice.
Because this is a small sample that underrepresents older adults, we should view these findings with caution. “As more data come in, we’ll see whether these results hold up over time,” Dr. Irvin said. “And we’ll use more rigorous techniques.”
As an early report card, though, this research makes the move out of a nursing home — for some older people, in some situations — sound both possible and rewarding. Money Follows the Person, originally scheduled to wind down this year, has been reauthorized through 2016. Let’s see how it goes.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
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