Nursing Home Alternatives - Community Options Increasing in Massachusetts

The state of Massachusetts has committed itself to a "Community First" philosophy, which means that care at home or in the community is the first resort, and nursing home care the last resort. There are many options these days to help you live at home. Knowing who to talk to is the place to start.

First it's important to understand that many people do need nursing home care. But for others, nursing home care is not necessary. 24% of the people in nursing homes in the Commonwealth can eat, bath, dress, walk and toilet by themselves. Massachusetts has a very high rate of institutionalization compared to the rest of the country. In 2006, 101,300 Massachusetts residents spent some time in a nursing home. Three out of four of these people were age 75 or over, and 68% were women. About 90% of the nursing home beds in this state are occupied, compared to the national average of 84%. Massachusetts has the 14th highest number of nursing home beds per person age 85+. We have the fifth highest percentage (30.2%) in the nation of people over the age of 85 who have had at least one stay in a nursing home. At the same time, 27 other states in the country spend a greater percentage of their money on community based care than Massachusetts. The Commonwealth is slowly trying to "rebalance" how it spends its tax dollars on long term care.

Even though the number of people spending some time in a nursing home has been rising slightly, the total number of "patient days" has been falling. The bed days paid for by Medicaid fell by -17% over the past five years. This is partly because more and more people are going in for shorter and shorter stays. They are coming back out with home care supports. More people are taking advantage of short-term rehabilitation, and then returning home.

Knowing whether nursing home care is right for a loved one involves talking with your local Aging Services Access Point (ASAP) agency. Every city and town has an ASAP. These agencies have staff who specialize in counseling families on what kind of long term care they need: everything from day care programs, to new residential options. In some circumstances, the state now allows family members (with the major exception of spouses) to be paid as a caregiver. Other programs allow you to hire your own worker. You can live in the home of another person, or have care brought into your home.

Begin by checking out your options before you need them by calling Somerville-Cambridge Elder Services, the ASAP for the two cities, at 617-628-2601. To find out about options in other communities, call your local ASAP at 1-800-Age-Info, and press "3." Or go to www.800ageinfo.com and click on "Age Info Centers" to see a map covering the entire state. When you call the ASAP, ask to speak with an Information specialist, and tell him or her you want to learn about alternatives to nursing homes. They can also help you search anywhere in the country.

Finding a Good Nursing Home

In Massachusetts, 80% of the people who enter a nursing home come from a hospital first. If a hospital discharge planner says your Mother must be out in 24 hours, and gives you a list of area nursing homes---you are suddenly under pressure to make a decision. But the goal in our state is to make nursing home care a last resort, so be sure to ask for home care alternatives as your first resort. And then:

• Extend your hospital stay: Use your appeal rights under Medicare to extend the hospital stay for two days. Ask for a "notice of non-coverage." That will buy you additional time.
• Check out alternatives: Call 1-800-Age-Info, press "3" to be connected to your local Aging Services Access Point (ASAP). Ask to speak with a nursing home screener. Somerville-Cambridge Elder Services is the ASAP for the two cities (617-628-2601 ext. 3151). If your relative is on MassHealth, inquire about the "community choices" program as an alternative to nursing home care, or the personal care assistance program.
• Get the names of local facilities: Your ASAP can give you a list of nursing homes and put you in touch with your local nursing home ombudsman. Ask that person about their experiences with area homes-good and bad.
• Look for report cards: The federal government maintains a "Nursing Home Compare" website at www.medicare.gov that will give you info on local homes. Also go to www.consumerreports.org and look for their "Nursing Home Quality Monitor."
• Check the ownership: Look first at the independent, non-profit homes, rather than at a for-profit chain. Non-profits or religious groups usually have a mission to help people, not just their bottom line. Ask if the home has changed owners multiple times. If the facility is part of a large chain, you may have a harder time complaining about bad care.
• Visit Several Times: If you’ve got one or two homes on your list, make unannounced visits. Stop by after breakfast to see how many people are still in bed. Visit at dinnertime and taste the food yourself. If residents are eating in their rooms, that’s not a good sign. Ask the nurse aides how many residents they each care for. The smaller the number, the better.
• Read the Reports: Ask for the home’s Form 2567. That’s the state inspection survey. If you have difficulty obtaining it, that’s not good. A survey with lots of violations indicates problems. Ask if the administrator and the director of nursing have worked at a facility for several years, that’s a positive sign. Frequent turnover of key staff can indicate bad morale or mismanagement.
• Talk to the administrator: What is his or her philosophy of care? Is this philosophy written down and given to families to read?
• Do advance research: Nursing homes are an expensive investment. Do some research before a family member needs care. Ask your ASAP about what alternatives exist in the community for people who might need nursing home care, and learn those options first.

Choices Program Offers Real Alternative to Nursing Homes

The Community Choices Program is offered by Somerville-Cambridge Elder Services and other Aging Service Access Points across the Commonwealth to very frail, nursing home eligible invididuals. With the help of this program, these individuals have the opportunity to remain at home rather than receive care in an institutional setting.

Community Choices provides intensive services to individuals who are at imminent risk of nursing facility placement and whose needs cannot be adequately met by other State Home Care programs. They receive a range of services that can help avoid nursing home placement - services such as homemaking, personal care, companion, and adult day health. Eligible individuals are: age 60 and over, are eligible for MassHealth, are at imminent risk of nursing home placement, and need additional supports to remain at home.

For more information about the Community Choices Program, please call the SCES Aging Information Center at 617-628-2601 ext. 3151.