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Program Pays Families to House Seniors
By Alice Dembner, The Boston Globe
July 8, 2005
Massachusetts has begun paying family members to house and care for their frail older relatives in an effort to keep them out of nursing homes and save the state money.
The program pays $1,500 a month to caregivers to make it more feasible for family members to provide round-the-clock care to a senior who needs extensive help with everyday tasks, such as eating, bathing, dressing, and using the toilet. It has enrolled 21 seniors since beginning on a trial basis in March, and will expand this fall to as many as 80 low-income seniors or disabled people, funded by $2 million in the state budget signed into law last week.
The state's goal is to provide the housing and home care that seniors want while reducing admissions to expensive nursing homes. The state expects to spend $1.6 billion for nursing home care this year.
''It's offering people a more compassionate level of care provided by people they know they're comfortable with . . . at a cost about half that of a nursing home," said Representative Barbara L'Italien, an Andover Democrat who pressed for inclusion of the money in the budget. She and other officials expect the program will be expanded to serve many more in future years.
Advocates say as many as 8,000 people could be eligible, depending on the criteria ultimately set by the state.
A growing number of states pay family members to house and care for seniors. But the practice has spread slowly because some people question whether society should pay for services that relatives have long provided for free. In addition, there are concerns about the quality of care and potential abuse of seniors.
The Massachusetts program, called Caring Homes, is the latest state effort to help ailing seniors remain in their communities. Massachusetts has historically had a larger percentage of its seniors in nursing homes than many other states -- in 2001, 6.8 percent of those over 65 were in nursing homes here, compared with 4.4 percent nationally.
Under a similar program called Adult Foster Care, which has been available for years, the state pays people to take in seniors and disabled people who need help. But that program excludes relatives as caregivers because of societal concerns about government paying family members.
Separately, disabled seniors may pay family members with state funds to provide several hours a day of personal care, but that service does not provide housing or continuous care. Caring Homes is the first state program to combine housing with paid caregiving by relatives, though federal rules require that the program exclude spouses and dependent children as caregivers.
''It's been wonderful," said Eleanor Smith, who moved her 81-year-old father, Gerald Dupuis, into her rural Templeton home last winter, shortly before the program started. Dupuis had repeatedly fallen out of bed in his elderly housing apartment and was living on fish sticks and chicken nuggets -- an unhealthy diet, particularly for a diabetic such as Dupuis. Bad balance, weak legs, and confusion compounded his more serious ailments of congestive heart failure, kidney trouble, and lung disease.
''I had promised him that I wouldn't put him in a nursing home," Smith said, but ''he couldn't be on his own anymore."
Smith, 42, had been missing more and more work caring for her father in his own home until she had to quit her job as manager of a beauty supply store.
Without the state stipend, she said, she couldn't afford to stay home with him. Not only did the family lose her income, but expenses rose with her father home all day and on oxygen.
At Smith's ranch house, Dupuis is only a few miles from Gardner, where he lived all his life. He maneuvers around the house with his walker, tethered to a hose from an oxygen tank, but can also go outside onto the deck or make midnight raids on the cookie jar (stocked with diabetic-friendly treats).
''If I had to go to a nursing home, I wouldn't take my medicine and I wouldn't eat," Dupuis said. ''If I'm going to die, I want to die here. I love it here."
The program was proposed here by Mass Home Care, an association of nonprofit home care providers that is being paid to help administer Caring Homes. It is modeled on a program in Oregon, which was the first in the nation when it was set up in the 1980s and now serves 2,000 seniors.
''It's good public policy that supports family care, home-based care, and is cost-effective," said Cindy Hannum, an administrator in the Oregon Department of Human Services. ''Some states have been against this because it seemed like paying families for what they should do anyway. But in real life, it's hard for families, since they have other obligations."
Nationwide, more than 8 million family members are providing unpaid care for loved ones 50 and older living in their household, according to a survey conducted last year by AARP and the National Alliance for Caregiving. Many who were providing constant care told surveyors it posed a financial hardship.
In the Massachusetts Caring Homes program, federal Medicaid rules exclude spouses and dependent children from being paid caregivers. But Vermont and North Dakota, which have similar programs, have won federal waivers or use state funds to include spouses. Massachusetts supporters hope for the same.
''We believe there are thousands of family members who would like this opportunity to take care of a loved one in their home," said Al Norman, executive director of Mass Home Care.
While the programs have gotten high marks from consumers in other states, concerns remain.
''There are times when the caregiver is exploiting or harming or neglecting the patient, and it's very hard for the patient to fire their own family member or even report that things aren't going well," said Joanne M. Otto, executive director of the National Adult Protective Services Association. She said that in 60 percent of elder abuse cases, the abuser is a family member.
''In addition, well-intentioned family members may not be trained caregivers," she said. ''There needs to be support and oversight."
Before the state begins paying a family for the care, state contractors evaluate the senior's needs, the home's safety, and the caretaker's qualifications. The care is monitored by a nurse, who visits monthly, and a case manager who checks on the family regularly.
''While there are still circumstances where nursing homes are the right choice, the only choice should not have to be institutional care," said Perry Trilling, assistant secretary of Elder Affairs.
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