I WANT TO STAY IN MY HOME NO MATTER WHAT

I have yet to meet a person who told me that they wanted to live in a nursing home. In fact, very few individuals ever want to leave their home, though some find themselves much happier after they’ve moved to a communal setting, such as an assisted living residence or adult community.

Despite their best efforts, some people cannot live at home alone – the person simply needs too much care and cannot provide that care to himself any longer. Instinctively, he will begin to think of methods that will enable him to continue to live at home, and invariably, he will be led in the direction of home health aide services.

But, like assisted living residences and nursing homes, the services of a home heath aide cost a good deal of money, perhaps $2,500 to $3,500 a month. For an individual with $800 a month in fixed income, the cost may be prohibitive. This often leads to the person foregoing needed care altogether – “I’ll survive on my own” – which only causes him to deteriorate more quickly because he is not getting the care he needs. A vicious cycle.

The New Jersey Medicaid program will pay for some care in the community; however, there limitations of the program tend to force needy individuals into higher levels of care, such as assisted living residence or nursing homes. The Medicaid program that will pay for the services of a home health is known as Community Care Program for the Elderly and Disabled, or CCPED.

The “fact sheet” on this program that the State publishes indicates that the program will pay for “case management, home health, homemaker, medical day care, non-emergency medical transportation, respite care, social day care, and prescribed drugs.” CCPED has a limited number of available spaces, meaning that even people who qualify for the program may, and often do, have to wait on a list before becoming entitled to benefits.

In numerous discussions with county social workers responsible for assessing a qualified individual’s care needs, I’ve learned that the maximum daily home health benefit that a person can receive under the program is between four to five hours. In other words, CCPED will not pay for a live-in home health aide, which is what many people need and from which they would benefit.

CCPED, as you may have noticed, will, however, pay for a number of services other than home health aide services, such as respite care and adult day care services. These services in combination with the home health aide services could serve as a comprehensive stop-gap measure that could enable an individual to remain in the community.

Adult day care centers are facilities designed to provide some medical and social care to seniors. The senior may live with a child who works during the day. The child doesn’t want to leave the parent home alone – perhaps because of a fear of isolation or perhaps because the senior has memory lapses and is a danger to himself. The adult day care center offers a viable alternative to leaving the senior home alone.

CCPED will help with the payment of adult day care centers. This, in combination with the home health services, may prevent the senior from having to live in a nursing home. For example, with care provided during the day, the child might only need a home health aide four to five hours a day in the evening and in the early morning.

Arranging for such limited services from a home health aide service may be difficult, if not impossible – most agency want to place live-in home health aides, not aides for only two hours in the early morning and two hours at night – but in theory, CCPED could be used to prevent nursing home placement and to ensure proper care. Of course, there is a strong argument to be made for the State increasing the amount of home health aide services that the CCPED program can provide.

If the program were able to pay for a live-in, the number of people who need more costly nursing home placement might decrease significantly, which in the end, would alleviate the State’s Medicaid budget, not expand it. Since a live-in home health costs $2,000 to $4,000 less than a nursing home on a monthly basis, expanding the CCPED program could actually decrease the cost of long-term care in this state.