Program changes make it easier for certain seniors to receive long-term care

Tuesday, October 4, 2011

Program changes make it easier for certain seniors to get long-term care

Goal is to reduce unnecessary placements in nursing homes

Changes to two programs administered by Council on Aging of Southwestern Ohio will make it easier for certain older and disabled adults to get help with long-term care.

Assisted Living Waiver Eligibility Changes

For the Assisted Living Waiver, the state of Ohio adopted a new rule that allows individuals to enroll directly in the program when they need it.Before the change, people could not enroll unless they had been on the PASSPORT in-home care program or had first lived in a nursing home or other care facility for at least six months.

The new rule opens the way for more disabled adults to enroll in the program.

In addition, people can now begin receiving assisted living services while their eligibility for Medicaid is being determined, rather than having to wait and increase the chances that they will go to a nursing home to access care.

The Assisted Living Waiver is an alternative for adults age 21 and older who need long-term care, but not necessarily in a nursing home. Ohio`s Medicaid program pays for low-income elderly and disabled adults to receive care in assisted living facilities where residents have more privacy and independence than in nursing homes. Because Medicaid covers the cost of long-term care services, clients may stretch their own resources to cover room and board.

The changes are designed to save state and federal Medicaid funds since nursing home care is more costly than assisted living. On average, it costs less than $2,000 a month to help someone on assisted living, less than half the cost of nursing home care.  

In its five-county area, Council on Aging served 470 clients on the Assisted Living Waiver in 2010, an increase of 52 percent from the previous year. Statewide, more than 3,200 people are enrolled in the program. 

Assisted Living services include 24 hour on-site response, personal care (help with bathing and grooming, supportive services (housekeeping, laundry, and maintenance), nursing, transportation, meals and recreational programming.

The program has been growing statewide, but has been limited by a lack of facilities certified to provide it and by few assisted living rooms in some facilities that do offer the program. Providers have reported that they find the Medicaid reimbursement rate to be too low or that they cannot meet certain requirements, such as private rooms and baths. There are 32 facilities and retirement communities that provide the program in Council on Aging`s five-county area.

The issue is also a concern because the program helps many people who enter an assisted living facility paying privately, but run out of money. If the facility offers the program, they can go onto Medicaid and stay. If not, they may be forced to move into a nursing home where they can access Medicaid-funded care, but at greater cost to the taxpayers. 


Hamilton County Elderly Services Program eligibility changes

A change to the Hamilton County Elderly Services Program, lowers the youngest age at which a disabled person can become eligible for the program from 65 to 60. As with the Assisted Living Waiver, the change is designed to divert more older adults from unnecessary placements in nursing homes. 

Funded by a county senior services tax levy, the Hamilton County Elderly Services Program helps nearly 8,000 adults annually with services designed to help them remain independent at home, such as Meals on Wheels, home care assistance, and medical transportation.

Because funding is limited, but need is growing as the population ages, Council on Aging has changed eligibility for the program over the past two years. In the past, the program was open to seniors with a range of disability levels.  Now, however, enrollment is limited to frail older adults who have need for a higher level of care. 

In general, the program is trying to manage growth, while providing more services to those in greatest need.

The most recent change - lowering the eligibility age to 60 - may seem contradictory, but it`s designed to help people who might otherwise go to nursing homes because they`ve experienced health crises at a relatively young age, such as early onset of Alzheimer`s disease or stroke.

As with assisted living, the Elderly Services Program is designed not only to help older adults remain in their homes and communities, but also to save taxpayers who otherwise bear the much greater cost of caring for someone in a nursing home on Medicaid. On average, the Elderly Services Program costs about $350 per person, per month, compared with about $4,200 per month for Medicaid nursing home care.

For more information about either program, contact Council on Aging at 513-721-1025 or