By CAITLIN COOK
On a given day, Brienne Allison, 41, may be getting ready for a date with her boyfriend, entertaining a friend or listening to Van Halen on her stereo.
That she is doing these things at her own home was unthinkable just a few years ago when she was living in the Essex of Salem I nursing home.
“They are still allowed to have a life outside of that facility if they want to go,” said Kathy Janecko, a long-term care ombudsman for the Area Agency on Aging.
Many Medicaid recipients, such as Allison, who were in long-term care, found it nearly impossible to leave.
Money from Medicaid would be allocated for an entire fiscal year to the nursing home and wouldn’t be available for any other form of care. This resulted in many residents, who were physically and mentally capable of living on their own, being stuck in long-term care facilities because of financial reasons.
In 2007, a new national waiver program was developed and implemented in Ohio — HOME Choice, Money Follows the Person. The program helps seniors, people with mental illnesses and people with physical and developmental disabilities leave nursing homes and long-term care facilities and move into their own homes. Now, all but seven states participate.
The program was developed as a way for states to spend less money on Medicaid.
Eventually, states found they spent $31,000 on home and community-based care services for each participant — a third less than what they had been spending on institutional care for the same person, according to the latest Mathematica Policy Research Money Follows the Person 2010 annual evaluation report.
In Ohio, nursing-home spending accounted for 11 percent of the total state budget in 2010, 10 percent in 2011, and 9.25 percent in 2012. So, the state went from spending $2.68 billion on nursing home care in 2010 to $2.44 billion in 2012.
For the first year after moving out of a nursing facility, HOME Choice participants receive up to $2,000 (for moving expenses), ongoing home medical services and community resources, such as transportation and nutrition counseling.
The program allows people to have a better quality of life, said Sam Rossi, public information officer for Ohio’s Office of Medical Assistance. They can choose when to get up, when to go to bed, what and when to eat, whether to get a job and whether and how to participate in their community.
“The best part of the program is seeing their face when they come home because they are so excited. This is theirs to start again,” Janecko said.
As of Sept. 28, Allison is one of the 2,580 long-term-care patients in Ohio who have moved from one Ohio’s 956 nursing facilities to their own home. Of those, 185 residents were re-institutionalized for more than 60 days. Also, as of Sept. 28, there were 1,363 nursing-home residents who had started the waiver process in an effort to move out of their nursing homes.
Ohio represents about 10 percent of all transitions nationwide, according to Ohio Jobs and Family Services. By 2011, more than 12,000 residents nationwide moved out of long-term care facilities. Of those, 85 percent were able to remain living on their own for a year.
Omsbudsmen are always looking for waiver candidates while on routine checks to nursing facilities. It was during one of Janecko’s visits to Essex, that she met Allison.
“When we find residents that can make it out in the community, we start talking about the waiver program,” said Janecko.
At the start of her nearly three-year stay at Essex, Allison thought she could handle living in a nursing home. As her health improved, however, she realized she did not belong there. At 39, she was significantly younger than most residents.
“I knew what I wanted to do,” Allison said looking back. “I was bound and determined to get it, and I met [Janecko].”
Allison’s health issues began when she was 5 and doctors removed a brain tumor. After that, she attended public school in East Liverpool and enjoyed her friends.
Everything was fine for several years until she developed another life-threatening brain condition. Doctors inserted a shunt to control swelling in her brain. When that shunt became infected, her condition worsened and she was taken to Essex to recover.
Upon arrival, Allison couldn’t move or speak. In time, Allison became aware of where she was, began talking and began to move with the use of a walker.
Allison, who is physically disabled from the effects of the brain injuries, has no family nearby. Her mother died, and she has no idea where her father is living. The chances of her being able to leave the nursing home without family help seemed impossible.
That first meeting with Janecko changed everything, however. Allison spent 12 months thinking about making the transition out of Essex.
“[Moving out] seemed like it would never come,” Allison said.
She found an apartment in Columbiana County. Within a week, Janecko had picked up the lease and filed the paperwork. Allison’s $2,000 waiver went toward the first month’s rent, a security deposit, furniture and food. She moved in Sept. 10.
Her apartment, a one-bedroom in New Waterford, is in a quiet area where she enjoys walking around the neighborhood.
Although Allison has never been capable of maintaining a job and must rely on state transportation or her boyfriend for rides she feels freer than ever.
She also has the help of a shower aide, who comes by five days a week. The aide also cleans dishes, reminds Allison to take her daily medication, does general housework and helps with other needs.
Janecko said $2,000 doesn’t go far, but it does pretty well for someone just getting started. Allison also receives a monthly Supplemental Security Income check for $700 and food stamps.
The federal grant gives Ohio $91.5 million through 2012. Through June 30, the state has received more than $73.4 million in federal funds. Also, the state spent $16 million in nonfederal funds on the program.
While Rossi is pleased with the Ohio program, there are flaws. There is a shortage of direct-service workers, accessible and affordable housing and reliable transportation, he said.
The Patient Protection and Affordable Care Act, better known as Obamacare, extends the program through September 2016. Any remaining money at the end of each fiscal year may be carried over into the next. Unused grant funds awarded in 2016 can be used until 2020.
“While it’s very difficult to predict the political and fiscal landscape beyond 2020, it is our hope that individual choice will continue to be valued well into the future,” Rossi added.
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