For decades those involved in elder care research have known that the vast majority of seniors would prefer to age in place at their own home instead of moving into a long-term care facility. Yet, our New York elder law attorneys know that for most of that time little was done to actually help seniors leave a nursing home or not enter it in the first place. Historically, only those who had conducted elder care planning well ahead of time (or were independently wealthy) had choices when they reached a point when they needed day-to-day living care.
Fortunately, times have changes. As an online article in last week's New York Times discussed, Medicaid rule changes now require senior and disabled care givers to be more proactive in helping these residents leave the facility if they are willing and able. In the past, most caregivers would ask residents if they wanted to move back to the community, but the law did not demand that they actually do anything to help the senior move. Now, if a resident mentions that they would like to move back home, the senior caregiver is obligated to connect the senior to an outside agency that will look into the feasibility of their moving back home.
The change reflects new national trends in long-term care. In the context of maximizing the quality of life for area seniors, this is a welcome development. The author notes that in the past "Medicaid, which pays for most long-term care, was spending way too much on care in the places nobody wanted to be--nursing homes--and very little on care in the places almost everyone preferred--their homes." The shift has been steady. In 1999, roughly 75% of Medicaid spending in this area went to institutional care. However, ten years later that spending level was down to 55%, with 45% going to home and community based services. The shift will likely accelerate even more as President Obama's "Money Follows the Person" program continues to take effect. It is helpful to note that this reallocation of resources still requires local residents to conduct New York Medicaid planning to shield assets from the going to pay for the program participation.
Along with the federal government, many more states are devoting Medicaid dollars to at-home care. Yet, New York seems to be lagging behind the pack. Along with Mississippi, New York is the only other state that has not seen any change in nursing home occupancy levels in the past six years. Some are concerned that part of the problem is the nursing home resistance to the proposal, because, as one advocate pointed out, "they make money keeping you in."
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