While Delaware’s new Aging & Disabilities Resource Center (ADRC) helps senior citizens and their families navigate the complex maze of services available to enable seniors to live longer in their own community, it also has a second, equally important responsibility: transitioning seniors and disabled individuals who now live in three state-run facilities back into their communities.
Delaware has been trying for years to reduce the overall population at the Delaware Hospital for the Chronically Ill, Emily P. Bissell Hospital and the Governor Bacon Health Center. In a 15-year period, from 1995 to December 2010, population at the three facilities declined from 515 to 384 — a reduction of about nine residents per year, according to William A. Love, director of the state Division of Services of Aging and Adults with Physical Disabilities. Since the ADRC was established in February, the rate of new admissions has dropped by about 75 percent and the number of residents has dropped more rapidly — to 356 in October, with a goal of reaching 328 by July 2012 and 289 by July 2013, Love said.
The reasons behind this strategy are philosophical, legal and financial. Senior citizens prefer services that support them in their own homes, the Americans with Disabilities Act requires that public agencies provide services in the most integrated setting appropriate to the individual’s needs, and community care is less expensive than institutional care.
And the financial pressures will continue to rise as the state’s population continues to age.
The Delaware Population Consortium, whose figures are used by many state and local government agencies to estimate future needs, projects that the 65-and-up age group will grow from 15 percent of the state’s population in 2010 to 24 percent in 2030. The projections show that the 65-74 age group is likely to grow by 88 percent, and the 75-84 age group by 93 percent while the 85-and-up sector will more than double in size.
“The service-needy period [defined as age 85 and up] is when the demand for health services increases dramatically and becomes more expensive, both to the senior and society,” Mary Joan McDuffie and John E. Stapleford wrote in their recent study, “Implications of the Gray Wave Crashing into Delaware,” published by the Caesar Rodney Institute.
It costs about three times as much to support a senior citizen living in a nursing home as it does to provide services to a senior living in the community, so it makes sense to transition nursing home residents back into the community if accommodations can be made for them, Love said.
A Medicaid initiative called “Money Follows the Person” helps make this possible, said Lisa Bond, deputy director of the state Division of Services of Aging and Adults with Physical Disabilities. In essence, if a person has been in a nursing home for 90 days or more and is capable of transitioning back into the community, Medicaid will pick up a major portion of those transitional costs, including items like security deposits for housing and utilities if the individual must find a new residence, Bond said.
In addition, Love said, Gov. Markell included $1.5 million into the current state budget for housing vouchers, subsidizing a portion of rental payments for former nursing home residents transitioning into the community.
In other cases, Bond said, “some people have housing in place, but the housing is no longer accessible to them,” noting the need for modifications like wheelchair ramps or widened doorways into bathrooms and bedrooms. The state will help pay these costs too, she said.
Having the state make a one-time payment for modifications like these pays off in the long run, Love said. “It doesn’t make sense to have someone wind up in a state facility, at a cost of $70,000 or $80,000 a year, just because we didn’t help them by providing a wheelchair ramp.”
Just as options counselors at the ADRC assist senior citizens living in the community to find the services they need to stay in their homes, counseling teams also meet with nursing home residents (and their families) to identify what services they will need to return to the community, Bond said. These case managers, usually with a nurse assigned to assist them, will keep track of each former resident’s progress in the community, adjusting services as necessary and, if required, arranging for readmission into a long-term care facility, she said.
There are no plans to close any of state’s three long-term care facilities, Love said. As population decreases, wings at each of the facilities are being closed and refurbished for use by other state agencies, Bond said.
They are not ruling out the possibility that the population at the three facilities will increase in the future as the over-65 population continues to grow.
“This is not about closing nursing homes. That’s part of the continuum of care,” Love said, “but we want to continue using them only for the people who required that restricted level of care.”
