Staff photo by Thomas Michael Corcoran GLAD TO BE HOME: Jeannette Ross sits in her wheelchair in her kitchen in Waterville on Saturday night. Ross didn’t mind a recent stay in the hospital, but when it became longer than she expected, she became irritated. WATERVILLE -- Jeannette Ross didn't mind going into the care facility at first.
Ross, an 85-year-old Waterville native, had gone through two hip operations and was grateful for the medical and physical-therapy assistance she received in the skilled unit -- the section where patients with more profound or immediate medical needs are housed -- of the establishment.
But after three months of rehabilitation, Ross no longer needed the same level of medical attention. That's when they moved her to the long-term care section of the facility.
Ross was not happy about the move.
"You might as well die to live in there," she said. "The people are there because they can't do anything for themselves, and they sit around in their chairs like there is no tomorrow. They wanted to put me in there, because they didn't think I was able to go home."
Ross, though, managed to get out.
Today she lives at home, in a Waterville apartment her brother owns. She is able to live independently with the help of two direct-care workers who provide 29 hours of assistance a week. That enables her to tend to flowers and do her cooking and live her life the way she sees fit.
Ross said she feels sorry for those in institutional care.
"Home is where you want to be as long as you have health," she said. "I'm lucky to have the women to help me. You don't want to leave your home and go somewhere else to live if your mind is still alert. As long as my mind is alert, with the help from the girls, I should be able to stay home. Nobody wants to leave their home. Nobody."
Funding discrepancy
The AARP Public Policy Institute examined how states use Medicaid money to fund long-term care services and support for older people and adults with physical disabilities.
What the institute found nationally is that funding favors institutions over home and community based care by about a 3 to 1 margin.
The same proportion held true in Maine. In 2006, Maine spent $78 million on home and community based care, while using $247 million on nursing homes.
Lenard W. Kaye, director of the University of Maine Center on Aging, said government is beginning to awaken to the value of home care for the elderly, but acknowledged that a funding imbalance remains between that option and institutional care.
"The amount of dollars set aside to fuel those programs," he said of support services to families, "is limited and continues to be a very small percentage of the long-term care budget compared to institutional settings."
On the other hand, the number of Medicaid patients in Maine who opted for home or community-based programs grew dramatically between 1999 and 2004, according to the AARP Public Policy Institute.
In 1999, the number stood at 935,160. By 2004, the total had jumped to 1,337,010, an increase of more than 400,000.
Medicaid patients in nursing homes, in contrast, grew by only 91,877, rising from 1,615,695 to 1,707,572.
Service shortage
The Blue Ribbon Commission to Study the Future of Long-term Home-based and Community-based Care is an effort to better meet the needs of those trying to care for elderly loved ones.
But one of the chief problems is finding enough money to meet the demand.
At a meeting last month in Augusta, the commission said 657 people are on a waiting list for homemaker services and 685 are on hold for home-based care services.
Yet a study by the state Office of Elder Services revealed that the average monthly cost for a Medicaid-eligible person in a nursing home is nearly $4,000 compared to $1,686 for a person who received assistance at home.
Jeanne Allen, a certified nursing assistant, is one of the professionals who helps Ross remain independent in her Waterville apartment.
Allen said she stays in the profession because she sees it as a calling. But she realizes that she tends to be the exception. Many CNAs and direct-care workers abandon the profession because of the low pay and lack of benefits.
"I'm just a different breed of CNA," Allen said, "because I really, really care about the people I take care of."
Allen said she knows many direct care agencies have high turnover rates. She said she knows of one that lost eight workers in one day.
"We have a serious shortage of long-term care workers in part because we have not made the career path very attractive," Kaye of the Center on Aging said. "Salaries are low, opportunities for advancement limited, and the benefits are less than you'd like to see them -- and the work is hard."
Family bonds
Joanne Miller runs a home care agency as well as a company, Homeshare Inc., that runs two community-based houses for older adults -- one in Owls Head, the other in Cushing.
The idea, she said, is to provide the elderly with an environment that is more like a home than an institution. Tenants contract with a separate agency for medical and personal services.
"I believe this is the wave of the future," Miller said. "I'd like to see a homestead in every community. These people become like a family unit. They care about each other."
So far, though, the homesharing opportunities are limited because there are no public dollars to support such approach, she said.
Her clients, she said, are people with enough financial resources to afford the rent. Most also have private health insurance to help them pay for any medical or personal services they need to access.
Several decades ago, back when extended families were more likely to live in one area, multiple generations within a family were more likely to live under the same roof.
Miller said that arrangement made for a healthier, happier society. That is a model of long-term care, she said, that society needs to embrace once more. "We have to start paying attention to what is really important," she said. "We have to value old age. Our old people should be revered, respected and taken care of. That is what we need to get back to. This can't be a burden. This can't be a chore. This has to be a labor of love."
Colin Hickey -- 861-9205 Morning Sentinel Sunday, October 19, 2008
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