Vermont experiment keeps seniors at home, out of nursing homes

WINOOSKI, Vt. — Florence "Tubby" Parsons, 93, has a lot going for her. She has her cat, Buddy, the plants in her one-bedroom apartment to tend to and a weekly 25-cent poker game with neighbors.

Best of all, she doesn't have to live in a nursing home. Instead, she gets daily visits from a longtime friend who draws a $10-an-hour paycheck from the state to care for her.

It is part of a unique experiment in Vermont. Under Vermont's Choices for Care program, Medicaid-eligible senior citizens who need someone to tend to their needs have the choice of being cared for at home by a family member, friend or neighbor, who gets paid by the state.

"A nursing home? They sit there and moan and holler and sit in a chair and sleep. I don't want that," said Parsons, who has heart and thyroid problems and uses a walker.

Experts say the project could spur dramatic changes in the way the United States handles long-term care for the elderly.

One year after enacting the program, Vermont officials say, it is reducing the number of people sent to nursing homes, cutting the cost of taxpayer-funded care and improving the quality of life for people such as Parsons.

Critics, including the nursing-home industry, say subsidized home care by family members and other nonprofessionals is no panacea. They say the care isn't as good, however well-meaning family members and friends are.

Penny Walsh, 41, a former tenant of Parsons', gets paid $10 an hour for 35 to 40 hours a week. She said she took the job because she was already doing some of Parsons' cleaning and other chores for nothing.

"It's like seeing my grandmother every day," she said, sitting by Parsons' side during a visit. Previously, Walsh was a clerk and a worker at a day-care center.

Elder-care experts say the Vermont program could help blunt one of the long-standing criticisms of Medicaid: It shunts people into institutions without regard to what they want.

Medicaid, which spent $38 billion on institutional care last year, wants to shift more toward home-care and community-based systems, where "the medical dollars follow the needs of the patient, rather than the other way around," said Mary Kahn, a spokeswoman for the Centers for Medicare & Medicaid Services, the federal agency that administers the programs.

It costs Vermont about $122 a day for Medicaid-covered senior citizens who live in nursing homes, compared with about $80 a day for those being cared for in their homes.

About 120 more Vermont senior citizens are getting Medicaid-subsidized home care now than in October 2005, when Choices for Care began. The number in nursing homes has dropped by 155, according to the state.

Moreover, "there's something about getting the care from someone who knows you," said Patrick Flood, commissioner of the state Department of Disabilities, Aging and Independent Living. "It has an impact on your quality of life, and we're seeing that."

But J. Churchill Hindes, president of a visiting-nurse association in Vermont, said: "Typically, a family says, 'Sure, we can do this' and brings their grandparent into the home ... And after a few months or a year, they realize how just how hard it is."

Parsons' caregiver said the arrangement is working well so far. For her part, Parsons likes the company, and the help she gets with cleaning, cooking and getting around.

"She's been as close as family for a long time," Parsons said. "You know what they say: You have to put up with your family, but you choose your friends. I chose her."