Finding New Ways to Help Family Caregivers

By Nancy Johnson

Connie Roberts of Elkhart was running herself ragged looking after her aging parents. For three years, with help from her siblings, she drove them to doctor appointments, cooked meals, did the laundry, cleaned their apartment, doled out medicines and handled their financial affairs. But she knew one thing: She didn’t want to put them in a nursing home.

With help from their doctor and from REAL Services, the Area 2 Agency on Aging affiliate in South Bend, Roberts lined up in-home services that will ease the burden on her while helping her parents, Coreen White, 85, and Turner White, 88, continue to live at home.

REAL Services, a private not-for-profit agency, helped the Whites apply for Medicaid last year, and they were approved for certain in-home services. While Roberts, 57, and her parents pay for bathing assistance and hot-lunch delivery, Medicaid will pay for homemaker services such as cleaning and laundry assistance. She hopes to add more services, but for now, “having this help will be a blessing,” she said.

Helping older residents age at home, rather than enter costly nursing institutions, is the goal of a federal program that Indiana and other states have joined.

The Balancing Incentive Payments Program, a little-known provision of the Affordable Care Act, creates incentives for states to expand home- and community-based services for older people.

“Indiana will get a higher federal matching rate for its Medicaid expenditures for this population,” said June Lyle, AARP Indiana state director. “Though Indiana in recent years has been doing an excellent job of expanding these services, we are really excited to see this new program.”

Reducing red tape
Under the program, Indiana will receive $78 million through September 2015 to serve more people through Medicaid Home and Community-Based Services. In return, the state promises to reduce red tape, improve services and make them more user-friendly, Lyle said.

The state also agrees to adhere to the “no wrong door” approach: Regardless of age, income or situation, a person can receive information on long-term care at one of many agencies, rather than having to navigate a maze of state and federal offices.

Indiana also has to ensure conflict-free case management, Lyle said. This means the person presenting care options, such as a hospital staffer, doesn’t steer a client toward a nursing home in which the hospital has a financial stake, rather than discussing alternatives.

Also, the state must create an integrated system for eligibility and level-of-care assessments. This means that no matter where a person lives or what agency is contacted, there are uniform standards, Lyle said.

She advises people looking for care options to start with their local Area Agency on Aging ( iaaaa.org). The number is 800-986-3505.

The program helps fill an important need. The vast majority of Americans—89 percent—wish to age at home as long as they can, Lyle said.

In addition, the program helps reduce strain on caregivers. They won’t have to quit their jobs to care for their parents, said Kristina M. Moorhead, state legislative representative for AARP. Taxpayers benefit as well, she said, because Medicaid can provide home- and community-based services to three people for the cost of serving one person in a nursing home.

“It’s a win for everyone,” Moorhead said.

Nancy Johnson is a writer living in South Bend.