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Boosting Alternatives to Nursing Homes Takes Center Stage in Legislature


Alternatives to nursing facility care have grown in Michigan, but there’s still room for improvement in options that let people age in their homes.

That’s the assessment of AARP Michigan, which will push for expanding those options during the state’s 2023 legislative session.

“We know that 89 percent of Michiganders do not want to step foot in a nursing home,” says Melissa Seifert, government affairs director for AARP Michigan. “But the funding for home- and community-based care just isn’t there for everyone.”

The 89 percent finding is from an August 2020 AARP survey of 50-plus registered voters, and similar results have been found in other polls. That’s why, as the state legislative session gets underway this month, Seifert believes the timing is ripe for transformative long-term care investments. In addition to its budget for health and human services, the Legislature has American Rescue Plan money it must expend by March 2025.

The state ranks 29th nationally in the share of Medicaid and state spending on long-term services and supports that goes to home- and community-based care for older people and adults with physical disabilities, notes a 2020 AARP scorecard.  “There’s a need for nursing home care,” Seifert says. “But we want to make sure that people who can stay at home have that opportunity.”

AARP supports more “small-house nursing homes” — facilities with 10 to 12 residents that research has found are happier and healthier than those in larger, traditional nursing homes.

Expanding care programs

Support for options such as the federal-state Program of All-Inclusive Care for the Elderly — known as PACE — and MI Choice is also key, Seifert says.

PACE provides social and health services through adult day centers and in-home supports. But the program isn’t available in the Upper Peninsula or Northeast Michigan. AARP plans to push for $9 million in American Rescue Plan funds to expand it into Alpena, Marquette and Escanaba.

The state’s MI Choice program provides help with chores, bathing, meals, transportation and nursing care. But its waiting list  is about 2,800 people long.

Though some slots are available, wait times vary depending on what services are needed and the availability of workers to provide them, says David LaLumia, executive director of the Area Agencies on Aging Association of Michigan, whose members administer the program.

Michigan’s shortage of direct care workers is projected to continue growing in coming years,  according to the IMPART Alliance, based at Michigan State University. AARP supports a proposal to attract and retain workers by addressing pay and benefits, job satisfaction, high turnover and training.

The difficult Medicaid application process also slows enrollment in MI Choice, LaLumia adds. An expansion of so-called presumptive eligibility would help, according to AARP. Michiganders needing long-term care typically enter a nursing home while they wait for a determination from Medicaid, Seifert explains. When benefits kick in, the facility is paid retroactively.

A new pilot program allows more people to choose home- and community-based services during the waiting period.

Find more details at

Sarah Hollander is a writer living in Cleveland.

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