Source: Detroit Free Press
By: RUBY L. BAILEY, FREE PRESS STAFF WRITER
Published: June 10, 2007
Experts say things will only get worse as loved ones seek living and nursing optionsIt was 2 a.m., the room was dark and Doris Wackerle, rising from the haze of sleep, didn't notice the bedside chair as she headed for the bathroom.
The 85-year-old stumbled, fell over the chair and onto the floor.
Wackerle crawled to the phone and roused her daughter, Peggy Trabalka, who lived nearby. Trabalka arrived to find her mother shaken, not hurt. But she realized that her mother's time in an independent-living center in Highland Township was nearing its end.
Trabalka, 63, had the difficult job of telling her mother, who'd always lived independently, that she'd have to move and accept more help.
"I thought, 'I can't drag my mother out of there against her will,' " Trabalka said, "so I tried to make it her idea. Once she lived with that thought for a while, she got comfortable."
The two then began a journey that thousands of families undertake every year: the search for appropriate long-term care.
Finding such options is likely to get harder as Michigan's population ages, straining nursing homes, assisted-living facilities and home-care dollars.
"The only growth in this region is going to be in the population 65 and older in the next 20 years," said Kurt Metzger, research director of the United Way for Southeastern Michigan. "All the needs, from housing to long-term care, are going to increase dramatically."
Seniors now make up about 12% of Michigan's population. By 2020, the percentage will rise to 15%. By 2030, people 65 and older will make up roughly 19% of all residents, Metzger said. The issue also affects residents with disabilities, who make up about 16% of the state's population.
Nursing homes, the long-term care option most often turned to, are the most expensive, averaging around $5,000 a month. With more people seeking help to pay for nursing homes, Michigan's Medicaid payments ballooned from $900 million in 2000 to $1.4 billion in 2006. About 320,000 disabled Michigan residents and 90,000 seniors are on Medicaid.
Help centers openHoping to get a handle on the spiraling costs as well as to help residents through complex decisions, the state Department of Community Health quietly opened four help centers in April. Called Long-Term Care Connections, they serve limited parts of metro Detroit and outstate areas, but are expected to expand.
Though nursing homes can be the best option for those in need of 24-hour care or those with conditions that can't be cared for at home, such options as home-based care or an assisted-living facility could be better and cheaper for many others.
Michigan spends less on non-nursing home care -- 14% of its Medicaid dollars -- than the national average of 22.9%, said Lisa Alecxih, who works for the Lewin Group, a health research firm based in Virginia. She has studied long-term care centers in Wisconsin similar to ones in Michigan.
"The hope is, by getting to these people at the decision point, by providing information about their options, that more people will be able to remain in the community and live independently," Alecxih said.
The hunt for information is difficult. It can take dozens of calls to get details about in-home medical assistance, help with meals and baths and guidance through Medicare and Medicaid requirements.
People looking for options "are pretty much into the phone book, the senior center or whatever you can sew together," said Michael J. Head, director of the state Office of Long-Term Care Supports and Services.
Families stretch their budgetsWackerle's family spent hours looking online and driving to check out several homes before finding an American House assisted-living facility in Grand Blanc. They've patched together a way to pay for it, using Wackerle's Social Security benefit of $1,100 a month to cover part of the $1,600 monthly fee, which includes meals and 24-hour care.
Trabalka will stretch her own household budget to cover the rest, including utilities. She'll do her mother's laundry to save on costs.
"We've been working around the clock, trying to get her where she needs to go," said Trabalka, who moved her mother in early May.
Kelly and Craig Satterfield have spent months searching for assisted living, health care and other assistance for their son, Steven, who has physical and mental disabilities. He'll turn 17 next year, and the Satterfields fear he could lose some or all of his state health care benefits and be dropped from special-needs programs. Finding information has been difficult, the Ferndale couple said.
"My fear is, when he's 18, he's on his own," said Kelly Satterfield, 42, who said Steven is learning to cook but fails to think about turning off the stove, bringing into doubt his ability to live on his own. "Even if he lived in a group home, he'd have to come up with his own insurance, transition to his own care."
Their son could continue to live with them indefinitely, but, "what happens once we're not around?" she asked.
"The hardest part is finding who's the gatekeeper for the information and how to access this stuff," said Craig Satterfield, 43.
"To just come up to a dead end, it's very disheartening."
Loved ones lack informationWith little time and scant resources, many families end up choosing nursing homes, the fastest way to get all their needs met, said Robert Kane, a professor and endowed chair in long-term care and aging at the University of Minnesota.
"It's an emotionally complex decision typically made in a moment of panic with an incredible clock ticking overhead," Kane said. "There is no good source of information."
When Robert Gurk's 84-year-old father, Warren, was diagnosed with Alzheimer's last year, his son, 52, received the names of three nursing homes from a hospital social worker. Because the state doesn't have a system that ranks quality or provides information about the number of beds available, Gurk checked the homes in person.
One in Saline was affordable but had a year-long waiting list. Another in Toledo was too far away for easy visits. The third, Arden Courts in Livonia, was expensive but had an opening.
Warren Gurk has lived there since. But he's rapidly depleting his Ford Motor Co. pension and savings to pay the $8,000 monthly costs for nursing home care for himself and his wife, Loretta. He receives roughly $1,700 a month from his pension and Social Security benefits.
Gurk's son hopes the Veterans Administration will help his father, a Navy veteran who served in World War II. But the wheels are turning slowly. He contacted the VA last July and spent months gathering the necessary documents, including doctor bills and financial information.
If his father's application is not approved, Gurk hopes his dad's depleted assets would allow him to qualify for Medicaid, though he doesn't understand why his dad has to lose everything -- and risk eviction -- before he can get help.
"The system is not confusing. It's baffling," said the younger Gurk, who has decided to put his father on the waiting list at the Saline home and hope for an opening.
The four Long-Term Care Connections centers were funded with $4.5 million from Michigan's Medicaid budget and $4.5 million in matching federal money. Experts say the state could save millions by helping residents find alternatives that cost as much as 80% less than nursing home care.
"We're talking about taking a teeny bit of that Medicaid budget with the expectation that nursing home care will drop off enough to cover costs," said Head. "In the longer run, we are concerned about the availability for long-term care. Ten to 15 years out, we know there's going to be pressure on it."
The Detroit center, in Brewery Park on the east side, serves the city, Highland Park and the Grosse Pointes but plans in late September to include all of Wayne County.
Customized care planClients are assigned a counselor, who offers care and housing options, referrals and nursing home admission screenings. The counselors work with hospitals, nursing facilities, home health providers and other community-based organizations to come up with a plan for each client, said Helen Love, director of the Detroit Area Agency on Aging, which runs the center and its 30 employees.
"We're talking about customized, one-on-one care," said Love, who said counselors travel to meet with clients in their homes if needed.
The Detroit center recently helped Arthur Rucker, who was discharged last year from Sinai-Grace Hospital to the Eastwood Nursing Home in Detroit after having a toe on his left foot amputated because of diabetes complications. Other options were never discussed, the 57-year-old said.
He lived there one year -- with the state footing the bill through Medicaid -- though he believes he was well enough to live in a less-costly setting. A social worker at the nursing home put Rucker in touch with a state long-term care counselor in April. He moved in early May to a Detroit apartment.
Mary Henderson's search for options is beginning. After colon surgery in early April, she had to move in with her daughter, Helen Phillips, in White Lake Township.
Henderson, 91, hopes one day to get back to her condo but figures she'll need help with shopping, driving, cooking and cleaning. She's hoping her income from rental units she owns and her small Social Security benefit will cover the costs.
"Having to go this route is new to me," she said, "but it just seems like it shouldn't be this hard."
Contact RUBY L. BAILEY at 313- 222-6651 or rbailey@freepress.com.
Labels: InTheNews, Research
