When Rick Cragg was wheeled into Four Corners Health Care Center after spinal surgery, he promised himself that he would walk out. It was a goal his surgeon never expected the 64-year-old to achieve, but in November 2013, he left the nursing home for a hotel.
Many people across Colorado also want to leave a nursing home, but many can’t because they don’t have enough financial support. But with more and more baby boomers experiencing this undesirable situation, the political will is building to come up with ways to move senior citizens and others back home and help them stay there, said Patricia Ziegler, assistant director for the Durango-based Southwest Center for Independence, which serves five counties.
Cragg sought the resources to make the transition on his own once he regained the ability to walk. He compiled nearly 60 phone numbers for organizations such as Visiting Angels and Southwest Center for Independence and created the network he needed to help him live at home with his mobility issues, diabetes, vision and hearing impairments. He moved into his own apartment in 2014.
“I was going to make it on my own,” he said.
The state is working to make that move easier for other senior citizens by launching Colorado Choice Transitions, a program specifically for that purpose in 2013.
Nursing home care averages between $6,000 to $7,000 a month, according to trade surveys. This cost falls on Medicaid, when senior citizens and others run out of resources to pay for it.
Colorado received $22 million from the federal government to run Colorado Choice Transitions to start addressing this issue and planned to move 490 people by 2016. So far, 53 people moved statewide with help of the program, and about 12 people are in the process locally, Ziegler said.
The grant money was offered to all the states, although not all took it. To Ziegler, the grant represents a paradigm shift in health care toward a more consumer-driven model.
Centers for independence have been fighting to give people with disabilities a choice between nursing home care and living at home since the 1970s, said Zielger, who has cerebral palsy and has been involved since the beginning. But the recession and the baby boomer population have motivated change, Ziegler said.
“States are very afraid of the aging tsunami that’s coming,” she said.
When Colorado Choice Transition was announced, it was celebrated by advocates, said Julie Reiskin, executive director of Colorado Cross Disability Coalition, an advocacy group.
“We were very excited the administration went for it,” she said.
But affordable and accessible housing and a complex reimbursement system have presented challenges, transition coordinators said.
Sometimes, clients cannot receive funding for home modifications unless they have moved out of a nursing home. In addition, landlords do not have to allow home modifications until someone has moved in, said Anaya Robinson, a transition coordinator for Atlantis Community Inc., an independent living center in Denver.
Reimbursement has also been a problem because case managers cannot receive grant money for working with a client until the person has successfully moved home. That has been a challenge locally, said Patsy Ford, health programs division director for San Juan Basin Health Department.
“We can invest a lot of hours, but if they don’t complete a transition, we are not paid,” she said.
The state is planning to address the reimbursement problem and other issues in the coming year, said Tim Cortez, manager for community options for the Colorado Department of Health Care Policy and Financing.
“We know there is a number issues we have to resolve,” he said.
Complexity is a theme that runs through Medicaid programs. To make services consumer-centered could mean streamlining a variety of Medicaid programs, so people can get the resources that would allow them to choose between home and nursing home care, Ziegler said. She plans to keep fighting for resources to preserve that choice for people like Cragg who know they can spend many more years at home.
“Some people give up, and you can’t do that,” Cragg said.