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Making Sure There’s Life Beyond the Nursing Home for Those Who Are Ready

The ‘I Choose Home NJ’ program has helped nearly 1,700 people make the move from nursing homes to community settings

Steven Sarton and Donna Collins
Steven Sarton and Donna Collins are married and now live in their own apartment in Ewing.

Steve Sarton and Donna Collins met while living in a nursing home in Maple Shade. They became friends, then married. But as long as they lived in the home they could not even share a room and had no private time, stuck with roommates and living on the schedule of the nursing home staff.

Then the couple, who have multiple medical needs including mobility assistance, learned about the “I Choose Home NJ” demonstration project, which helped them move into an independent-living apartment in Ewing, and now they are truly living together and are happy.

“I was happy immediately, “ said Sarton. “It definitely overmet our expectations … you get all the care you need, plus you have the freedom to walk around and do what you want when you want. I can sit down and have a bowl of cereal anytime I want. We are our own boss. We make our own destiny.” The two can cook and care for themselves. What they need is monitoring for their medical issues, which they can get without being confined to a nursing home.

Using federal dollars from Medicaid's “Money Follows the Person” demonstration program,, the New Jersey Department of Human Services, began the “I Choose Home NJ” initiative. The money was initially provided via the federal Deficit Reduction Act. The program has since moved 1,675 people back into community settings and has become a demonstration project of the Affordable Care Act and is available in many states across the country. The DHS held a celebration of that milestone at the Division of Developmental Disabilities headquarters in Hamilton on Wednesday.

“This is certainly very humbling,” said Terre Lewis, “I Choose Home NJ” project director. “ We still have barriers. We need more affordable housing. We need to spread the word” about this program, which enables people who are currently confined to nursing homes but could live independently to move into private homes using Medicaid dollars.

Lewis said only seven states have placed more than 2,000 individuals in community housing through this program and she expects New Jersey to hit that mark by the time the state completes its placements at the end of 2020. Lewis also pointed to a survey of participants that is taken a year after placement, which finds 94 percent are satisfied with the program in New Jersey, compared with 81 percent nationwide.

“But that’s still not enough,” she added, indicating she wants everyone to be satisfied.

While many state and federal officials -- not to mention federal law under the Americans with Disabilities Act and Olmstead decision -- believe community placements are best and the least restrictive for everyone who can live outside an institution, not everyone is in agreement.

Specifically, some relatives of the disabled have argued against moving patients from nursing homes to group homes. The MFP program covers those with disabilities, and some family members believe their loved ones need as much nursing help as possible and argue against group home environments. But for the most part, they blame the closing of two state developmental centers in 2014 for forcing the issue. These family members charge that two dozen former residents died after being put in community placements. There is now a law requiring DHS to follow up and report outcomes of those transferred out of the centers.

But the dozens of individuals placed in home or community settings and staff and service providers who help them had nothing but praise at Wednesday's event celebration.

Anita Clavering
Anita Clavering

Anita Clavering, who moved out of the Old Bridge nursing home where she had lived for three years and into an apartment in Long Branch last October, called the change a “wonderful opportunity to live on my own with the right supports” and said that she wishes she could “repay” PennReach, the nonprofit that helped her get into the apartment.

MFP gives states an enhanced federal reimbursement (75 percent versus 50 percent) for the cost of required services when they move people into the community. Nationally, more than 51,000 people had transitioned back into community homes through the end of December 2014 as a result of the demonstration project. In addition to New Jersey, 42 other states are also participating in MFP.

Eligible in New Jersey are people age 65 and older, those 18 or older with physical disabilities, and people at least 21 years old with intellectual or developmental disabilities; those who have spent at least three months in a nursing home or developmental center; those who need long-term care or meet other clinical requirements; and those who are Medicaid-eligible. They must move to one of three kinds of community residences: a home owned or leased by the person or his family, an apartment, or a group home with no more than three other residents.

Program requirements are strict. A participant must need nursing facility level of care in order to qualify. People who are totally independent and require little assistance may not be eligible, but neither might those who require around-the-clock care, have no family support, and might not be safe at home. Each case is assessed individually to determine whether the person meets clinical and financial eligibility.

When a person enrolls, a team that includes the individual; family members; and their guardians, social workers, discharge planners, and others meet to decide what services the individual will need. The team then develops an individualized plan of care for the individual. Those services may include home health aides, adult day care, transportation, and meal delivery.

The federal government's goals for MFP are to put more people in community-based services; eliminate barriers in state law and Medicaid plans that restrict the use of Medicaid funds so people can get long-term care in whatever setting they choose; and increase community residences and services for those eligible.

This project has been extended through the end of September with $2.3 billion over five years as a result of the Affordable Care Act. While the program officially ends in five months, states can continue to spend any unused federal grants through the 2020 fiscal year. It is a separate program from the state’s Comprehensive Medicaid Waiver which aims to do similar things, but which is run by the Department of Human Services in conjunction with managed care providers. That program, which is separate and is eligible for all Medicaid patients if they meet health standards, uses the traditional 50/50 Medicaid-funding mechanism and will continue beyond the demonstration project.

New Jersey officials say this higher fiscal match -- 75 percent of state costs for a person's first year in the demonstration program, rather than the traditional 50 percent -- has helped the state reinvest in additional community resources. As of the end of 2015, because it received additional funds from the federal government, the state had spent $18.6 million to help people age in place, live in local communities, and avoid institutionalization.

Between July 1, 2008, and March 16 of this year, New Jersey's program has helped 710 people with intellectual or developmental disabilities, 542 seniors, and 423 physically disabled people live in community residences. DHS hopes to move another 525 people into community settings through 2020, resulting in a total savings of $35.5 million over the life of the project. New Jersey has spent its savings to date on training the professionals who help those who are eligible, buying a dozen homes for 48 individuals, providing refresher training to those formerly living in institutions who want to re-enter the work force, and spreading the word that "A nursing home may not be the only option."

Affordable and accessible housing in high-cost New Jersey can be difficult to find. State officials work with local housing authorities, developers, and other housing advocates to identify housing opportunities in each county. The “I Choose Home NJ” program may also provide the first-month’s security deposit, as well as home furnishings and other items that might be needed to establish the person in a new residence.

Through a new piece of the program, which began last December 15, the state Division of Aging Services has also made a total of nearly $3.9 million available to developers who agree to designate accessible apartment units for the physically disabled. Developers can seek up to five loans worth $78,000 each for providing up to five units that will remain affordable.

While the program will officially end in 2020, Ronan said the state's “I Choose Home NJ” program will continue even after the enhanced funding match ends.

For more information, call 855-HOME-005 or visit the I Choose Home NJ website.

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