Comunity based services VS Nursing Home Care

Most people who use LTS prefer to receive services in the community rather than in a nursing facility, and this desire becomes more prevalent as age increases.
75% of individuals age 45 to 54, and 83% of individuals age 55 to 64 strongly agree or somewhat agree that they wish to remain in their current homes as long as possible; 92% of individuals age 65 to 74 and nearly all (95%) individuals age 75 and over want to do so.14
Among elder and disabled MassHealth members living in the community, as well as among those who are not MassHealth members, there is a desire for more access to home and community-based supports. The ability of elders and people with disabilities to choose community over institutional care is affected by the availability of community options.15
Increasing numbers of Massachusetts elders and people with disabilities receive community-based LTS through MassHealth and through discretionary programs administered by state agencies.16
Approximately 130,000 elders receive services in the community through the Executive Office of Elder Affairs (EOEA) and approximately 100,000 individuals with disabilities receive community services through the Department of Developmental Services (DDS, formerly the Department of Mental Retardation), the Department of Mental Health (DMH), the Massachusetts Rehabilitation Commission (MRC), the Massachusetts Commission for the Blind (MCB), and the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH).17 Another 30,000 children receive early intervention community-based supports through the Department of Public Health.
Community-based services funded through MassHealth have shown significant increased participation rates over the last decade. The PCA program has more than doubled its participants over the last ten years; in the last five years both Group and Adult Foster Care and Adult Day Health have increased participants by more than a third.
13 Ibid.
14 Bayer, A. & Harper, L. (2000). Fixing to Stay: A National Survey on Housing and Home Modification Issues Research Report. Washington, DC: AARP. Retrieved from assets.aarp.org/rgcenter/il/home_mod.pdf
15 Commonwealth of Massachusetts, The Community First Olmstead Plan (2008). Boston, MA: Author. Retrieved from www.mass.gov/Eeohhs2/docs/press_release_docs/080912_comm_living_options.pdf
16 Massachusetts Executive Office of Health and Human Services and Massachusetts Executive Office of Elder Affairs. Boston, MA.
17 This number does not include individuals in MRC vocational rehabilitation programs or individuals receiving ASL interpreter or CART referral services.


Massachusetts Long Term Care Policy

Massachusetts has a lengthy history of supporting the long-term care needs of elders and people
 with disabilities across the lifespan. The Patrick Administration’s
 long-term care policy is community first
, an approach that emphasizes maximizing
 independence in home and community
settings while assuring access to needed
 institutional care. This fact sheet provides
 a snapshot of the current state of long-term
 care supports (LTS) in the Commonwealth,
 including information about the populations
 who use LTS, projected changes in the
 demand for and cost of these services,
 and trends in utilization and payer mix.
 Data in this arena is unevenly available
 across populations and service components.
To the extent possible, population-based and
 relevant national indicators are used.
The fact sheet and additional qualifying
 information about data sources and supporting
 research documents can be found at www.mass.gov/hhs/communityfirst.

  Executive Office ofHealth and Human Services

Plan multigenerational developments

The days of designing and developing retirement communities that segregate older citizens from the rest of the population might be over now that baby boomers are storming into their twilight years, according to architects who say boomers will “do retirement” on their own terms, in a location of their choosing.

About 10,000 boomers are turning 65 each day and will continue to do so until 2030, according to U.S. Census data. But as of 2007, a scant 6% of Medicare enrollees aged 65 or older lived in community housing with services or any sort of long-term care facility, with most remaining in a traditional community, according to a 2012 Center for Housing Policy study.

Meanwhile, an overwhelming majority of retiring baby boomers have no plans to move, according to a recently released MetLife Mature Market Institute study, and this attitude might impact where senior housing developers locate their communities.

Only 11% of MetLife survey respondents said they had plans to enter an active adult community, but 83% said they had no plans to move from their current home. AARP has previously released studies showing 90% of retirees indicating a strong desire to remain in their homes and communities, and this could be a key indicator of the need for designing developments with multiple generations in mind.

Rather than having segregated housing for the nation’s seniors, architects need to plan multigenerational developments, and developers must build with more than one demographic in mind, says Dave Stolte, vice president of senior housing at Encino, Calif.-headquartered NAI Capital.

“If you can get the kids to move into a neighborhood where they can be around their parents, and their kids can have their grandparents around—these would be communities with much more utility, where people can age in place. That’s the key,” Stolte says. “Instead of a separate community, seniors can be included into the community.”

There aren’t too many current examples of well-planned, comprehensively thought out multigenerational communities, Stolte concedes, but he says many senior living developers are realizing that “lifestyle” is a more important concept than “shelter.”

What’s key is incorporating lifestyle into a planned community, with proximity to churches, hospitals, shopping, entertainment, and close to adult children who might become their parents’ caretakers.

“People aren’t wanting to be segregated or seen as a senior,” says Greg Irwin, the president and principal of Irwin Partners Architects. “They want to be a part of all life—not just their own age demographic.”

A large percentage of older Americans remain in their homes because they don’t want to enter an age-specific community, where they’re around lots of people who are similar to them in age only, Irwin says, adding that the future of senior housing development involves finding ways to accommodate seniors’ needs and interests while keeping them a part of the overall community.

“You’re seeing a trend right now to go into a more urban environment and create more opportunity for people,” he says. “We’re seeing an increase in developers asking about how to incorporate senior accommodations into community designs.”

Despite not having current examples to showcase, Irwin says he’s hearing a lot of talk about what it means to blend senior living into a multigenerational community. His firm is currently “working with concepts and ideas on projects,” but isn’t far enough along yet to name any specific projects.

Coming soon, articles on the rise in multigenerational housing, an intergenerational development currently in the works in Massachusetts, and the design of hospitality-style retirement accommodations.

Written by Alyssa Gerace

Massachusetts Home Care (HCP) and Enhanced Community Options Programs (ECOP)

What are the Home Care and Enhanced Community Options Programs?

What are the Eligibility Requirements for HCP and ECOP?

The Home Care Program requires that Massachusetts residents be living at home or in the home of a caregiver; they cannot reside in an adult foster home, assisted living residence or nursing home. They must be at least 60 years old or diagnosed with Alzheimer's. The income limit for an individual is approximately $25,000 / year or $35,000 for a couple. Finally, individuals must be assessed and found to have a need for services by a case manager.

For subsidized respite care only, there is a higher income limit of approximately $45,000. Respite care is available for individuals with income in excess of that amount however they will be charged the full cost of the care.

The Enhanced Community Options Program has similar eligibility requirements to the Home Care Program, however individuals must require a higher level of care. Participants must be assessed and determined to require the level of care provided in a skilled nursing facility (or nursing home).

What Services are Provided in the Home Care and Enhanced Community Options Programs?

A very wide range of support services for seniors, the disabled and their caregivers are provided in these two programs. Final services are determined on a case-by-case basis and can include any of the following:

-Adult day health care
-Alzheimer's / dementia care
-Companion services
-Food shopping
-Home health aides
-Home health services
-Homemaker services
-Meal delivery
-Meal planning and preparation
-Medication assistance
-Minor home repair and yard work
-Nutritional counseling
-Personal care services
-Personal emergency response services
-Respite care
-Skilled nursing care
-Transportation assistance

How to Apply for the Home Care and Enhanced Community Options Programs

Both programs and respite care are managed by the local Massachusetts Area Agencies on Aging. To learn more and apply for these program contact your local area agency on aging or call the helpline at 800-AGE-INFO.

Massachusetts residents might also be interested in the Caregiver Homes Program which is another option that enables the elderly to remain living in the community.

Housing Policy

Supporting development of various senior living community models, encouraging developers to incorporate universal design, creating flexible zoning rules, and providing assistance for aging-in-place retrofits are some policy suggestions that could help the nation get ready for the impending silver tsunami, according to the Center for Housing Policy.

“We all know it’s coming—baby boomers are about to swell the ranks of older Americans,” begins the Center’s recently released study looking into the nation’s preparation to house an aging population.

The 65+ population is expected to increase from 40 million to more than 88 million by 2050, encompassing 20% of Americans, according to census data, and the 85+ population will triple during this timeframe to 19 million.

“Demand for housing will shift dramatically and the need for services to help older adults age in place will grow exponentially,” the researchers say, citing an AARP survey that 90% of respondents wish to remain in their homes “as long as possible.”

However, the nation’s old, poor households are faced with severe housing cost burdens, and it will be necessary to pay more attention to housing and supportive services for the aging population, especially as nearly half of low-income seniors spend more than half of their income on housing.