A pilot program that could be prologue to a new era of hospitals discharging ailing seniors to their homes instead of to care centers received unanimous approval Friday from a state legislative panel.
The program is a response to the combination of forces bearing down on health-care services for the elderly: dramatic increases in the cost of care along with the boom in the 65-and-older age group in Utah.
Members of the Medicaid Interim Committee agreed to underwrite a trial that would determine if in-home services actually produce equal or better health-care outcomes and at a much cheaper cost than traditional nursing homes.
Under the pilot program during the 2008-09 fiscal year, 36 seniors who normally would have gone into a nursing home for follow-up care after surgery or other hospital-based procedures will go back home.
Programs to prevent nursing-home placement have been in place but are underutilized.
"It is our belief that some seniors who are Medicaid-eligible and who meet skilled nursing level of care are being placed in a skilled nursing facility because the discharge planner or the senior didn't know other options are available," said legislative fiscal analyst Debbie Headden.
One hospital from each of the state's three major hospital chains will be chosen to receive ongoing training and coordination of patients who are eligible for in-home recovery and care services, Headden said.
According to current state expenditures of in-home care vs. nursing-home care, in-home care for 36 patients cost $358,000 about $3,000 in state General Fund money and just under $7,000 in federal funds per patient. Nursing home care for 36 patients totals $1.4 million, or about $12,000 each in state funding and $28,000 from federal money.
Lawmakers agreed that the bottom line is not the only factor dictating that a trial be conducted. The step toward home health care takes advantage of nonprofessional health caregivers: family, friends and community members who are much more available and thereby much more supportive in the at-home setting.
The American Association of Retired Persons executive council in Utah said the pilot program adds some logic and a specific approach to a system of longer-term care that is "fragmented, uncoordinated and costly."
A whole host of problems dealing with long-term care and the aging still have to be addressed, said Rep. Bradley G. Last, R-St. George, who noted care centers have proliferated in southern Utah with booms in both the senior and general population in the area.
He said he is concerned that the state seems to "be going down two roads at the same time," because it encourages building facilities and certifying new beds while at the same time discouraging their use with in-home services.
Alan Ormsby, director of the state Division of Aging and Adult Services who proposed the pilot program, said it shouldn't be taken as an attempt to undermine care centers.
"There will always be a need for long-term care centers," he said, noting that Utah has had nationally recognized programs to divert and deinstitutionalize patients when possible. "But when you can provide safe and often more effective services at home and at a fraction of the cost for many seniors, we have to at least begin moving in that direction."
Pressure to transition funding to where it is most effective is mounting, particularly in Utah, which according to state figures has the sixth-fastest growth rate in the nation for people 65 and older.
The federal government, as well as the full Legislature, would have to approve the pilot project. Lawmakers aren't likely to balk, because administration costs for it are around $60,000. The funds would likely just be moved from the state Department of Health to the Aging Division.
The federal government has already endorsed the idea in principle. During a September visit to Utah, Josefina G. Carbonell, assistant secretary for the aging at the U.S. Department of Health and Human Services, said any such steps in any state should be welcomed.
"Anything that can be done to effectively treat and keep the elderly at home is not only what we need to be promoting, it's what the new wave of baby-boomer senior citizens is demanding," Carbonell said.
She said at least 200,000 of the elderly in the United States could be diverted from nursing-home care over the next decade."It's critical that we have these programs in place and running, because 10 years is exactly when the largest wave of the baby boomers becomes seniors."
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