The Change Agents of Elderly Care in Vermont

The WSJ put out a simply amazing article yesterday that still has me thinking about the future of elderly care. The change agent at work is Patrick Flood, Commissioner of Vermont’s Department of Aging and Disabilities, who is leading what you can only call a paradigm shift regarding the delivery of elderly care in the United States.

Is it possible that the term “nursing home” will soon fade from our vocabulary? Is it possible that Flood’s program will scale to every state in the country, and that family members will start to recieve payment for taking care of their elders? Consider the following excepts from the article and please share your thoughts:

In an effort being watched around the nation, Vermont is trying to give elderly people choice of where they want to be cared for: in an institution or at home. To create more home-care workers, the state has been paying for family members to care for aging relatives, at about $10 an hour. If Vermont’s program works, it could influence a wider change in the multibillion-dollar industry that cares for the aged.

“We are never going to build another nursing home,” says Patrick Flood, commissioner of Vermont’s Department of Disabilities, Aging and Independent Living. “It is an outdated model.”

As the number of older Americans — and the cost of caring for them — soars, the federal government is pushing efforts like the one in Vermont. Advocates say in-home care could improve the lives of many seniors, while saving the government money. But the idea faces huge hurdles, including opposition from the nursing-home industry and a culture of dispersed, busy families that has become accustomed to having others care for their loved ones.

In July, the federal Centers for Medicare & Medicaid Services announced grants totaling $1.75 billion to states to encourage them to do what Vermont is doing — find alternatives to institutional care. Besides home care, Vermont is encouraging assisted-living facilities, privately run boarding homes for seniors and elder day-care centers. All this would be a big change from the last four decades, during which nursing homes became the dominant, and often only, option for a frail senior dependent on federal programs.

For more than 40 years, federal law has said that poor seniors are automatically entitled to nursing-home care. That has sent hundreds of billions of dollars to nursing homes. But in-home care hasn’t been considered an entitlement equally eligible for government funds.

“It is a crazy situation,” says Vermont’s Commissioner Flood. “The service that people don’t want and is more expensive” is guaranteed by the government, while “the service people prefer and is cheaper, isn’t.”