Federal Help, States Struggle To Move People
Out Of Nursing Homes
KHN Staff Writer
APR 22, 2010
This story was produced in collaboration with
PEACHTREE CITY, Ga. — Richard Hasselbach and
Deborah Kadlec met in a nursing home and
dreamed of a life together outside its
Their health conditions made living on their
own a challenge: Hasselbach, 63, is disabled
from a stroke and lost a leg to a blocked
artery. Kadlec, 52, has multiple sclerosis.
They both use wheelchairs and need help with
chores such as bathing, cooking and
remembering to take their medicines. Most of
their relatives live in other states.
Despite those obstacles, Hasselbach and Kadlec
got their own apartment and a personal care
aide last summer through the help of a
federally funded program run by the state.
The program, known as Money Follows the Person,
is the nation’s most ambitious effort to
move people out of nursing homes and other
It aims to help people live on their own and
also save tens of millions of dollars for
Medicaid, the state-federal health insurance
program for the poor and disabled that pays
for two-thirds of nursing home bills in the
Nationally, nursing home care averages about
$75,190 per patient each year. Care in the
home, through such services as
meals-on-wheels and daily visits by a health
aide, averages $18,000 a year, according to
the AARP Public Policy Institute.
The program gives nursing home residents
personal and financial help to live on their
own or in small group settings, as well as
payments for costs such as apartment
security deposits, household furniture and
alterations to make homes or cars accessible
to the handicapped.
Georgia is one of 29 states and the District of
Columbia participating in Money Follows the
Person. Its experience shows both early
successes and an illustration of the
program’s slow start nationwide. Georgia had
hoped to move 1,312 people from nursing
homes and other long-term-care facilities by
2011. But through the end of last year it
has moved out only 221.
Progress On Goals Wide-Ranging
Congress established Money Follows the Person
in 2005, and states set a combined goal of
moving out more than 37,000 residents from
nursing homes and other facilities by 2013.
Most states, including Georgia, started
their programs in 2008. Two years later,
just 5,774 residents have moved nationally,
according to state data collected by Kaiser
The new health overhaul signed into law last
month extends the program to 2016, adds $900
million to what was a five-year, $1.3
billion initiative and loosens eligibility
"The impact could be very significant," said
Debra Lipson, a senior researcher at
Mathematica Policy Research, a Princeton,
N.J. based think tank that is evaluating the
program for the federal government.
Most states are moving slowly for various
reasons: problems finding affordable
housing, resistance from nursing homes,
stringent federal rules that limit who is
eligible and what types of community
settings they can move into, according to a
recent study by Mathematica.
Alice Hogan, who heads the Money Follow the
Person program in Georgia, said she
considers the program a success. "Like most
states, we wished things were going along
faster but implementation has been more
difficult than expected," she said. "But
personally I am not disappointed because I
am very happy with those that we got out
because each of them is a real person who is
now in the community."
State data show wide-ranging progress on
- Texas has moved 2,029 people out of nursing
homes and other long-term care facilities.
That’s more than one-third of the national
- A dozen states have moved fewer than 60
people. States moving the fewest: Louisiana
(10), North Dakota (19) and Delaware (22).
- Illinois, which set the highest goal, is
furthest from its target. The state had set
3,357 transitions as its goal by 2013, but
through last year has done just 58. “Meeting
that goal by 2013 appears nearly
impossible,” said Jean Summerfield, the
Illinois project director.
Many states blame their slow start on the
program's requirement that people live in
nursing homes and other institutions for at
least six months to qualify for transition
assistance. State officials said those
residents are hard to move because they
often have the most complex medical
conditions and have typically lost their
home and family support system.
Congress last month lowered the requirement to
a stay of three months that is paid by
In addition, the program's rules bar
participants from moving into group homes
that house more than four people, which
effectively shuts out most assisted-living
A More Realistic Target
Georgia earlier this year cut its 2011 target
by more than half to 618 people. Joye
Burton, spokeswoman for the Georgia
Community Health Department, said the
updated goal is more realistic given early
problems finding housing and arranging
funding for community-based services.
While dozens of people have been helped by the
program, advocates for the poor and disabled
say the program's slow start highlights the
state's lack of investment to help people
live on their own.
"I'm discouraged," says Ruby Moore, executive
director of the Georgia Advocacy Office, a
non-profit agency that works with the
disabled. "We have a disproportionate number
of people in nursing home facilities who do
not need to be there."
Advocates for the disabled have pressed the
state for years to improve its
community-based services. A lawsuit filed
against the state led to a landmark U.S.
Supreme Court ruling in 1999 that
"unnecessary institutionalization" is a form
of discrimination. That decision had been
expected to spur states to enhance home and
community services to help people avoid
nursing homes, but Moore says too little has
"Cutting the benchmark in half has never been
known to be a good strategy to improve
performance," Moore said.
The state has contracted with a private
company, B&B Care Services, to handle the
nursing home transitions. The firm's
employees visit nursing homes to identify
residents who might be interested and work
with family members and nursing homes to
smooth the way.
One sign of the program's value, according to
Lynnette Bragg, CEO of B&B Care Services, is
that of the 107 nursing home transitions,
only 10 people have returned.
Jay Wright, a transition coordinator for B&B,
helped find a home for Joe Morman, who had
spent two years in an Atlanta nursing home
after being hospitalized with an infection
of the brain or spinal cord. Morman has
moved into an apartment in a gated community
in Decatur, Ga.
The program paid his security deposit for the
apartment and utilities, covered his moving
expenses, bought him a bed, chair, dining
room table, a microwave and even some food.
And it arranged to get him a personal care
aide eight hours a day to clean, cook and
"It feels absolutely wonderful," Morman said.
"I feel alive again."
But Bragg notes that many parts of the state
don't have public housing subsidies or
appropriate housing options.
Christine McDaniel, 50, has been trying to move
out of an Atlanta nursing home for about a
year. "I didn't come here to live. I came
here to get better and I'm ready to move
on," said McDaniel, who has HIV and has been
treated for hepatitis. Even though she
qualified for a Medicaid waiver to help
cover her cost of care, the program has had
trouble finding her a place to live in
Northwest Georgia – near her family -- with
her $675 a month Social Security check.
Nursing home officials say most of their
residents are happy where they are. "The
advocates feel like every person in a
nursing home could go home and live
successfully. That is not realistic," says
Norma Jean Morgan, CEO of Effingham Extended
Care Center in Springfield, Ga. Yet she
adds: "You do not want a person staying in
an institution if he or she can be viable at
The transition back home has not been seamless
for Kadlec and Hasselbach. They've had
trouble accessing public transportation and
Kadlec is unable to maneuver her wheelchair
to use the apartment shower. Still, neither
wants to move back to the nursing home.
"I'm much happier here," Hasselbach says,
sitting by Kadlec in the living room of
their one-bedroom apartment that overlooks a
golf course in this leafy Atlanta suburb.