The Orange County Register


July 6, 2003

FOCUS: IN DEPTH // The case for home care // Keeping older people out of
nursing homes would cut spiraling health costs, advocates say.


Author: JANE GLENN HAAS


By all rights, Colletta Whitcomb-Davis should have someone taking care of
her.



She's 70, legally blind and suffering from rheumatoid arthritis.


She's also fiercely independent. So she takes care of herself -- and her
husband, Gilbert Davis, 80, who is bedridden after several strokes, a broken
hip, vertigo and heart surgery.


``As long as I can take care of him, I'll do it,'' Colletta says. ``I
wouldn't put him in a nursing home. No, no, no. We are going to stay home.''


Most seniors say they want to live at home. Independent. On their own.


State and federal politicians, alarmed at spiraling costs for
taxpayer-supported nursing-home care, are increasingly focused on helping
these seniors get their wish.


In recent months:


The U.S. Supreme Court has ruled that states are responsible for ensuring
that seniors and people with disabilities have options to stay home.


President George W. Bush said he wants to reduce the national health-care
budget by helping impoverished seniors avoid nursing homes.


The U.S. House of Representatives proposed expanding a special Medicare HMO
that funds in-home care.


Long-term care costs can plunge seniors into poverty. For thousands of
California's elderly, nursing homes are the only way to get Medi-Cal, or
publicly funded long-term care.


Nursing-home care accounts for $2.9 billion of California's $27.7 billion
Medi-Cal budget. About $200 million of Orange County's $706 million Medi-Cal
budget was spent on nursing-home care last year, according to Cal-Optima,
the agency integrating Medi-Cal services.


The California Healthcare Foundation says 64 percent of all nursing-home
days in the state are paid by tax-supported Medi-Cal. Overall, 42 percent or
$5 billion of all publicly supported long-term care for state elders is paid
by the federal-state program, the foundation says.


With elders living longer and boomers edging closer to old age, efforts must
shift toward cheaper, home-based care rather than expensive nursing homes,
said Josefina Carbonell, U.S. assistant secretary on aging.


Carbonell insists the government will be paying for more home-based elder
care for Medi-Cal recipients in the future.


However, the initial plan benefits only people already in nursing homes by
offering to move them back home with more Medi-Cal paid services. The plan
will be tested in 2004.


Gloria Regalado of Orange would welcome any increase in Medi-Cal home care.
She provides 24-hour care for her mother, Maria Barroso, an Alzheimer's
patient.


Barroso, 67, is a Medi-Cal patient who qualifies for nursing-home care
because of her advanced needs. But neither Gloria nor her husband, Silbereo,
wants to put her in an institution despite the difficulties of keeping her
home.


``Sometimes it takes both of us to care for her,'' he said.


Barroso has lived with the family for five years.


``I pray to God,'' says Gloria. ``(It takes) a lot of patience to do this.''


She gives her mother medicine, feeds her and takes her to the bathroom. The
responsibility confines her to the small apartment, she says. Her only
respite comes when her husband is home or when other family members help out
on weekends. The Orange County Alzheimer's Association provided care for
Barroso for two weeks so the family could take a vacation.


Some caregivers have no option but to put a loved one in a nursing home.


Maria Miramontes moved her husband, Victor, to a Westminster home six years
ago after caring for him for half-a-dozen years.


Now in advanced Alzheimer's, Victor does not talk and spends all his time in
bed. He shares a room with another man. The family visits him almost daily.


social hmos give some the help they need


Colletta and Gilbert Davis are taking advantage of the HMO program set up to
provide home care for frail elders.


The Anaheim couple remain self-sufficient because their Medicare HMO, SCAN,
provides up to $700 a month in home-based care for each, dollars other
Medicare HMOs are not able to provide. The experimental HMO is one of four
nationwide that offer the coverage. Colletta and Gilbert Davis use their
care allowance for taxi vouchers for trips to the doctor and a housecleaner
for their Anaheim home.


``I've been almost blind since birth, so I can't see the dirt and my husband
doesn't tell me,'' she quipped.


It takes her almost 40 minutes to get her husband ready in the morning.
She's up at 5:30 a.m. to bathe, powder and dress him, she says. Gilbert
hasn't walked in three years except with a walker.


``When I put him to bed, he's dead weight. Sometimes he falls off the bed
and it's hard for me to lift him,'' she says.


Yet the childless couple are determined to remain together at home.


Connecting seniors with services is one of the key tasks for SCAN
counselors, says Lisa Roth, manager of the independent living program.


Despite their needs, the couple does not use the total $1,400 home-care
benefits SCAN could provide. By comparison, nursing-home care would cost a
minimum of $3,500 each.


In the House version of the Medicare prescription-drug plan, SCAN is renamed
an ``enhanced Medicare plan'' and gains options to expand beyond its current
52,000 membership, including 12,300 in Orange County.


While proponents say SCAN saves taxpayer dollars, there are no data to prove
that, says Mike Mayers, director of public and government affairs for the
insurance program.


He estimates 13,000 members are eligible for nursing-home care but remaining
at home under SCAN's program.


Still, there is no way to measure how many tax dollars are saved through the
home-care program because elders eligible for nursing-home care do not
always opt for that type of care.


(714) 796-7987 or jhaas@ocregister.com .


Caption:
MANAGING AT HOME: Colletta Whitcomb-Davis is legally blind and a caregiver
for her husband, Gilbert B. Davis, a stroke patient. The couple rely on
their Medicare HMO's home-care services to keep them out of a nursing home.
Best option: Maria Miramontes, and daughter Marlene visit her husband
Vincent, who has Alzheimer's disease, at the Helping Hands Nursing Home in
Westminister. She says she would rather have him at home, but she has to
work.





Copyright 2003 The Orange County Register
Record Number: 62798760