Area Agency on Aging of North Central Texas Council of Governments is hoping to make living a little more comfortable for nursing home residents with the introduction of its Home By Choice program.

Administered through the NCTCOG area of AAA in Arlington, the program has responsibility in 19 counties — including Ellis County — and relies on a number of partners, its staff and contract relocation specialists to provide services directly to residents housed in its facilities.

The program was introduced to Ellis County in mid-February.

“This program has been in effect on the state level for about two years but this is the first time services have been available in all counties,” said Doni Van Ryswyk, manager of aging programs. “The program was a result in response to a Supreme Court ruling (Olmstead decision), which makes it illegal to force people to live in institutions in order to access the support services they need. The court held that keeping people in institutions constitutes discrimination under the Americans with Disabilities Act.”

This innovative program is designed to help residents of local nursing homes return to their community and live more independently.

It also provides services at no charge to those nursing home residents who qualify for the program and who also receive Medicaid benefits.

To qualify for the program, residents have to be living in a nursing home facility and approved for Medicaid at which Home By Choice will provide intense case management services to them.

“Meeting these requirements, residents are usually qualified right away,” Van Ryswyk said. “It typically takes at least two months in most cases to get all the services and even longer if we’re looking into subsidized housing, which is housing the government pays for. Subsidized housing is a wonderful resource but it always has a waiting list and that could hinder the qualifying process. It’s easy to set up the in-home services but really hard to find affordable housing.”

As a benefit of relocation, residents who have been certified for Medicaid nursing home care are able to bypass lengthy waiting lists for community-based programs that provide benefits such as nursing care, therapies, attendant care, health-related goods and supplies, minor home repairs and home-delivered meals.

In addition, relocation specialists may help residents apply for small grants to assist with rental and utility deposits and necessary household furnishings, should they move into unfurnished apartments.

“This program works with residents in several ways by setting up in-home services and working up a personal budget because most people have a very low income which would qualify them to receive government assistance,” Van Ryswyk said. “Residents may need assistance with their utility bills and this program works with that issue also. If someone needs to apply for subsidized housing, this program can do that too.”

Through the Home By Choice program, relocation specialists work with nursing home residents who are receiving Medicaid benefits and hopefully identify and remove barriers to independent living, which would ultimately lead to returning to the community.

Relocation specialists’ duties may include affordable housing, arranging in-home services, applying for financial assistance, acquiring medical equipment and securing other health and social services as needed.

“The specialist will conduct a comprehensive assessment, which helps them to better understand the needs of a nursing home resident,” Van Ryswyk said. “They look and evaluate what the residents want and need to help them live more independently and comfortably. They go out and meet with residents face to face and try to arrange services in a way of meeting all their emotional, medical, social, functional and spiritual needs. They develop a plan that may address all these needs. Pretty much whatever it takes to remove the barriers to independent living, that’s what the specialist does. Once the resident leaves, the specialist keeps in touch for at least three months to make sure he or she receives the services they need and to make sure that they feel safe and happy in their home, because it could be a rough adjustment when a person is used to living around a lot of people and then suddenly is on their own.”

Home By Choice program is funded by the Texas Department of Aging and Disability Services as a part of its Promoting Independence Plan, which outlines several strategies for providing people with disabilities viable alternatives to nursing home care.

According to Van Ryswyk, the issue supporting this plan is that it is easy to access care in nursing home services, but it can be very difficult to care in the community.

“The Promoting Independence Plan provides a way for people who are receiving Medicaid benefits and living in institutions to leave the institution and receive the care they need in the community, if they choose to do so,” she said. “This plan also allows nursing home residents to bypass waiting lists for in-home services. That’s the nice thing about the Promoting Independence Plan, because residents don’t have to wait for two years to be approved; they automatically go to the top of the list. Currently, there is a two-year waiting list on state programs such as community-based alternatives.”

Van Ryswyk said the program’s goal is to help residents gain more control over their lives and to live independently anywhere they choose.

“It’s all about promoting personal freedom, because this allows residents to make personal choices and save money,” she said, noting community-base care cost less than nursing home care in general.

“Moving someone out of the nursing home into the community saves about 20 percent on their Medicaid cost and it also saves Medicaid dollars,” she said. “About 26 percent of the state’s revenue are dedicated to the Medicaid program and costs are expected to increase.”

Van Ryswyk said she supports the program because of the changes she’s witnessed and the more it will do in the future for nursing home residents.

“I think this program is a tremendous benefit because a lot of people living in nursing homes feel they don’t belong there but may not have the ability to move out and get everything set up by themselves,” she said, adding, “I see this as a program that will continue to expand due to the state receiving a grant from the Texas Department of Aging and Disability Services to help people who live in institutions return to the community. This grant will not affect the Home By Choice program directly but it will give Texans living with disabilities more options. Until now, our focus has been on nursing homes but that’s now going to expand.”

NCTCOG is a voluntary association of local governments established in 1966 to assist local governments in planning for common needs, cooperating for mutual benefit and coordinating for sound regional development.

NCTCOG’s purpose is to strengthen both the individual and collective power of local governments and to help them recognize regional opportunities, eliminate unnecessary duplication and make joint decisions.

NCTCOG serves a 16-county region of North Central Texas that is centered around the two urban areas of Dallas and Fort Worth. It has more than 230-member governments, including all 16 counties, 164 cities, 24 school districts and 27 special districts.

For more information about the program, call (800) 272-3921.

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