Increasing numbers of Vermont seniors are finding long-term care in other families’ homes. The Medicaid-funded program known as Adult Family Care has become critical for Medicaid patients with dementia and other complex needs, who get turned away from traditional nursing facilities and don’t have families to care for them.
For eight years, 71-year-old David Calderwood lived at Scenic View, a residential care facility in Westfield. There, staff helped him with medications, bathing and meals. Then, the company that owned Scenic View announced it would close. Calderwood qualifies for Medicaid for long-term care. But, he said, he couldn’t find a facility that would take him.
Eventually, he decided to move into Crystal and Todd Abel’s cozy Newport home. Today, he sleeps in a bedroom still turquoise from when it belonged to the Abels’ now-grown daughter. During the day, he shares the wood-paneled living room with the Abels, one other long-term care resident, the family’s two big dogs, their cat, and two daughters who still live at home — one is in middle school, the other is in college.
Calderwood is not related to the Abels. But, sitting at their kitchen table in a collared shirt, sweater-vest and gray goatee, he described them as “like my own family.”
Calderwood is part of a program in Vermont called Adult Family Care. Other states have similar programs.
Vermont’s works a lot like foster care. Families like the Abels can have up to two residents move into their home. The residents pay room and board. The state pays the family between $80 and $160 a day per person, based on the complexity of their needs.
The money comes from the same Medicaid dollars that would be going to a long-term care facility, although this program costs the state less.
Right now there are only 136 Medicaid recipients enrolled, a tiny fraction of the nursing home population. But the program is growing fast: by roughly 30 participants each year.
Crystal Abel cares for Calderwood and one other gentleman. She used to work at in a school cafeteria, and then at the local Dollar Tree, before she began providing care in her home full-time.
“It’s definitely more money than I was making before,” she said. Still, she thinks she would do it even if the money wasn’t there. “I absolutely love it, and I love our guys,” she said.
Abel helps Calderwood with bathing and meals. She divvies up his 30 prescriptions, makes sure he uses his oxygen machine, and drives him to the doctor. It’s a 24/7 job, she said, except for the few days a week when both men go to a day program.
Calderwood said at first, living in someone else’s home felt strange.
“It was a little rough,” Abel remembers. She said Calderwood was very quiet at first, and hers is a loud, mischievous family.
Since then, Calderwood has come around.
Today, Calderwood said he prefers the give-and-take of his current situation to the one-way relationship of his last facility. “It’s more... living like I used to on my own.”
Initially, the program was supposed to help people who wanted to leave nursing homes they were already in, like 70-year-old former social worker, David Beauregard. Beauregard spent five years in nursing homes after a stroke.
“It’s no real life, you know what I mean?” asked Beauregard. When he got a chance to move in with a family in Hyde Park, he said, “I just jumped at it.”
Above the sink in Nadia Marin's kitchen is an enormous bowl of asparagus. Marin is Beauregard's home provider. She said she makes sure to serve her family asparagus frequently, because it's Beauregard's favorite, along with shrimp. She noted he lost 20 pounds after moving in with her family from the nursing home.
Beauregard’s caseworker, Judy Hayes, said he is also gaining back some limited use of his legs after years of being lifted from his bed to his wheelchair and back.
But Beauregard seemed more interested in his newfound human connections than in his physical health. "Things have changed a lot since I've been here," he said.
Increasingly, however, the Adult Family Care program is serving a different Medicaid population: those with expensive needs who nursing homes can’t or won’t admit. Hardest to place are patients with cognitive and behavioral issues stemming from dementia. Those prone to falling can also face barriers to long-term care.
Sean Londergan is Vermont’s long-term care ombudsman. He calls the program a “two-sided coin.” The upside: life in a home can be less restricted and more meaningful than in a nursing facility.
But Londergan says there is also a downside. “There’s a lot less regulation on adult family care homes,” he said.
The homes aren’t licensed, although providers do have to pass a background check and a home inspection.
Vermont's Department of Disabilities, Aging and Independent Living provided two years of redacted incident reports regarding Adult Family Care homes. Those forms include allegations of abuse or neglect in a handful cases.
Megan Tierney-Ward heads up Adult Services for Vermont’s Department of Disabilities, Aging and Independent Living.
She said the state contracts oversight of the program to 15 private agencies across the state. Those agencies employ caseworkers who perform oversight.
“They have a minimum requirement of having contact with them every 30 days,” said Tierney-Ward, who noted most caseworkers check in even more frequently. The caseworkers are required to see residents face-to-face every 60 days.
Crystal Abel describes her caseworker as quote “phenomenal.” Still, she said, she had no idea the state required an orientation with a nurse for each new resident. She also hadn’t been told about the required six hours of training per year. Tierney-Ward said she’s looking into that apparent discrepancy.
Abel also said she thinks the state should mandate surprise visits for all homes, even when there’s no suspicion of mistreatment.
CORRECTION: This story initially stated caseworkers are required to see residents face-to-face every 90 days. The correct interval is every 60 days.
CLARIFICATION: VPR added details about redacted allegations of abuse or neglect on May 7, 2019.