Emily Corwin / Vermont Public Radio
As the baby boomers get older and the workforce shrinks, there may not be enough people or money to look after all our elders, especially those with medical needs. In many ways, this reality has already arrived in Vermont.
A small but growing number of Vermont families are relieving themselves by opening their homes to older people who need a lot of care.
Robert Bousquet did not have to be in the hospital, but he was detained there anyway – for two months – earlier this year. "It was a nightmare, I've never cried so much in my life," said Bousquet's wife, Joan Bousquet. "I would leave him to go home and sob all the way home."
Robert has Alzheimer's disease. Joan brought him dehydrated with a bladder infection to the hospital: He had refused to take a bath or to eat. The hospital treated him quickly. But Joan felt she could not take care of him at home anymore. And, she said, none of the many nursing homes within driving distance of her rural Vermont home would take him.
Robert qualifies for Medicaid for long-term care. But Medicaid does not pay enough to cover the cost of high-demand patients, such as those with dementia or behavioral problems. That's why a caseworker needed two months every day to find a Vermont care home that would take him.
Emily Corwin / Vermont Public Radio
This happens throughout the country.
In Vermont, where more elderly patients are already traveling as nurses, nursing homes are particularly picky.
Jane Suder directs patient management at Northwestern Medical Center. A small hospital in St. Albans, Vt. She recently said that six out of the hospital's 34 inpatient beds were taken by people waiting for long-term care.
"We had people here from one month to just four months ago," she said. "I know, years ago we had someone here for almost a year."
A fast-growing program called Adult Family Care in Vermont is helping.
David Calderwood spent eight years in a residential care facility. Calderwood suffers from lung disease and needs help managing his many prescriptions. When his facility announced the closure, he spent three months trying to get into another facility. Eventually, he moved into Crystal Abel's house, into a bedroom whose walls were still turquoise as it belonged to the now-grown Abel's daughter.
"It's like my own family," Calderwood said, though he's not related to Abel or her husband.
About a dozen states have similar programs. Many are referred to as Adult Foster Home Care. They vary greatly in terms of licensing and licensing requirements, population and compensation. Many programs allow up to five inhabitants.
Here families like the Abels can have up to two residents who move into their house. The residents pay for accommodation and food. In addition, the state pays the family between $ 80 and $ 160 per person per day, depending on the complexity of their needs.
The money comes from the same Medicaid dollars that would go to a long-term care facility. Per person this program costs less than one institution.
Crystal Abel is not trained in health care. Previously, she worked in the local Dollar Tree and a school cafeteria. But she says she cares more about Calderwood and another man than she was before she joined the program. Still, she said, "Even if we had no money, we would find a way to make it work, you know, I can not imagine our life without them."
Abel helps Calderwood bathe and eat. She releases his 30 different recipes and makes sure that he uses his oxygen machine. It's a job around the clock, except on the few days a week the boys go to daytime programs. She and her husband recently took her on a family vacation to Florida.
First, Calderwood said moving to a strange house felt rather strange. But, he said, "there is an openness here, a give and take that I have never had," and he has come. Besides, he said, the Abels are a mischievous bunch, and, "Oh my God, yes, I love to tease."
Some advocacy groups warn that poorly managed programs can lead to neglect or abuse. This does not seem to be a problem with Vermont's program for now. During a review by VPR, records of complaints and violations of Vermont Adult Family Care's regulators who did not detect abuse or neglect were kept for two years. All complaints were apparently processed quickly.
Participation in the program has grown by an average of 30 people a year, a lot for a tiny state.
With growing demand, the challenge has convinced more and more families to open their homes.