美国国家公共电台 NPR A Workable Alternative To Nursing Homes In Vermont — Adult Family Care（在线收听）

SCOTT SIMON, HOST:

As baby boomers age and the workforce shrinks, what if there's not enough people or money to care for older people? That's the concern in Vermont that's come to pass for some elderly Vermonters, but a growing number of families in Vermont have opened their homes to them. Vermont Public Radio's Emily Corwin reports on how this works and why.

EMILY CORWIN: Robert Bousquet didn't need to be in the hospital, but he was stuck there anyway for two long months earlier this year.

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JOAN BOUSQUET: It was a nightmare. I've never cried so much in my life. I would leave him to go home and sob all the way home.

CORWIN: This is Joan Bousquet, Robert's wife. Robert has Alzheimer's. The hospital treated his bladder infection quickly, but Joan felt she couldn't care for him at home any longer. And none of the handful of nursing homes in driving distance of their rural Vermont home would take him. See, Robert qualifies for Medicaid for long-term care and Medicaid doesn't pay enough to cover the costs of high-needs patients, like those with dementia. This happens all over the country. But in Vermont, where there's already more elderly patients than there are nurses to go around, nursing homes are especially picky. Jane Suder heads up patient management at a small Vermont hospital called Northwestern Medical Center.

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JANE SUDER: We've had people here from one month to, recently, four months. But sometimes - I know, years ago, we had someone here almost a year.

CORWIN: Recently, she says, six of her hospital's 34 inpatient beds were taken up by people like Robert, waiting for care - people who didn't need to be there.

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CORWIN: There is a program that's helping.

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CRYSTAL ABEL: Hello? Come on. Go outside. Go. Go see.

CORWIN: This is Crystal Abel's house.

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ABEL: Dave, you want to come on out, buddy?

CORWIN: For eight years, David Calderwood lived in a residential care facility. When it announced plans to close, he spent three months trying to get into another facility. Finally, he moved in here, to a room with walls still turquoise from when it belonged to the Abel's now-grown daughter.

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DAVID CALDERWOOD: Just like my own family.

CORWIN: Calderwood is not related to Abel or her husband. He's 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 nursing facility, only this program costs the state less.

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ABEL: It's definitely more money than I was making before.

CORWIN: Abel cares for Calderwood and another gentleman. She isn't trained in health care. Before this, she worked at the local dollar tree and in a school cafeteria.

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ABEL: Even if, you know, my husband and I had talked about it and even if the money wasn't there, we would find a way to make it work. You know, I can't imagine our lives without them.

CORWIN: Abel helps Calderwood with bathing and meals. She divvies up his 30 different prescriptions and make sure he uses his oxygen machine. It's a 24/7 job, save for when the guys go to day programs a few days each week. At first, Calderwood says, moving into a stranger's house felt pretty weird. But he says he came around.

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CALDERWOOD: There is an openness here - year a give and take, which I never had before.

CORWIN: The Abel family is mischievous.

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CORWIN: Do you, like, tease each other or...

ABEL: Oh, yes, all the time. We tease each other more than we're serious, I think.

CORWIN: You get in on the teasing?

CALDERWOOD: Oh, my God, yes. I love to tease.

CORWIN: Some advocacy groups warn badly-managed programs can lead to neglect or abuse. A review suggests that hasn't happened in Vermont. Here, participation in the program has been growing by an average of 30 recipients a year - a lot for this tiny state. As demand grows, the challenge is convincing ever more families to open their homes. For NPR News, I'm Emily Corwin in Vermont.

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