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Over the Back Fence By HANK HENRY State rates well in its senior care H ere's a question for you: "What state provides in-home services to a larger percentage of infirm seniors and the disabled than any other?" You would think the answer would be one of the states with large numbers of retired people -- such as Florida, Texas or Arizona -- but the state that keeps the largest percentage of Medicaid patients in their own homes is our state -- Oregon. This means Oregon saves millions of dollars a year by keeping the frail elderly in their own homes, not nursing homes. To be a little more specific, the monthly cost of a Medicaid patient's nursing home stay in Oregon last year was $2,153 per month, or $25,836 per year. The patient has to pay that cost until all resources have been spent down to $2,000 or less. Then Medicaid takes over and the cost of residing in a nursing home comes from federal taxes. Back in 1981, Oregon legislators and senior advocates got together and worked out a plan to keep older people in their homes in spite of their physical debilities. They knew that a few hours of help a week would be enough to keep them at home for extra months or even years. Now, three-fourths of the senior and disabled Medicaid clients in Oregon are served in home- and community-based settings. The average monthly cost of keeping an elderly person at home is $516.52. Change is happening in a hurry. A news release from the Oregon Department of Human Services notes that people over 85 are the fastest-growing group in the state's population. Between 1995 and 2010, the general population is expected to grow by 21 percent, while the numbers of those over 85 are expected to increase by 62 percent. The impetus for keeping the elderly in their homes came in 1975 when the legislature passed "Oregon Project Independence," which is funded out of the state budget alone. This provides a relatively small amount to supplement the federal funds from the Older Americans Act. Together, these funds give this state the ability to keep more of the elderly in their homes. Most personal assistance care for them is still provided by family members. But caring for a family member can be a stressful 24-hour service that can lead to burnout. The state provides respite care, training and advice to support the effort to keep the elderly in their homes. This is done by recruiting and retaining home-care providers. These helpers can go into the home of an elderly person several times a week to assist in personal needs -- bathing, doing dishes, cleaning the house, and even going shopping -- tasks which are difficult or impossible for the client to perform alone. Many elderly people find out about the services available to them when they are ready to go home after a stay in a hospital. The institutions have discharge planners who will meet with the patients after receiving the doctor's written orders about what will be needed when that person goes home. The doctor may call for nursing help at home, or rehabilitation as an outpatient of the hospital. Senior and Disability Services steps in when the elderly patient cannot afford rehabilitation. Case workers work with the clients and their families to devise individual care plans that include social, financial and health-care options. The downside to the recruiting of in-home workers is the low pay and lack of benefits. As the demand for in-home services continues to increase, it is even harder to find, hire, train and monitor a care-giving workforce, especially in the more rural parts of the state. Over a period of time, the Department of Human Services has learned to serve individuals with very significant disabilities and chronic health problems right in their own communities. They are also linking up nurses, doctors, health plans, clients and their families, and in-home caregivers. When I retired some four years ago, I found myself with time on my hands. I decided to volunteer for Senior Services, the organization that provides an array of services for the elderly, including meals at senior centers, adult foster homes, assisted living facilities and nursing homes. At any given time, only a little more than five percent of all retirees over 65 are in some sort of facility. But they are among the most needy of any citizens of this country. That's why I have chosen to be an advocate for seniors. For more information about the help that is available, contact the Area Agency on Aging in Jackson or Josephine counties. (Hank Henry is a retired Jackson County commissioner and a former radio and television announcer. Call him at 772-9055.) Prime Times front page Mail Tribune front page Copyright � The Mail Tribune 1999, Medford, Oregon USA