TennCare provides at-home services for older people and people with disabilities, such as shopping, personal care, housekeeping, meals and running errands. The program will cover more people starting in March. Photo: Corbis

Summary:
• Tennessee ranks 50th in spending on at-home services.
• Home care services will expand in March.
• Call 1-866-836-6678 toll-free for information.

For years, Tennessee has ranked dead last in helping older people and people with disabilities stay in their own homes.

While other states directed more Medicaid dollars to visiting nurses, meal delivery, home health aides and other in-home assistance, TennCare poured 99 percent of its long-term care dollars into nursing homes. Poor, disabled or older residents who were older, had disabilities or were who needed daily care had almost no choice but to leave their homes and move into an institution.

Starting next March, the state will expand services for people needing long-term care services at home—like Carolyn Joyner.

At 61, the Chattanooga-area resident has congestive heart failure, pulmonary disease and a degenerative disc that limits her mobility. TennCare provides meals and an aide to help with bathing, housekeeping and running errands.

“I was desperate for this kind of help,” Joyner said. “And I’m sure that many nursing homes are great, but why would I want to move into a nursing home if I can stay in my own place?”

Joyner was fortunate. Hundreds of people are on a waiting list.

But next year, the waiting list will evaporate as expanded services become available across the state. It will begin in Middle Tennessee in March, and then gradually roll out to other regions. Anyone who qualifies for long-term services through TennCare will have access to them.

“This is just revolutionary for us in being able to help people stay at home who can safely stay at home,” said Steve Witt, director of the Southeast Tennessee Area Agency on Aging and Disability in Chattanooga. “This will help us begin to rebalance the long-term care money, so as time goes by, the goal will be to see more money spent for in-home services versus nursing homes.”

Witt’s agency is one of nine Area Agencies on Aging and Disability that will help people who meet income and physical requirements choose services that fit their needs. Options include housekeeping, home aides and house modifications as well as respite care for caregivers. Case managers will explain all long-term care services, and nursing homes will remain an option for those who need it.

TennCare will oversee funding for nursing homes as well as home-based care. Patrick Willard, advocacy director for AARP Tennessee, said this is a key step toward providing care based on each individual’s needs.

“We’re going to be watching the implementation of this plan very closely to make sure that the system works in a way that best serves seniors,” Willard said.

Home care is more cost-effective, too, with a price tag of about $14,000 per year for two hours of daily at-home services compared with $66,000 for a nursing home.

Nursing homes initially opposed some of the changes, but legislation that expanded the program included some disarming incentives: more than $5 million in grants to nursing homes interested in providing home and community services of their own.

Sen. Diane Black, R-Gallatin, is a registered nurse who cosponsored the bill. “We have a real opportunity here. We recognized that we’re starting at the bottom, and if you’re at the bottom the only place to go is up, but I believe there is great political will here to continue to do better.”

Cosponsor Sen. Lowe Finney, D-Jackson, said demand for at-home services will grow as the state ages. By 2030, 19 percent of Tennesseans will be 65 and over.

“We are expecting this to build up over time,” Finney said. “I do think we will see Tennessee ... do better than No. 50 as time goes by.”

Go to this website to find the Area Agency on Aging and Disability for your county in Tennessee, or call toll-free 1-866-836-6678.

Anita Wadhwani is a reporter based in Nashville.