Emily Bregel

Jun. 23, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- As Gov. Phil Bredesen tries to redirect state money toward home- and community-based services for the elderly and disabled, three health care facilities in Hamilton County are getting Medicaid dollars to do just that.

St. Barnabas Senior Living Services, the Health Center at Standifer Place and Rose of Sharon's Senior Villa have been approved to get Medicaid funds for such services as assistance with meal preparation, housekeeping, dressing and bathing. These services are part of a statewide push to give long-term health care patients less-intensive and less-expensive options than nursing homes.

Home and community-based services are ideal for people who only need moderate help to remain independent, said Eric Boston, president and CEO of St. Barnabas, whose assisted living apartments on Pine Street received Medicaid approval this month for such services.

"Now the waiver program will allow people that just need that assistance but do not require 24-hour-a-day nurse monitoring to (access services that) assist their independence in a home-like environment, in their own personal residence or in a residence like St. Barnabas," he said.

St. Barnabas is in the process of getting approval to provide these services in a patient's home as well, he said.

The Health Center at Standifer Place on Walker Road, a nursing home and assisted living facility, received approval in October, and Rose of Sharon's Senior Villa assisted living facility received approval in August 2007, said Terry Woods, waiver manager for the Area Agency on Aging and Disability.

The Medicaid approval -- technically known as a waiver -- for these services makes it possible for people who otherwise couldn't afford assisted living to use state funds to get that care, said Steve Witt, director of the Southeast Tennessee Area Agency for Aging and Disability, which administers the area's home- and community-based services. Before the waiver Medicaid wouldn't cover such services.

In the 10-county Southeast Tennessee area, including Hamilton County, about 60 providers -- outside of nursing homes -- now offer a variety of services covered under the Medicaid home- and community-based services waiver, from homemaker services to pest control, Ms. Woods said. The waiver provides up to $1,100 a month from the TennCare Bureau to pay for services, but it does not cover room and board in a facility, she said.

Awareness about the Medicaid waiver is spreading, Ms. Witt said.

"People are really catching on, and we're getting lots of good referrals and people who didn't know they had choices" other than a nursing home, Ms. Woods said.

The nursing home industry as a whole appears to be receptive to Gov. Bredesen's efforts to rebalance funding in the state's long-term care system by giving more funding to home- and community-based services, Mr. Witt said. The governor's reform efforts give more money to such services and make it easier for nursing homes to expand services into clients' homes, he said.

"That's one of the things the governor was wanting to see happen because the nursing-home industry is so important and their function is important," Mr. Witt said. "But as times are changing and people have more options to stay home, nursing homes we hope will diversify and offer other services,"

In the past, long-term care funding in Tennessee overwhelmingly has supported nursing homes, with only about 2 percent of the funds going for less-intensive services that allow some patients to stay out of a nursing home, state officials have said.

In the fiscal year 2009 budget, Gov. Bredesen allocated an extra $12 million to funds coverage for 2,300 more people on the state's home- and community-based care Medicaid waiver, which currently can cover 3,700 people.

The state also is working to improve delays for patients trying to get approved for the waiver services. Approval requires meeting financial criteria for Medicaid as well as requirements for intermediate-level nursing home care. Gov. Bredesen has said he aims to remedy that with his recently-signed Long-Term Care Community Choices Act of 2008.

The legislation streamlines the process for residents to be approved on the home and community-based care Medicaid waiver, state officials have said.

Newstex ID: KRTB-0202-26170913