Family Care program shifts more people into group homes Concerns remain

Stacy Forster

Jul. 2, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- MADISON -- When Nathaniel Wright wanted to move out of a nursing home last year, he faced a yearlong waiting list for a group home.

But through the state's Family Care program, Wright, 56, moved in January to a Pleasant Prairie adult family home, where he lives with three other people and a live-in aide.

"He wanted to have his own place, and that's all he was really concerned about," said Alice Wright of Kenosha, Nathaniel Wright's niece and guardian.

Nathaniel Wright is one of thousands of Wisconsin residents who have been able to receive care in long-term, community-based settings through the statewide expansion of Family Care. The state Medicaid program allows a greater number of low-income seniors and people with disabilities to move out of nursing homes. Some spent years on waiting lists before obtaining services in their homes or group settings.

The program started in five counties in 2001, and the statewide expansion got under way in 2007.

Family Care started July 1 in Waukesha County, when the first wave of 200 participants in current programs and about 30 people from waiting lists started to make the transition. About 1,200 people from Waukesha County will eventually move from existing programs, and the rest of the waiting list of 800 will move into the program by July 2010.

It will be a challenge to provide continuity of services for those already enrolled, but it will be a boon to those on waiting lists, said Jack Bodien, operations manager for the Aging and Disability Resource Center in Waukesha County.

The state projected it would take five years to expand the program statewide and eliminate waiting lists.

Seventeen of Wisconsin's 72 counties now offer Family Care programs, with 26 by the end of the year and 44 by mid-2009. About 13,450 people are enrolled in the program, while 11,170 remain on waiting lists; about 53,000 are expected to participate when the waiting lists are gone.

Advocates for the elderly and disabled said nursing homes used to be the only way to receive such fundamental services as help getting out of bed.

"If you're on a waiting list for a service like that, your life could be in danger," said Lynn Breedlove, executive director of Disability Rights Wisconsin.

Those watching the expansion said it has gone smoothly, but concerns remain about whether the program will be able to serve more people with the same amount of funds, and if there will be a large enough work force to provide the necessary level of services outside of long-term care facilities.

Among the counties to which Family Care has already expanded are Racine, Kenosha, Washington, Ozaukee and Sheboygan.

Milwaukee County, part of the original pilot project, already serves frail adults ages 60 and over through Family Care and is expected to soon submit an application to add as many as 7,600 adults with disabilities to the program, said Milwaukee County Health and Human Services Director Corey Hoze.

"The goals are to provide access to service and information, to provide good quality services, to give people choices about how they live their lives and provide cost-effective services," said Sinikka Santala, administrator of the Division of Long Term Care at the state Department of Health Services.

The expansion is supposed be covered by existing funds. A review during next year's budget process will give officials a better idea of the costs and expenses, said Rep. Kitty Rhoades (R-Hudson), co-chair of the Legislature's Joint Finance Committee.

"The whole premise of Family Care is that this would not only be cost-neutral, but would actually be more efficient in our use of revenue," she said. "Anticipating that revenues are going to continue to be scarce in the next biennium, this is going to be reviewed to see if it's meeting its original goals."

Steps to start program

To offer Family Care, an area must create an aging and disability resource center to provide information about available services. Counties must also establish a managed-care organization to administer services.

In Ozaukee County, which started its resource center in January and Family Care in March, about 50 people a month are being moved from other Medicaid programs to Family Care, as well as about seven from the waiting lists.

Groups supporting the elderly and disabled remain concerned that there won't be a big enough work force to provide the care, particularly in rural counties, and that the rates paid to service providers aren't high enough.

"The expansion to community-based care in less restrictive settings inherently requires more individuals one-on-one," said Tom Moore, executive director of the Wisconsin Health Care Association, which represents about 190 Wisconsin nursing homes.

Community Care, of Milwaukee, and Care Wisconsin, in Madison, which serve as managed-care organizations in Family Care counties, said they're aware of that concern but it hasn't been an issue where the program has expanded.

Newstex ID: KRTB-0130-26383698