A Looming Crisis in Long Term Care

My maternal grandmother – Nana – was a central figure in my life growing up. When she was young, she was a talented seamstress who sewed wedding dresses for fancy customers. When she got married, she stayed at home and raised two daughters who were born “during the War.” Once the childrearing was done, her life was largely spent cooking and cleaning and sewing and doing laundry. She was deeply skeptical of my husband when I first brought him home and she discovered that he did all of those things for himself – and often for me too.
She dressed up and put on make-up to go out, and always wore heels until the day she fell and broke her pelvis. That was the beginning of her slow decline. Hypertension, diabetes and several falls plagued her in the last decade of her life. “Don’t get old, honey, it’s hard” was a common refrain. 
I’m starting to watch my parents and my husband’s parents go through the same cycle. All three of the parents we have left between us had falls this year. All three of them live alone. The moment any of them becomes disabled – even temporarily – they need assistance.
Vermont is a leader when it comes to caring for people as they age. Through the Choices for Care program, those people who need a nursing facility level of care and who qualify financially for long-term care Medicaid have a choice – they can receive care at home or in a nursing facility or other long-term care facility. A lot of people choose to stay home as long as possible. That’s been good for the people we serve, who keep their independence longer. It’s good for their families and loved ones – most often women – who can remain in the workforce, instead of caring for aging parents. It’s also been good for Vermont’s Medicaid budget. The Medicaid program spends about half as much on people receiving care at home than in nursing facilities.