Mary Beth Wagner and Scott Slade
Staff writers
Greenfield

John Cutter is going home today to celebrate Independence Day with his family.

The 74-year-old Greenfield resident would like nothing more than to make permanent the fourday absence from the nursing home where he lives - a possibility made more likely on Tuesday when Indiana law SEA 493 took effect.

The new law requires Indiana to expand a Medicaid waiver system that provides state residents with funding for, among other things, alternatives to nursing home care. It directs the state to seek more slots for the program from the federal government and raises the income limits for those who may qualify. Advocates say the law ultimately will spread benefits further, allowing more people to get assistance. The waiting list for Indiana's home health care program, for example, is over 20,000 names long. That could change for people like Cutter, who desperately want home care but need the state's help to get it.

Cutter moved into Brandywine Nursing and Rehabilitation Center 16 months ago, after his wife, Flossie, had two small strokes and could no longer take care of him. He's had two heart attacks and two strokes himself. His left leg had to be amputated because of diabetes.

He and Flossie were together later last year as she recuperated from her strokes. Three months later, she returned to the couple's home, where Cutter would like to be.

"My wife lives there," he said tearfully. "We've been married 30 years."

Medicaid wouldn't pay for home health care for him or Flossie; but it pays $3,000 per month for his nursing home care.

He has applied to the state's CHOICE program, which provides financial assistance for home health care services to state residents found to be at risk of losing their independence from disease, injury, aging or any other ongoing disabling condition. But he remains on a waiting list for the program whose benefits change based on demand, state funding and income.

Cutter said he wants to use the Medicaid dollars being spent on his nursing home care to pay for a home care alternative.

After serving 25 years in the Army, including in wartime, he said he is frustrated with laws that that keep him in a nursing home.

"Every time I re-enlisted in the Army, they said, 'We'll take care of you,'" Cutter said.

"This ain't right. I put a lot of time in the military to help the American people, but the government doesn't help me with anything."

Providing options

That perception may change soon, explained John Cardwell, chairman of the Indiana Home Care Task Force and the Generations Project, a statewide alliance advocating greater access for Hoosiers to home- and community-based health care services.

SEA 493 sets out to enable more Indiana residents to apply for Medicaid waivers, which are exceptions to federal Medicaid laws, to let funds be spent on home and community-based care instead of nursing home care.

The bill directs the state to seek 20,000 additional Medicaid waivers, to be allocated to six different population groups, including seniors and those with disabilities. With a waiver, seniors legally entitled to nursing home care from Medicaid can use that money on other more appropriate care, so long as that care is no more expensive than a nursing home.

Medicaid is a federalstate program that helps pay for health care for lowincome families, seniors and people with disabilities. It is not the same as Medicare, the federal health insurance program for older Americans.

Not only are there to be more waivers: The new law also triples the income limit, meaning more people will qualify for Medicaid assistance for alternatives to nursing homes.

It also means fewer people will be applying for the CHOICE program, freeing up more funds for seniors who don't qualify for a waiver.

"It's a great piece of legislation," Cardwell said. "Once it's implemented, it will make it far easier... for people to be placed in the kind of long-term care which is appropriate for them."

Indiana spends $194 million for home and community-based care. It spends more than $1.1 billion for institutions.

"This thing that has largely kept people in nursing homes... is that there was no mechanism to let those dollars follow someone into the home care setting," he said.

Heartbreaking family challenge

Cutter's stepdaughter, Wanda Batton of Shelbyville, witnesses the downside of a system that forces a person into a nursing home when a lessrestrictive environment could be viable.

She works a full-time job, and the family farms. She shuttles Flossie to her appointments and checks in on her daily. Every week, they visit Cutter at Brandywine, and the couple talk every day on the phone.

Batton knows he's heartbroken he can't be with Flossie, but she doesn't see a way out of the predicament.

Her mother is a natural caregiver who used to work in a nursing home and will lovingly try to meet her husband's needs even when she can't meet her own, in or out of the nursing home.

"It's a bad situation, but you don't know what to do," Batton said.

She added: "In an ideal life, I'd be able to win the lottery, afford 24-hour-a-day care and build a home that's handicapped-accessible."

Funding will be key

Cardwell is optimistic about the legislation's new possibilities for seniors but says it's no fast fix.

"Senate Bill 493 did nothing to increase funding for CHOICE," he said, which will still be necessary. Although it will expand income eligibility for Medicaid waivers, some people will only be eligible for CHOICE because of income.

It will take some time to get the ball rolling, too.

"For the first time in Indiana law, the state is supposed to have publicly funded assisted living, foster care and personal care services," Cardwell said. "It will take a while to get all those things in place."

He is sympathetic to Cutter's plight.

"The challenge for him is going to be this: For him to hang on long enough to get 493 implemented so he can use this law to go home."

An estimated 1,500 Hoosiers who are on official waiting list for home care services die every year, according to the Indiana Family and Social Services Administration. Fifteen thousand were eligible to enter nursing homes but instead chose to stay at home and wait on the list.

"The No. 1 way people get off waiting lists in this state is by dying," Cardwell said. "I find it is embarrassing... That should not be the primary means to get off the waiting list for CHOICE or a Medicaid waiver for home care."

The new legislation may or may not help Cutter return home to his wife; but at the least, it offers another avenue to explore.

He recently heard one Brandywine resident say to a staff member, "I want to go home." Cutter heard the staff member respond "You are home," and it aggravated him.

"How dumb do they think we are?" Cutter said angrily. "I ain't home and I don't want to be here."