For Veterans, an Alternative to the Nursing Home

For Veterans, an Alternative to the Nursing Home

Paulia and Bienne Bastia set two dinner tables in their house in Mount Airy, Pa., each night, one for their three children, and another for themselves and the two older men the children call “Grampa.”

The Army veterans Booker Lovett, 79, and Wesley Ottis Furr, 95, are not related to the Bastias or to each other, but this has been their home since late winter. They’re participants in the Department of Veterans Affairs Medical Foster Home program, which places veterans who need round-the-clock care in private homes.

Mr. Lovett, who previously lived with his sister in Philadelphia, had a stroke — he still has trouble speaking — and has glaucoma. Mr. Furr, who maintained his own Philadelphia home, remains talkative and agile despite his age.

The Bastia children, ages 5, 6, and 7, consider the veterans family. Mr. Bastia thinks of them as father figures — he calls each “my king.”

“I felt at home as soon as I come here,” Mr. Furr said.

Mrs. Bastia, 36, a certified nursing assistant, and Mr. Bastia, 45, owner of a tax preparation business, drive the men to appointments, serve meals tailored to their dietary needs and administer medications. The Bastias can communicate with a nurse through a V.A.-provided telehealth monitor equipped with a video camera, blood pressure cuff and other equipment.

On a recent afternoon, Mrs. Bastia fastened the cuff on Mr. Furr’s thin arm while a nurse at the Philadelphia V.A. Medical Center 13 miles away observed. “Thank you, your blood pressure reading has been accepted,” said an automated voice from the monitor.

Medical foster homes provide an alternative to nursing homes for veterans who are unable to live safely and independently at home or lack a strong family caregiver. Conceived in 2000 by V.A. social workers in Little Rock, Ark., the program currently serves 535 veterans; it has cared for 1,468 since it began.

Though the veterans range in age from 23 to 101, their average age is 70. About half have some form of dementia. They often stay until they die, an average of 459 days.

“I know a lot of people suffering,” Mrs. Bastia said, explaining why she decided to participate. “I used to work in nursing homes. I know how it’s like when you get 14, 16 people to take care of. You don’t have time to do what you’re supposed to do. I figure out, if I take them to my house they can get more care.”

Now operating through 73 V.A. sites in 36 states, the medical foster homes program is scheduled to expand to 10 more states within two years. Eventually, the V.A. hopes to introduce the program to all 153 of the agency’s medical centers, said Dan Goedken, national program analyst.

It costs a site about $260,000 a year to introduce the program; each site can serve up to 30 vets. The V.A. finances each place for two years, after which the program is expected to be self-sustaining, said Dr. Thomas Edes, national director of geriatrics and extended care operations at the V.A.

Though medical foster homes are intended to provide better care, not to reduce costs, they operate for half the cost of nursing homes. “It is quite likely that it will save V.A. money and taxpayer money and veterans’ money,” Dr. Edes said.

The Bastias, who met in Florida after emigrating from Haiti, went through months of interviews and background checks to qualify as caregivers. A social worker, a nurse, a dietitian and a fire-safety expert inspected their two-story home on a quiet suburban street, and it will be reinspected annually.

Given the vulnerability of the older veteran population, the V.A. approval process is rigorous. Only one in 10 to 15 applicants are selected. People with no formal training can apply, however, and many with family caregiving experience do. Once a veteran is placed in a home, the V.A. provides training for tasks like cleaning wounds, managing incontinence and safely transporting the new residents.

And it provides periodic respite for caregivers. “It really is 24/7 care,” Mr. Goedken said. “This is a fairly intensive expectation on our part on what they’re going to do. Some willingly back away.”

Veterans pay $1,800 to $3,000 a month for care, depending on their medical needs, often using their combined V.A. and Social Security benefits. Mr. Furr and Mr. Lovett each pay the Bastias $2,000 a month for their shared bedroom and their care. The couple has another room available and is awaiting a third veteran, the maximum allowed.

A national V.A. study measuring veterans’ satisfaction and costs won’t be completed until 2013 and 2015. But 30 percent of veterans who would qualify for V.A.-paid nursing homes choose instead to pay out of pocket for medical foster homes — evidence, Dr. Edes said, that they prefer a home setting.

Even with dementia or mental illness, “they recognize this as their home. It’s very familiar,” he said. “They’re given a lot of autonomy. And it’s very one-on-one attention.”

Mr. Furr and Mr. Lovett get along well in their dorm-style room, with its twin beds and flat screen television. They take turns — Mr. Furr watches the news, while Mr. Lovett prefers football. One is a Democrat and the other a Republican, so they keep political talk to a minimum. Members of Mr. Furr’s congregation drive him to and from his Methodist church twice a week, and he often takes walks. He recently surprised his roommate, who prefers napping and relaxing at home, with a box of Lorna Doone cookies.

“I don’t expect him to be like me, and I can’t be like him,” Mr. Furr said. “So, I accept him as he is and he accepts me as I am. It’s a good deal.”



The Drama of Aging and Caregiving, on YouTube

“I don’t want to take care of them,” Erica confesses in Episode 12 to the man she’s just slept with, speaking about her elderly parents.

“Who does?” The man is the real estate broker who has just sold her parents’ home in San Francisco so that, after a year’s resentful debate, they can downsize.

“People do. Children do,” Erica replies. “They think of it as payback for all the sacrifices their parents made for them. They think it’s a privilege.”

“I don’t know those kinds of people,” he says.

Amy Lippman invented those characters, told them what to say, then directed all 13 episodes of “Ruth & Erica,” a YouTube drama about aging and caregiving. You can find the first one today on the female-centric channel called WIGS, which stands for Where It Gets Interesting.

“I decided to write about something I was experiencing, and all my friends were experiencing — parents who’d been independent and self-sufficient, but were beginning to need more support and guidance,” said Ms. Lippman, who’s in her late 40s. “It seems to have come as a shock to all of us.”

Each slickly produced “Ruth & Erica” episode runs about eight minutes. New ones will appear on Mondays, Wednesdays and Fridays; all 13 will live indefinitely online.

Funny how the number of movies, TV shows and books that focus on aging, and on dementia in particular, keeps growing. “It’s sort of in the ether right now,” said Ms. Lippman, whose own parents recently sold their house — a painful step — in Northern California.

I recently saw “Robot & Frank,” for example. It’s set in “the near future” when, apparently, people have even schmancier phones and zippier minicars and wonderfully helpful caregiving robots, but dementia remains incurable and elder care issues provoke as much family tension as ever.

“Robot & Frank” didn’t climb into my personal Top Five Movies About Aging (since you asked: “Away from Her,” “The Iron Lady,” “The Savages,” “About Schmidt” and “Iris” — what’s your list?), but it had its charms.

“Ruth & Erica,” which unfolds over a year, goes deeper. The veteran actors Lois Smith and Philip Baker Hall give wonderful, wrenching performances as Ruth and Harry Rappaport, who fight their only child’s suggestions of a move to a retirement community as Harry sinks into dementia.

Maura Tierney seems a decade or two too young to be their daughter. Flying in for visits and crisis management, she doesn’t look nearly careworn and frazzled enough. But she’s otherwise a very believable Erica — funny and honest and willing to say aloud what lots of adult children think.

Producing scripted drama for the Web gave Ms. Lippman a shot at something that would have been hard to pull off in movies or television. “It’s an opportunity to tell an intimate, realistic story with absolutely no pyrotechnics,” she said.

In fact, it was so realistic that during production, “almost everyone who worked on the series, including the crew, came up to me and said, ‘My grandmother.’ ‘My parents.’ ‘My sister had to move in with my mother,’” Ms. Lippman said. “I felt this reverberation.”


Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”



Foster Care for Elderly: Like a New Home

Foster Care for Elderly: Like a New Home

In the middle of the night, when she gets a hankering for something tasty, Mary Taub slides into her slippers, goes into the kitchen and raids the refrigerator.

If she were in a nursing home, which is where some people thought the 77-year-old woman should go last year when she became too forgetful and scared to live on her own, she would not be able to indulge in the pleasure of a bologna sandwich at midnight.

But in a cozy brick house here surrounded by trees, Mrs. Taub has found privacy, companionship, a hand to help fix her soft white hair, three healthy meals a day and even after-hours snacks, living with a foster family paid to provide her with the amenities of home she can no longer provide for herself. ‘I Want to Stay’

“I like it here, I want to stay here,” said Mrs. Taub, who has been living for the last three months with Cora and Fred Mondonedo and their two daughters, Cathy, 27, and Casandra, 12. “It’s nice to be with a family. They make me laugh.”

Foster care, a system developed to find homes for abandoned and abused children, is growing in the New York region and across the nation as a way to keep elderly people in home settings and communities they know.

As the number of elderly and frail elderly people in the country rises, along with the cost of nursing homes, the government, health policy experts and families are looking for alternatives to both save money and afford older people the greatest freedom in choosing a safe and comfortable place to live.

With monthly costs averaging about $1,000 — one-third those of nursing homes — and the immeasurable value of living within the embrace of a family, supporters say foster care should play an increasingly vital role in caring for the elderly.

Two states that have had extensive experience with foster care for the elderly, Oregon and Washington, have found few drawbacks. So far, cases of abuse have been very limited, people who work in the field said, although they add that as programs proliferate, they will have to be vigilant in looking out for such problems.

The problems that arise most often tend to involve emotional attachments, experts say. When the elderly person becomes too ill to stay in foster care and must move on to a nursing home, the move can be wrenching for all parties.

And the use of foster care can be difficult for relatives of the elderly. They often feel guilty that they are not taking in their aged parent, aunt or grandparent. Sending the elderly to a nursing home, experts say, offers the illusion that a greater level of care is needed, even when it is not.

There are no overall figures on how many older people are living in foster homes since there is no single agency or organization that monitors the dozens of programs nationwide. Experts estimate that tens of thousands of older people of varying ages and conditions are in foster homes and they see those numbers increasing. Responding to a Need

“We started this program as a response to a need we saw,” said Eleanor Frenkel, director of programs for the Bergen County Visiting Homemaker and Home Health Aide Service, which administers a pilot adult foster-care project in northern New Jersey with 27 placements so far.

“We saw people wanting to be cared for at home,” Ms. Frenkel said, “frail elderly not wanting to go into a nursing home but not having a situation that could support care at home either because they had no family or they needed more supervision than they could afford, or they were in substandard homes that were unsafe or unsanitary. But it was very important to them to stay in the community, not in an institution. This is not their original home, but it creates a home where they can be cared for.”

In New York State, Gregory Giuliano, who heads the adult foster-care program in the Office of Housing and Adult Services, said the state had about 800 licensed adult foster-care operators, with 1,600 people in the program. “The important thing is to be creative, to look at many options and to realize that no one alternative is right for everybody,” he said. Less Expensive

Foster care for adults is like foster care for children: a person or a family is paid to take in other people and provide them a home — meals, laundry, a place to sleep, someone to talk to and watch over them. While children are placed in foster care when others decide it is best, the elderly in foster care choose it themselves.

In some programs, the residents pay for the care with their own money, although often a government agency or a nonprofit organization brings the family and the participant together. Mrs. Taub was matched with the Mondonedos through the Family-Type Home Program for Adults, run by Westchester County’s Social Services Department, but she pays the family $950 a month out of her own income, which includes Social Security, dividends and her husband’s pension. Medicaid Waivers

Some elderly people have their foster care paid for with Supplemental Security Income. And in some cases, states have received Medicaid waivers that allow them to spend Federal long-term nursing funds for community-based care programs like adult foster homes.

“It’s a very cost-effective option for the elderly,” said Dr. Susan Sherman, a professor of social welfare at the State University of New York at Albany, who has studied foster care for older people. “And one thing we have found is that it provides as much of a family for care providers sometimes as it does for the residents.”

Taking in Mrs. Taub and Julia Schlegel, a 63-year-old mentally disabled woman, has allowed Mrs. Mondonedo to be home when Casandra gets out of school each day. The Mondonedos first became a foster family for adults when they were living in California and then in Oregon.

“Not everyone can do it — it’s a 24-hour-a-day job,” said Mrs. Mondonedo. “It takes a lot of love, a lot of compassion, a lot of ear to listen to them. But I love elderly people and my daughter needs a grandma. Casandra just loves Mary.”

“Casandra makes me laugh,” said Mrs. Taub, her pale blue eyes crinkling as she giggled.

Regulations and licensing requirments vary with the programs. In New York a foster family can care for up to four adults; in Massachusetts, up to three; in Washington State, up to six, and in Oregon, up to five.

Many people in Oregon and Washington have made a business of adult foster care by buying several houses and hiring families to live in them and care for elderly people. ‘More Humane’

“It is a more humane and human environment than a nursing home for many older people,” said David Olson, coordinator of the adult foster home program in Oregon, which has licensed more than 8,600 adult foster-care beds. “There is independence with supervision but without the feeling of an institution. It’s a home and it quickly does become their home.”

Helen Roethe brought her own chest of drawers, end table, bed and television set when she moved into a foster home in Gladstone, Ore., 13 months ago. She put some prints on the walls and family photos on the dresser top. Then it felt like home.

She is 81, was never married and was living with her sister and brother-in-law in Milwaukie, Ore., but it became too difficult for them to care for her.

“What else was there to do — go live in an institution?” Miss Roethe asked. “Not me. I don’t want it. We care for each other here, like a family. That suits me better.”

Elderly people in foster care, even those with serious medical conditions, do not focus on their health problems, said Thomas Tobin, director of the Family Care Program of Cape Cod Hospital in Hyannis, Mass., which has had an adult foster-care program for 15 years.

“The whole focus is on wellness despite whatever might be wrong with them,” Mr. Tobin said. “Someone in a nursing home is constantly confronted with infirmity and so it becomes a center of their lives.” ‘Very Excellent Break’

Richard Connor spent five years in a nursing home in Wareham, Mass., after a stroke. He was divorced and could no longer live alone, and it was not feasible for him to live with either of his two daughters.

The nursing home was confining and dispiriting, he said, and he considered it “a very excellent break” when he heard a year ago about the adult foster-care program on Cape Cod. He now lives in Yarmouthport with Matthew Keanan, a widowed psychotherapist, and his 18-year-old son, James, a college student.

“Nursing homes of necessity are very restrictive, very crowded,” said Mr. Connor, 68, a retired physicist. “They can’t take you for rides or to the beach. But here with Matthew, I can go out and do things. I can visit Boston for some plays and musicals.”

The transition from the confinement of a nursing home to the freedom of living in a home with a family, Mr. Connor recalled, “was almost shocking.”

“I had to readjust myself to my own way of doing things,” he said. “There was a renewed pleasure in dealing with normal chores: what would I like to eat, or should I bake some bread? In a nursing home you tend to adopt the depression of people around you. In a home, you adopt the atmosphere there, and this is a happy one.”

Published: March 08, 1994