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John Boyd is paralyzed from the shoulders down as a result of an accident at the age of 14. Until 1999, Boyd worked at a Red Lobster in Orlando and lived at home with the help of a caregiver whom he paid for a few hours each day.

Now, at 50-years-old, Boyd finds himself at the mercy of state funds for his food, shelter and care. He could live at home again with a part-time caregiver, he says, if only the state would open up more slots. Right now, there’s a waiting list that’s expected to increase, not decrease.

Instead, Boyd has spent the past nine years living in a nursing home.

“I feel it’s robbed me of all these years,” said Boyd, from his room at Harts Harbor Health Care Center in Jacksonville.

Boyd and five other adults with disabilities enlisted the AARP Foundation in suing the State of Florida. They want the state to spend more of its Medicaid dollars on in-home care for people like them, rather than nursing homes. The case now awaits a ruling on a petition for class-action status to represent possibly thousands of other disabled Floridians in nursing homes who could otherwise live at home.

It’s a no-brainer, says Boyd, because the cost of in-home care is so much less expensive than a nursing home.

“Medicaid pays more than $4,000 to keep me in this nursing home,” Boyd said. “With half that amount, I could set up a system where I pay people to come in and do what they do for me here. And I wouldn’t be incarcerated.”

In Florida, the Nursing Home Diversion project costs between $1,100 and $1,800 a month per person. But that doesn’t include other public subsidies that people living at home may enjoy such as subsidized housing and food stamps.

The case brought by AARP in Florida follows two similar cases both brought by AARP in Illinois and California, said Bruce Vignery, attorney for the AARP.

“Florida hasn’t made a whole lot of progress with respect to shifting their reliance from a nursing home to home-based care,” Vignery said. “This case isn’t about closing nursing homes. It’s about giving people the choice.”

Nothing against the people at Harts Harbor, said Boyd, but he feels institutionalized. “This is a form of incarceration,” he said. “I truly wonder if when getting out of here it’s going to take some time to adjust.”

In almost every state that shifted resources to in-home care when appropriate, as opposed to nursing homes, states have saved money, said Vignery, who doesn’t understand why Florida wouldn’t do this.

The state currently spends 87 percent of its long-term care Medicaid funding on nursing facilities – the 10th-highest rate in the nation, according to the complaint filed by the AARP. “For people with physical disabilities, Florida’s per person spending for nursing facilities is nearly 13 times that for home and community-based care,” the complaint states.

State officials were unable to comment for this article.

Perhaps a shortage of skilled nurses in certain areas might contribute to fewer disabled adults going home, said Ed Towey, spokesman for the Florida Health Care Association.

“Nursing homes don’t have a lot to do with where Medicaid patients end up,” Towey said. “The nursing homes have always argued first that the person be appropriately placed.”

Florida nursing homes receive 60 percent of their funds through Medicaid, but if the state decided to divert more disabled adults from nursing homes into home-care settings, it won’t be any skin off their backs, Towey said. “There will always be plenty of demand,” he said.

According to Towey, after roughly 10 years of the Nursing Home Diversion program, the state “still doesn’t know if it saves money.”

No one needs to convince John Boyd. He knows home care would save money, and he is taking his case to court to try and prove it.

“In these days of budget cuts, and people complaining about their taxes,” Boyd said, “sure, it’s certainly a viable option as way to cut expenses.”



May 2008

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