Abstract

In Louisiana, there are 18,000 people on waiting lists for programs that deliver home-based and community services (Hood, 2010). The Governor’s Office of Elderly Affairs implemented the Louisiana Answers for Living at Home (LALH) pilot program, from October 1, 2008 through December 31, 2010. LALH was designed for the Louisiana Aging Network to “assist individuals, who are at imminent risk for nursing home placement, but not eligible for Medicaid, to avoid nursing home placement and spend-down to Medicaid.” LALH offered participant direction to empower participants to select their service package by using a fiscal agent or to become direct employers. This approach is more flexible than the traditional agency model, where the consumer accepts whatever services are offered. To be eligible, applicants required enough care to enter a nursing home and their level of income and assets were limited. The goal was to provide flexible services, so residents could stay in their community. Participants were extremely satisfied with, often elated about, the flexibility to manage their own resources to obtain preferred services. This program allows people to age in place, instead of spending down their assets to enter nursing homes. LALH seems cost effective when compared with alternative programs, such as Medicaid in a skilled nursing facility. The annual cost per participant is $29,627.67 for LALH, while the cost of providing Medicaid to residents in nursing homes is $47,482.50. Annual cost savings from the LALH program is: $17,853.42 per person. Metlife’s (MetLife Mature Market Institute, 2009) Market Survey of Long Term Care Costs reports that the cost of home care in Shreveport, Louisiana is $27,040 annually without benefits, about the same cost as LALH. The LALH pilot program provided more services and flexible options for care than home health. To paraphrase a caregiver: “This is wonderful, this is the future!”